Management of Early Osteoarthritis

Joint Arthroplasty ◽

Joint Disease ◽

Treatment Modalities ◽

Inflammatory Drugs ◽

Lifestyle Physical Activity

Osteoarthritis (OA) is a chronic degenerative joint disease of dynamic pathology with multiple etiologies. It involves progressive process of softening, loss of articular cartilage, subchondral bone sclerosis, development of osteophytes, and cyst formation. OA usually contributes to decreased activity associated with aging, secondary to diminished function and pain, thus consequently impairing quality of life. It is well established that pain due to OA, swelling, or stiffness can make it difficult for individuals to perform simple daily living activities. Although OA is not curable, a variety of treatment modalities are available to improve symptoms. Main elements include pain management maneuvers, education, changing lifestyle physical activity (PA), and weight reduction in case of overweight. Although total joint arthroplasty (TJA) is considered a cost-effective treatment for people with OA, TJA should only be considered after failure of conservative treatments. Symptoms of OA are usually managed by either pharmachological or nonpharmachological protocols; joint replacement surgeries are considered in advanced cases. Analgesics remain the keystone of pharmacological treatment for OA symptoms, including paracetamol, topical and oral nonsteroidal anti-inflammatory drugs (NSAIDs), and opioids. However, benefits from paracetamol and opioids are minimal, and NSAIDs are not ideal for many patients because they have many side-effects. Intra-articular therapies such as corticosteroids are also commonly used, though usually with short-term benefits.

Role of Agnikarma in Pain Management of Various Musculoskeletal Disorders: A Review Study

International Journal of Ayurveda and Pharma Research ◽

10.47070/ijapr.v9i8.2040 ◽

2021 ◽

pp. 89-96

Author(s):

Badwe Yogesh ◽

Shilvant Rishabh ◽

Shinde Jyoti

Keyword(s):

Pain Management ◽

Musculoskeletal Disorders ◽

Pain Treatment ◽

Cost Effective ◽

Modern Medicine ◽

Treatment Modalities ◽

Research Article ◽

Inflammatory Drugs

Agnikarma is one of the important Para-surgical procedures described in Ayurveda, which has been widely used in the clinical practice now days. Sushruta has given detail description about Agnikarma. Superiority of Agnikarma over other the treatment modalities are timely described by our ancienter because of its Apunrabhavatva i.e., no recurrence property. Pain (Ruja) is the cardinal feature of most of the musculoskeletal disorders and it can affect the quality of life. In modern lifestyle, patient needs instant relief from pain. Treatment available in modern medicine commonly NSAID’s (Nonsteroidal anti-inflammatory drugs) but it has some hazardous effects on body. This review is an attempt has been made to study various research article, analyzed the role of Agnikarma and its applicability on various painful disorders which help to gain best knowledge about Agnikarma. In this article total 15 research works from various journals have been studied conducted on Agnikarma. Agnikarma was found very important tool in pain management of many musculoskeletal disorders. It was found safe, easy, cost-effective and OPD level procedure.

What Is Known and Unknown About Twice-Weekly Hemodialysis

Blood Purification ◽

10.1159/000441577 ◽

2015 ◽

Vol 40 (4) ◽

pp. 298-305 ◽

Cited By ~ 21

Author(s):

Yoshitsugu Obi ◽

Rieko Eriguchi ◽

Shuo-Ming Ou ◽

Connie M. Rhee ◽

Kamyar Kalantar-Zadeh

Keyword(s):

Quality Of Life ◽

De Novo ◽

Urine Volume ◽

Cost Effective ◽

Standard Of Care ◽

Treatment Regimens ◽

Interdialytic Weight Gain ◽

Incremental Hemodialysis

Background: The 2006 Kidney Disease Outcomes Quality Initiative guidelines suggest twice-weekly or incremental hemodialysis for patients with substantial residual kidney function (RKF). However, in most affluent nations de novo and abrupt transition to thrice-weekly hemodialysis is routinely prescribed for all dialysis-naïve patients regardless of their RKF. We review historical developments in hemodialysis therapy initiation and revisit twice-weekly hemodialysis as an individualized, incremental treatment especially upon first transitioning to hemodialysis therapy. Summary: In the 1960's, hemodialysis treatment was first offered as a life-sustaining treatment in the form of long sessions (≥10 hours) administered every 5 to 7 days. Twice- and then thrice-weekly treatment regimens were subsequently developed to prevent uremic symptoms on a long-term basis. The thrice-weekly regimen has since become the ‘standard of care' despite a lack of comparative studies. Some clinical studies have shown benefits of high hemodialysis dose by more frequent or longer treatment times mainly among patients with limited or no RKF. Conversely, in selected patients with higher levels of RKF and particularly higher urine volume, incremental or twice-weekly hemodialysis may preserve RKF and vascular access longer without compromising clinical outcomes. Proposed criteria for twice-weekly hemodialysis include urine output >500 ml/day, limited interdialytic weight gain, smaller body size relative to RKF, and favorable nutritional status, quality of life, and comorbidity profile. Key Messages: Incremental hemodialysis including twice-weekly regimens may be safe and cost-effective treatment regimens that provide better quality of life for incident dialysis patients who have substantial RKF. These proposed criteria may guide incremental hemodialysis frequency and warrant future randomized controlled trials.

Periprosthetic fractures of the knee: a comprehensive review

European Journal of Orthopaedic Surgery & Traumatology ◽

10.1007/s00590-019-02582-5 ◽

2019 ◽

Vol 30 (3) ◽

pp. 387-399 ◽

Cited By ~ 3

Author(s):

Vadim Benkovich ◽

Yuri Klassov ◽

Boris Mazilis ◽

Shlomo Bloom

Keyword(s):

Knee Arthroplasty ◽

Rare Complication ◽

Treatment Options ◽

Joint Arthroplasty ◽

Joint Disease ◽

Periprosthetic Fractures ◽

Complex Injury ◽

Life Threatening ◽

Total Knee

AbstractDemographic changes have resulted in an increase in the number of older patients diagnosed with degenerative joint disease. Developments in the field of joint arthroplasty allow a broader population to improve their lifestyles. An increased demand for knee arthroplasty has led to a rise in operations performed worldwide. Although there has been a constant propagation of technology and an increase in medical staffing at a professional level, many patients still encounter complications. Though rare, these factors may lead to life-threatening scenarios and a devastating effect on the success of the operation. One such rare complication includes periprosthetic fractures around the knee, a complex injury which requires a cautious and experienced approach. In this review, we analyze the prevalence, risk factors and classification, investigation and treatment options for periprosthetic fractures with total knee arthroplasty.

The Cost-effectiveness of Celecoxib versus Non-steroidal Anti-inflammatory Drugs plus Proton-pump Inhibitors for Treating Osteoarthritis in Algeria

Journal of Health Economics and Outcomes Research ◽

10.36469/9865 ◽

2013 ◽

Vol 1 (2) ◽

pp. 184-199 ◽

Cited By ~ 1

Author(s):

Nadir Hammoumraoui ◽

Sid Ahmed Kherraf ◽

Joaquin Mould-Quevedo ◽

Tarek A. Ismail

Keyword(s):

Cost Effectiveness ◽

Adverse Events ◽

Proton Pump ◽

Cost Effective ◽

Private Clinic ◽

Effective Treatment Option ◽

Life Years ◽

Inflammatory Drugs ◽

Anti Inflammatory

Background: Cyclooxygenase-2 inhibitors such as celecoxib are as effective as non-selective non-steroidal anti-inflammatory drugs (ns-NSAIDs) in the treatment of osteoarthritis (OA), have fewer gastrointestinal side effects, but are more expensive. Objective: To evaluate the incremental cost-effectiveness ratio (ICER) of celecoxib versus ns-NSAIDs, with/without proton-pump inhibitor (PPI) co-therapy, for treating OA in Algeria. Methods: The National Institute for Health and Clinical Excellence (NICE) health economic model from UK, updated with relative risks of adverse events using CONDOR trial data, was adapted for costeffectiveness analysis in OA patients aged ≥65 years. Patients could initiate treatment with celecoxib or ns-NSAIDs with/without omeprazole. Conditional probabilities were obtained from published clinical trials; effectiveness measure was quality-adjusted life years (QALYs) gained/patient. The analysis was conducted from a healthcare payer’s perspective. The average daily treatment costs and frequencies of resource use for adverse events were based on data collected in August 2011 from a private clinic located in Cheraga, Algiers, Algeria. Probabilistic sensitivity analysis (PSA) was performed to construct cost-effectiveness acceptability curves (CEACs). Results: QALYs gained/patient over a 6-month horizon were higher with celecoxib (0.368) and celecoxib+PPI (0.40) versus comparators. The lowest expected cost/patient was associated with ibuprofen (US$134.76 versus US$175.67 with celecoxib+PPI, and US$177.57 with celecoxib). Celecoxib+PPI was the most cost-effective drug treatment, with an ICER of US$584.43, versus ibuprofen. Treatment with celecoxib alone showed an ICER of US$1,530.56 versus diclofenac+PPI. These ICERs are <1 gross domestic product per capita in Algeria (US$7,500). Over 1-year, 3-year and 5-year horizons, celecoxib with/without PPI co-therapy showed higher QALYs/patient versus comparators, and decreasing ICERs. The ICER of celecoxib+PPI was lower than that of comparators over all time horizons. These findings were confirmed with CEACs generated via PSA. Conclusion: Using data from a single private clinic in Cheraga, Algiers, Algeria, and after considering new adverse event risks, we showed that celecoxib with/without PPI co therapy is more cost-effective than ns-NSAID+PPI for treating OA patients aged ≥65 years. Celecoxib+PPI remains dominant over a 5-year horizon, making it the most cost-effective treatment option for medium- and long-term use.

The Role of Novel Bone Forming Agents in the Treatment of Osteoporosis

Journal of Pharmacy Practice ◽

10.1177/0897190020961227 ◽

2020 ◽

pp. 089719002096122

Author(s):

Hansita B. Patel ◽

Lynsie J. Lyerly ◽

Cheryl K. Horlen

Keyword(s):

Elderly Population ◽

Cost Effective ◽

The Elderly ◽

Bisphosphonate Therapy ◽

Evidence Based ◽

First Line ◽

Treatment Of Osteoporosis ◽

Cost Effective Treatment

Osteoporosis is a growing epidemic that leads to significant morbidity and mortality among the elderly population due to associated fractures that lead to disabilities and reduced quality of life. Bisphosphonates are well-established as a first-line and cost-effective treatment for osteoporosis. Unfortunately, clinicians are often uncertain as to how to select treatments when bisphosphonates are ineffective as initial treatment or contraindicated. Romosozumab and abaloparatide are 2 alternative agents that have been recently FDA approved for the treatment of osteoporosis in postmenopausal women at high risk for fracture or patients who have failed or are intolerant to other osteoporosis therapies. Currently, the National Osteoporosis Foundation (NOF) has no formal recommendations in regard to these 2 novel agents. The purpose of this review is to help guide pharmacists on how to ensure appropriate utilization of these 2 novel bone-forming agents as potential alternatives to bisphosphonate therapy by providing evidence-based recommendations according to the current literature and key counseling points.

Sports Activity Following Cementless Metaphyseal Hip Joint Arthroplasty

Journal of Human Kinetics ◽

10.1515/hukin-2017-0112 ◽

2017 ◽

Vol 60 (1) ◽

pp. 225-232

Author(s):

Szymon Czech ◽

Jacek Hermanson ◽

Piotr Rodak ◽

Tomasz Stołtny ◽

Łukasz Rodak ◽

...

Keyword(s):

Physical Activity ◽

Hip Joint ◽

Joint Arthroplasty ◽

Joint Disease ◽

Harris Hip Score ◽

Joint Diseases ◽

Sports Activity ◽

Level Of Functioning ◽

Degenerative Joint Diseases

Abstract An adequate level of physical activity has a substantial effect on both mental and physical human health. Physical activity is largely dependent on the function of the musculoskeletal and articular system. One of the most frequent diseases of this system is degenerative joint disease. Due to the changing and more demanding lifestyles and patients’ willingness to be involved in sports activity, the expectations of hip joint arthroplasty are becoming increasingly high. Alleviating pain ceases to be the only reason for which patients choose surgical interventions, while the expectations often include involvement in various sports. Only few studies contain recommendations concerning the frequency, type and intensity of sports activity which are acceptable after hip joint arthroplasty. The aim of the study was to evaluate function and physical activity of people following cementless short-stem hip joint arthroplasty in the observation of at least five years. The study group comprised 106 patients who underwent total hip arthroplasty due to degenerative joint diseases, chosen according to inclusion criteria. Patients underwent routine physical examinations following the Harris Hip Score protocol, responded to the UCLA scale and questionnaires concerning pre-surgical and current physical activity. Our results demonstrated that hip joint arthroplasty in people suffering from degenerative joint diseases has a beneficial effect on their level of functioning and physical activity. Although physical activity and the level of functioning obviously reduced as a person aged, the level of physical activity continued to be very high in both groups, with function of the hip joint evaluated as very good.

Efficacy of intraarticular steroid injection in knee osteoarthritis using knee society score and visual analog score

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20190795 ◽

2019 ◽

Vol 5 (2) ◽

pp. 299

Author(s):

Shriram Sampath ◽

J. K. Giriraj Harshavardhan

Keyword(s):

Knee Society Score ◽

Steroid Injection ◽

Joint Disease ◽

Post Injection ◽

Osteoarthritis Of Knee ◽

Osteoarthritis Knee ◽

The Mean ◽

A Prospective Study

Background: Osteoarthritis of knee is a chronic degenerative joint disease which leads to pain, swelling, stiffness and decreased quality of life. The purpose of this study was to assess the effect of intra-articular steroid injection for osteoarthritis knee by using knee society score (KSS) and visual analog scale (VAS).Methods: A prospective study of 38 patients (44 knees) diagnosed with osteoarthritis of knee were given 80mg of intra-articular methylprednisolone injection. The outcome was assessed using KSS and VAS before the injection and 3 months post injection.Results: The mean VAS improved 3 months post injection whereas there was no improvement in the mean KSS. The scores of VAS 3 months post injection were statistically significant whereas the KSS scores were statistically insignificant compared with the pre injection values.Conclusions: Intra-articular steroid injection for osteoarthritis of knee produces significant pain relief for most patients even in severe cases but this not translate to better functional outcomes.

Study the Effect of Ipomea carnea Jacq. Patra swarasa (Leaves Juice) in Treatment of Indralupta (Alopecia Areata): A Pilot Study

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2021/v33i37a31971 ◽

2021 ◽

pp. 1-6

Author(s):

Prashant R. Umate ◽

Pramod D. Khobragade ◽

Saurabh Deshmukh ◽

Sonali Wairagade ◽

Minal Kalambe ◽

...

Keyword(s):

Alopecia Areata ◽

Negative Impact ◽

Cost Effective ◽

Treatment Modalities ◽

Rank Test ◽

Signed Rank ◽

Signed Rank Test ◽

Life Threatening ◽

Leaf Juice

Introduction: Hair and skin disease create negative impact on individuals. Although such diseases doesn’t have any life threatening effects like systemic diseases still have much more importance as the cosmetic issue concern. Indralupta is a rare entity found in both male, and female at any age which can be correlated with Alopecia areata. There are many treatment modalities are available for the Indralupta (Alopecia areata) but application of leaf juice of Ipomoea carnia is simple and cost effective treatment. Aim &Objective: Study the effect of Ipomea carnea Jacq. patra swarasa (leaves juice) in management of Indralupta (Alopecia Areata). To study the adverse effects of Ipomea carnia leaf juice local application if noted during study. Methodology: Fresh leaf juice will be extracted from clean leaf of Ipomea carnia and apply over the spot where hairs are lost for 15 days at morning before bath. 10 objects will be selected from kaychikitsa OPD randomly and consider for study after their willingness and consent. Outcomes will be assessed with the help of different criteria according to hair texture, Hair fall and scalp area examination. Result: Result will be observed according to criteria and Wilcoxon signed rank test will be a applied. Conclusion: Ipomea carnea will be effective in Indralupta(Alopecia areata).

Gerybinių stemplės anastomozės striktūrų gydymas

Lietuvos chirurgija ◽

10.15388/lietchirur.2008.3.2149 ◽

2008 ◽

Vol 6 (3) ◽

pp. 0-0

Author(s):

Eugenijus Stratilovas ◽

Egidijus Sangaila

Keyword(s):

Cost Effective ◽

Late Complications ◽

Esophageal Surgery ◽

Treatment Modalities ◽

Simple Mode ◽

Key Words Esophageal Cancer ◽

Cost Effective Method ◽

Long Time ◽

Benign Stenosis

Eugenijus Stratilovas, Egidijus SangailaVilniaus universiteto Onkologijos instituto Bendrosios ir abdominalinės chirurgijosir onkologijos skyrius, Santariškių g. 1, LT-08660 VilniusEl paštas: [email protected] Įvadas Viena iš dažniausiai pasitaikančių vėlyvųjų komplikacijų po stemplės rezekcinio pobūdžio operacijų yra gerybinė anastomozės striktūra. Dėl striktūros išsivysčiusi disfagija ilgam pablogina ligonio gyvenimo kokybę. Pagrindiniai šios komplikacijos gydymo metodai išlieka dažnos endoskopijos, dilatacijos bužais sukėlus nejautrą. Autoriai siūlo taikyti gana paprastą šių striktūrų gydymo metodą – dilataciją Folley kateteriu. Rezultatai Šiuo būdu gydyti keturi pacientai. Visi procedūrą pakėlė gerai, gydymo komplikacijų nebuvo. Po dviejų procedūrų rijimas tapo normalus, toliau procedūros tęstos ambulatoriškai, praėjus 3 mėn. rijimas išliko normalus. Išvada Anastomozės striktūros dilatacija Folley kateteriu yra saugus, veiksmingas ir pigus metodas. Reikšminiai žodžiai: stemplės vėžys, anastomozės striktūra, dilatacija The treatment of the benign esophagus anastomosis strictures Eugenijus Stratilovas, Egidijus SangailaVilnius University, Institute of Oncology, Department of Generaland Abdominal Surgery and Oncology, Santariškių str. 1, LT-08660 Vilnius, LithuaniaE-mail: [email protected] Background One of the most frequent late complications after the resectable type of esophageal surgery is benign anastomosis stricture. The subsequent dysphagia worsens the patients’ quality of life for a long time. The main treatment modalities for this complication remain frequent endoscopy, dilatation using weighted bougies under anesthesia. Authors recommend use a simple mode of treatment – dilatation with the Folley catheter. Results Four patients underwent the treatment. All patients felt well, there were no treatment complications. Swallowing after two procedures became normal, the treatment was continued in outpatient clinic; after three months the swallowing was good. Conclusions Dilatation of a stricture with the Folley catheter is a safe and cost-effective method. Key words: esophageal cancer, anastomosis benign stenosis, dilatation

Omalizumab Reduces Unplanned Healthcare Interactions in Irish Patients With Chronic Spontaneous Urticaria

Frontiers in Allergy ◽

10.3389/falgy.2021.810418 ◽

2021 ◽

Vol 2 ◽

Author(s):

Katie Ridge ◽

Vyanka Redenbaugh ◽

Niall Conlon

Keyword(s):

Cost Effective ◽

Healthcare Resource Utilization ◽

Decision Makers ◽

Chronic Spontaneous Urticaria ◽

First Line ◽

Before And After ◽

Irish Data ◽

Impaired Quality

Chronic spontaneous urticaria (CSU) is a common, debilitating skin disorder associated with impaired quality of life and psychological comorbidity. Symptoms can be difficult to control and many individuals will not respond to first line treatment. Due to the chronic and unpredictable nature of the disorder, patients frequently have repeated healthcare attendances. Despite this, little is known about healthcare resource utilization internationally. Furthermore, there is no Irish data to inform fundholding decision makers. Omalizumab is an anti IgE monoclonal antibody used in refractory urticaria. It is a comparatively high cost medicine and access to this treatment can be challenging. Recent assessments of omalizumab compared with usual care suggest that omalizumab is a cost-effective treatment for refractory urticaria. We carried out a retrospective review of 47 patients commenced on omalizumab. We evaluated unplanned primary and secondary care attendances and urticaria symptomatology before and after treatment. As expected, patients with refractory disease that were commenced on omalizumab had objective improvements in urticaria symptoms. Importantly, we show that this is reflected in a dramatic reduction in unplanned healthcare interactions at primary care and emergency departments. These data suggest that omalizumab may benefit these patients by reducing disease activity and thereby reducing the need for unplanned healthcare interactions.