Areas of potential attention were identified and the need for modifications, update or clarification was examined. Proposals were then developed based on literature reviews and through oarsi osteoarthritis and cartilage consensus process.
It was agreed that the current guideline overall still reflects the current knowledge in OA, although two possible modifications were identified. The first relates to the number and timing of measurements required as primary endpoints during clinical trials of symptom-relieving drugs, either drugs with rapid onset of action or slow acting drugs. Secondly, values above which a benefit over placebo should be considered clinically relevant were considered. This working document might be considered by the European regulatory authorities in a future update of the guideline for the registration of drugs in OA. Zagaria, PharmD, MS, CGPIndependent Senior Care Consultant Pharmacist and President of MZ Associates, Inc. Independent Senior Care Consultant Pharmacist and President of MZ Associates, Inc.
Pharmacy Practice Award from the Commission for Certification in Geriatric Pharmacy. The prevalence of disabling joint diseases increases with age. Musculoskeletal disease is the most common cause of chronic disability in individuals older than 65 years, and arthritis, currently a growing medical problem, is the most common cause of disability in people over 75 years of age. Today, arthritis and foot pain are both major public health problems. Riskowski et al, it is surprising that this topic has received little attention in the rheumatology community. Furthermore, reduced flexibility and mobility in seniors can result in limitations affecting not only the movements and locomotion required for everyday functioning and responsibilities, but also leisure activities, vacations, and caregiving. Differences between normally aging cartilage and osteoarthritic cartilage have been described, suggesting that OA is truly a disease and not just a natural consequence of aging.
For example, the water content and the ratio of chondroitin sulfate to keratin sulfate constituents differ in normally aging and osteoarthritic cartilage. Furthermore, while found in both normally aging and osteoarthritic cartilage, denatured type II collagen is more prevalent in OA. Another important distinction is that elevated degradative enzyme activity is found in OA, but not in cartilage undergoing normal aging. MMPs appear to be important mediators of cartilage destruction.
Following destruction, progressive cartilage degradation and OA ensue. Age is the most consistently identified risk factor for OA, regardless of the joint being studied. Prevalence rates for both radiographic OA and, to a lesser extent, symptomatic OA rise steeply after age 40 years in women and age 50 years in men. Pain is the predominant symptom in degenerative arthritis.
An enlargement forms and overlies the joint, and swelling develops around the joint. In MPJ OA, a change in the ability to ambulate with ease, coupled with stiffness and pain, accentuates the risk of falls in senior patients. Symptoms, physical findings, and radiographic changes constitute the diagnostic triad of OA. The American College of Rheumatology has set forth classification criteria to aid in the identification of patients with symptomatic OA that include, but do not rely solely on, radiographic findings. Of note, the presence of monarticular heat, redness, and swelling indicates infection until proven otherwise, although gout is more likely. At this time, there are no pharmacologic agents capable of retarding the progression of OA or preventing OA. This is a fundamental and important area of current research.
New therapies focused on reducing MMP activity and on stimulating matrix synthesis are in development. Studies of community-dwelling and nursing home elderly clearly demonstrate that an important benefit of exercise is a reduction in the number of falls. According to a study by Riskowski et al, clinical trials and prospective studies will be required to unravel the links between foot pain, foot conditions, and interventions that lessen the impact of rheumatic diseases. Both arthritis and foot pain are major public health problems. Pharmacists can guide patients, healthcare providers, and caregivers toward modalities to relieve MPJ pain and stiffness for the maintenance and improvement of joint mobility, joint functionality, and quality of life.
Aging of the muscles and joints. In: Halter JB, Ouslander JG, Tinetti ME, et al, eds. Hazzard’s Geriatric Medicine and Gerontology. In: Fillit HM, Rockwood K, Woodhouse K, eds. Projections of US prevalence of arthritis and associated activity limitations. Riskowski J, Dufour AB, Hannan MT. Current musculoskeletal research on feet.
Menz HB, Tiedemann A, Kwan MM, et al. Foot pain in community-dwelling older people: evaluation of the Manchester Foot Pain and Disability Index. Dufour AB, Broe KE, Nguyen US, et al. Foot pain: is current or past shoewear a factor? Menz HB, Levinger P, Tan JM, et al.