Sickle cell disease, which is characterized by chronic hemolytic anemia, is prevalent in the United States. In addition to the profound multisystem effects of vasoocclusion associated with sickle cell disease, osteonecrosis of the femoral head classically develops at an early age. Because of advanced medical technology and new treatment modalities, patients with sickle cell disease are living longer. More adults with this genetic disease are becoming candidates for total hip arthroplasty. This article describes the pathophysiology of sickle cell anemia, explains the process of osteonecrosis, and discusses total hip arthroplasty in this unique patient population.
The findings of this study confirm earlier conclusions that, like our physician colleagues, the vast majority of nurse practitioners lack adequate preparation to manage common nonsurgical musculoskeletal problems.
Osteoarthritis (OA), a degenerative joint disease affecting articular cartilage and synovial joint fluid, is the most common of the rheumatic diseases. OA is a huge public health issue that diminishes the quality of life of millions in the United States. Current treatments for OA include physical therapy, antiinflammatories, narcotics, steroids, and surgery. Unfortunately there is currently no cure for OA and many of the effective treatment modalities have many harsh side effects. Quite recently patients suffering from OA had little alternative to total joint replacement surgery once they exhausted their allotment of steroid injections and started to experience the GI complications associated with traditional NSAIDs. The introduction of viscosupplements, injectable compounds that mimic healthy synovial fluid and often relieve the suffering caused OA, has given patients with OA a longer-term, nonsurgical treatment alternative.
Psoriatic arthritis is an inflammatory arthritis associated with the skin disorder psoriasis. The exact etiology of psoriatic arthritis is unknown, although more than 40% of people with the cutaneous disease of psoriasis are estimated to also have joint involvement. This article presents an overview of psoriatic arthritis, including the origin, genetic influence, and immunologic factors involved in its evolution. The clinical features of psoriatic arthritis are also reviewed in this article, and a discussion of the diagnosis and treatment is included.
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