DIAGNOSIS AND NONSURGICAL MANAGEMENT OF OSTEOARTHRITIS, 5th EDITION

Abstract

MD. Editor. West Islip NY, Professional Communications, 2010, Softbound + 368 pages ISBN: 978-1-932610-42-0, List price: $24.95 This pocket-sized book offers a wealth of information on the diagnosis and management of r patients with osteoarthritis (OA). It should be useful for all clinicians involved in OA management: primary care clinicians, rheumatologists, orthopedic surgeons and others.Dr. Brandt addresses how we perceive OA and how that influences how we approach treatment for our patients. Many physicians and patients still consider OA to be the degenerative joint disease and a consequence of inevitable aging with the belief that once it becomes symptomatic, it follows a progressive and deteriorating course. The author believes that conveying that does a disservice to patients because many OA patients do become better and OA itself can lead to painless, asymptomatic joint.The book addresses the epidemiology, pathology and etiopathogenesis of OA as well as the importance of correctly diagnosing OA and its pitfalls, ranging from synovial fluid analysis and radiography of OA. Both nonpharmacological therapy and pharmacotherapy for OA are described. Even though there is no cure for OA today, much may be learned that can be useful in its management in helping patients to relieve joint pain, improve mobility and enhance their quality of life.Current definitions of OA and how they fail to recognize that OA is a process in which the joint is attempting to contain damage caused by a local mechanical problem are addressed. The book describes how the manifestation of the joint to heal and ameliorate the abnormal biomechanics, and that the OA process itself is often successful in leading to a stable painless joint. Radiographic evidence of OA is extremely common in the population and many people with severe x-ray changes of OA are asymptomatic. The author believes that the long held distinction between primary and secondary OA is not meaningful because OA is always secondary to something. The book addresses that following issues. Common OA is not a homogeneous entity, but may result from congenital, anatomic abnormalities, obesity, trauma, ligamentous instability, chondrocytes defects, periarticular muscles weakness or microincoordination. OA is due to the concentration of intraarticular (IA) mechanical stresses and thus if the alleviated can result in symptomatic and structural improvement. OA mostly affects weight bearing joints, such as the hips and knees. It is more appropriate to consider these as load bearing joints, because most of the load on a synovial joint does not stem from the ponderal mass, but from the strength of contraction of the periarticular muscles and forces opposed on. As such, load across even the smallest of joints, for example the hand, generated by contraction of the powerful flexor digitorum profundus may be roughly comparable to the loads across the hips or knees. Joint malalignment is not the cause of hip or knee OA; it is the effect of that malalignment in concentrating and worsening...