Lyme arthritis
Tibial osteotomy is an option for some patients who have a relatively small varus angulation (less than 10 degrees) and stable ligamentous support. lyme arthritis Psoriasis arthritis. Total knee arthroplasty is recommended for patients with more severe varus, or any valgus, deformity and ligamentous instability. Arthroplasty is also indicated for patients who have had ineffective pain relief following a tibial osteotomy, and for those with advanced hip OA. Patients who have not yet developed appreciable muscle weakness, generalized or cardiovascular deconditioning and who would medically withstand the stress of surgery are ideal surgical candidates. lyme arthritis Arthritis back pain. In contrast, full mobility and function may not be realistically expected in patients with significant cognitive impairment or symptomatic cardiopulmonary disease, since these conditions can impede post-operative rehabilitation. (top of page) Functional Assessment Several questionnaires have been established as validated, reliable research instruments for assessing functional outcomes in patients with arthritis. These include the Lequesne index, the Western Ontario McMaster Arthritis scale (WOMAC), activities of daily living (ADL), etc. lyme arthritis Pain meds. Several performance-based tests of function can be done rapidly and easily in the office, however, and may be more sensitive in predicting impending disability than direct questions about disability and impairment. Such measures include grip strength, a timed walk, sequential chair-stands, and others listed below. . These tests can provide the clinician with valuable information on the patients current level of function, as well as serve longitudinally to assess decline in function. (top of page) Future Directions The development of selective COX-2 inhibitors has been an exciting advance in the management of pain and inflammation, as discussed above. If the safety profile of the specific COX-2 inhibitors is confirmed in additional long-term studies to be superior to non-selective COX inhibitors, they are likely to replace traditional NSAIDs in the management of arthritis and other painful, inflammatory conditions. It should be kept in mind, however, that no matter what their degree of selectivity, COX inhibitors (NSAIDs) do not alter the natural history of OA and a "disease modifying" agent is still critically needed. One disease modifying strategy is to suppress the progressive degradation of cartilage that occurs in OA. To accomplish this, the ratio of MMP inhibitors to MMP enzymes must be shifted in favor of the former. This could be accomplished by enhancing articular levels of TIMP by recombinant gene therapy or by administration of exogenous TIMP. Studies of exogenous TIMP administration to animals with OA-like disease have had inconclusive results, however, perhaps due to ineffective penetration of this relatively high molecular weight protein into the cartilage matrix. An alternate approach , that has progressed more rapidly, is to develop oral inhibitors of MMPs. In fact, several synthetic small molecular weight inhibitors of MMPs have proven efficacious in animal models of arthritis and are entering Phase III clinical trials in humans.
Lyme arthritis
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