MBBS, MSc, PhD, FRACP, FAFPHM Lynette M. March (Associate Professor in Medicine, Senior Staff Specialist in Rheumatology), MD Clarissa J.M. Bachmeier (Junior Consultant)
{"title":"10 Economics of osteoarthritis: a global perspective","authors":"MBBS, MSc, PhD, FRACP, FAFPHM Lynette M. March (Associate Professor in Medicine, Senior Staff Specialist in Rheumatology), MD Clarissa J.M. Bachmeier (Junior Consultant)","doi":"10.1016/S0950-3579(97)80011-8","DOIUrl":"10.1016/S0950-3579(97)80011-8","url":null,"abstract":"<div><p>Musculoskeletal disorders, of which osteoarthritis (OA) is the most common, incur significant economic, social and psychological costs. Costs of illness have risen over recent decades accounting for up to 1–2.5% of the gross national product for those countries studied so far, including the USA, Canada, the UK, France and Australia. Arthritis has a significant impact on psychosocial and physical function and is known to be the leading cause of disability in later life. There are also significant out-of-pocket costs and loss of earnings due to changes in occupation and roles in domestic duties. Current guidelines for the management of OA of hip and knee include the recommendation of inexpensive but effective interventions. Although the guidelines have not had a specific economic evaluation, cost reductions may be expected. OA is a very common disease and will become an increasing economic burden as the population ages.</p></div>","PeriodicalId":77032,"journal":{"name":"Bailliere's clinical rheumatology","volume":"11 4","pages":"Pages 817-834"},"PeriodicalIF":0.0,"publicationDate":"1997-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S0950-3579(97)80011-8","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20358285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"5 What is the current status of biochemical markers in the diagnosis, prognosis and monitoring of osteoarthritis?","authors":"MD, PhD L. Stefan Lohmander (Professor)","doi":"10.1016/S0950-3579(97)80006-4","DOIUrl":"10.1016/S0950-3579(97)80006-4","url":null,"abstract":"<div><p>Biochemical markers for osteoarthritis (OA) may serve different purposes. Since markers reflect ongoing dynamic metabolic processes in the joint tissues (cartilage, synovium, bone, etc.), they are most likely to be useful to predict prognosis and response to treatment, to monitor response to treatment, and for disease staging. Markers are currently being used at the research level for these purposes. The goal of using these markers to assess the disease process in the OA clinical trial setting or in the clinical routine has, however, not yet been reached.</p></div>","PeriodicalId":77032,"journal":{"name":"Bailliere's clinical rheumatology","volume":"11 4","pages":"Pages 711-726"},"PeriodicalIF":0.0,"publicationDate":"1997-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S0950-3579(97)80006-4","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20358280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BSc, MD, FRCP John R. Kirwan (Consultant and Reader in Rheumatology), MA, BM, PhD, MRCP Elizabeth Rankin (Senior Registrar)
{"title":"8 Intra-articular therapy in osteoarthritis","authors":"BSc, MD, FRCP John R. Kirwan (Consultant and Reader in Rheumatology), MA, BM, PhD, MRCP Elizabeth Rankin (Senior Registrar)","doi":"10.1016/S0950-3579(97)80009-X","DOIUrl":"10.1016/S0950-3579(97)80009-X","url":null,"abstract":"<div><p>Although intra-articular therapy is widely used in the treatment of osteoarthritis (OA), those controlled clinical trials which include placebo groups suggest that there is little to be gained over joint aspiration alone, or even over a simple needle prick. Glucocorticoids may however offer a small additional symptom benefit over one or two weeks. Viscosupplementation may offer a slightly longer benefit. Intra-articular radiotherapy probably confers no benefit. Serious adverse effects are rare but local effects may occur in up to 10% of patients treated with visco-supplements. Future research should always include a placebo group in clinical studies, should clarify the possible benefits of viscosupplementation and should include in vitro work to consider the biological basis for possible actions of intra-articular therapy.</p></div>","PeriodicalId":77032,"journal":{"name":"Bailliere's clinical rheumatology","volume":"11 4","pages":"Pages 769-794"},"PeriodicalIF":0.0,"publicationDate":"1997-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S0950-3579(97)80009-X","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20358283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
MA, MSc, PhD Thomas B.L. Kirkwood (Professor of Biological Gerontology)
{"title":"3 What is the relationship between osteoarthritis and ageing?","authors":"MA, MSc, PhD Thomas B.L. Kirkwood (Professor of Biological Gerontology)","doi":"10.1016/S0950-3579(97)80004-0","DOIUrl":"10.1016/S0950-3579(97)80004-0","url":null,"abstract":"<div><p>The relationship between osteoarthritis and ageing raises important questions about what exactly defines ‘normal’ ageing and whether the pathogenesis of osteoarthritis shares common pathways with other age-associated dysfunctions, or whether osteoarthritis is a time-dependent disorder distinct from normal ageing with a separate causative mechanism at work. Theories of ageing now emphasize the stochastic nature of the ageing process, that is the role played by accumulation of essentially random cell and tissue damage, such as somatic mutations, oxidative damage and the formation of aberrant proteins. The role of genetic factors in determining longevity and predisposition to age-associated diseases is probably in programming the efficiency of somatic maintenance functions and influencing the development of a durable soma. Gene-environment interactions, for example through lifestyle, can also be important. Many of the risk factors and mechanisms that are thought to contribute to osteoarthritis can be accommodated within this framework.</p></div>","PeriodicalId":77032,"journal":{"name":"Bailliere's clinical rheumatology","volume":"11 4","pages":"Pages 683-694"},"PeriodicalIF":0.0,"publicationDate":"1997-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S0950-3579(97)80004-0","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20358278","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
MSc, MBBS, FRACP, PhD Flavia M. Cicuttini (Senior Lecturer), MSc, MD, FRCP Tim D. Spector (Consultant Rheumatologist)
{"title":"1 What is the evidence that osteoarthritis is genetically determined?","authors":"MSc, MBBS, FRACP, PhD Flavia M. Cicuttini (Senior Lecturer), MSc, MD, FRCP Tim D. Spector (Consultant Rheumatologist)","doi":"10.1016/S0950-3579(97)80002-7","DOIUrl":"10.1016/S0950-3579(97)80002-7","url":null,"abstract":"<div><p>Although for many years it was speculated that osteoarthritis was genetically determined, little data were available to support this contention. A major problem with early work was a lack of consistency in the definition of osteoarthritis. Based on a radiographical definition of osteoarthritis, which is currently the optimal method for epidemiological and genetic studies, data from a recent twin study have provided an estimate of the hereditable component of osteoarthritis to be in the order of 50 to 65%. In addition, sophisticated molecular biology techniques are being increasingly used to explore potential genetic abnormalities in cartilage and matrix components in osteoarthritis. These exciting new data are examined as we address the role of genetic factors in osteoarthritis.</p></div>","PeriodicalId":77032,"journal":{"name":"Bailliere's clinical rheumatology","volume":"11 4","pages":"Pages 657-669"},"PeriodicalIF":0.0,"publicationDate":"1997-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S0950-3579(97)80002-7","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20357793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
MD, PhD P.D. Delmas (Professor of Medicine and Director), BSc, MBBS, FRCP A.D. Woolf (Consultant Rheumatologist)
{"title":"11 Osteoporosis: outstanding issues","authors":"MD, PhD P.D. Delmas (Professor of Medicine and Director), BSc, MBBS, FRCP A.D. Woolf (Consultant Rheumatologist)","doi":"10.1016/S0950-3579(97)80025-8","DOIUrl":"10.1016/S0950-3579(97)80025-8","url":null,"abstract":"<div><p>Major advances have occurred in our knowledge of osteoporosis and its treatment in the past 10 years. This paper reviews aspects of the epidemiology, pathogenesis, and diagnosis of the disease that deserve further investigation. Although anti-resorption treatments such as hormone replacement therapy and bisphosphonates have been shown to reduce the incidence of osteoporotic fractures, there is room for improving available treatments. Today, there is no bone-forming agent that has been shown to decrease fracture rate, and several agents are under clinical investigation. The potential value of combined therapy will also be discussed.</p></div>","PeriodicalId":77032,"journal":{"name":"Bailliere's clinical rheumatology","volume":"11 3","pages":"Pages 645-649"},"PeriodicalIF":0.0,"publicationDate":"1997-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S0950-3579(97)80025-8","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20298898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
MD, FRCP Stuart H. Ralston (Professor of Medicine and Consultant Physician)
{"title":"2 What determines peak bone mass and bone loss?","authors":"MD, FRCP Stuart H. Ralston (Professor of Medicine and Consultant Physician)","doi":"10.1016/S0950-3579(97)80016-7","DOIUrl":"10.1016/S0950-3579(97)80016-7","url":null,"abstract":"<div><p>Bone mass at any point in life represents a balance between the amount of bone laid down during growth and development and the amount of bone lost with ageing. At a cellular level, these changes in bone mass occur as the result of bone remodelling; a process whereby bone resorbing cells (osteoclasts) and bone forming cells (osteoblasts) remove and replace small packets of bone at discrete points throughout the skeleton. This process is in turn regulated by a complex interaction between genetic factors and environmental influences such as nutrition and exercise, which affect bone cell function both directly and indirectly by altering the production of local and systemic hormones that modulate bone cell activity. In this chapter, I shall review the relative importance of genetic and environmental factors in regulating bone growth, peak bone mass, and bone loss. Discussion of the genetic aspects shall focus on recent data linking polymorphisms in candidate genes to bone mass and bone loss, and on the possible role which gene-environment interactions may have in regulating these processes.</p></div>","PeriodicalId":77032,"journal":{"name":"Bailliere's clinical rheumatology","volume":"11 3","pages":"Pages 479-494"},"PeriodicalIF":0.0,"publicationDate":"1997-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S0950-3579(97)80016-7","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20297802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
PhD Didier Hans (Assistant Adjunct Professor of Radiology), PhD Thomas Fuerst (Assistant Adjunct Professor of Radiology), PhD Thomas Lang (Assistant Adjunct Professor of Radiology), PhD Sharmila Majumdar (Associate Professor in Resident), PhD Ying Lu (Assistant Adjunct Professor of Radiology), MD Harry K. Genant (Professor of Radiology, Medicine and Orthopedic Surgery), PhD Claus Glüer (Professor of Medical Physics)
{"title":"3 How can we measure bone quality?","authors":"PhD Didier Hans (Assistant Adjunct Professor of Radiology), PhD Thomas Fuerst (Assistant Adjunct Professor of Radiology), PhD Thomas Lang (Assistant Adjunct Professor of Radiology), PhD Sharmila Majumdar (Associate Professor in Resident), PhD Ying Lu (Assistant Adjunct Professor of Radiology), MD Harry K. Genant (Professor of Radiology, Medicine and Orthopedic Surgery), PhD Claus Glüer (Professor of Medical Physics)","doi":"10.1016/S0950-3579(97)80017-9","DOIUrl":"10.1016/S0950-3579(97)80017-9","url":null,"abstract":"<div><p>Osteoporosis is a systematic skeletal disease characterized by low bone mass and microarchitectural deterioration of bone tissue. This leads to diminished biomechanical competence of the skeleton and is associated with low-trauma or atraumatic fractures. In the past decade, considerable progress has been made in the development of methods for assessing the skeleton non-invasively, so that osteoporosis can be better managed. While dual X-ray absorptiometry (DXA) is still the preferred methodology, several limitations will be addressed. Another densitometric technique which is widely accepted for diagnosis of spinal osteoporosis is single energy QCT. Measurements of vertebral trabecular bone mineral density (BMD) demonstrate larger percentage decrements between vertebrally-fractured subjects and normal controls, and confer higher relative risks for vertebral fracture than either anteroposterior or lateral DXA measurements. As an emerging alternative to photon absorptiometry techniques, there is a growing interest in the use of quantitative ultrasound (QUS) measurements for the noninvasive assessment of osteoporotic fracture risk in the management of osteoporosis. The attractiveness of QUS lies in the fact that indirect and in vitro experience has suggested that ultrasound may give information not only about BMD but also about architecture and elasticity. Whether or not combining QUS and DXA improve fracture prediction is still unclear and needs further analysis. Due to the growing evidence supporting the use of QUS in osteoporosis and the large number of QUS devices already on the market, a general clinical consensus on the application of QUS is urgently needed. Other techniques that are less widely used for the management of osteoporosis. For example, peripheral quantitative computed tomography, quantitative magnetic resonance (QMR) and magnetic resonance microscopy are promising tools for the evaluation of the skeleton. For example, the ability of QMR and high resolution magnetic resonance imaging has been explored and shows promise as a technique for assessing trabecular bone structure in osteoporosis.</p></div>","PeriodicalId":77032,"journal":{"name":"Bailliere's clinical rheumatology","volume":"11 3","pages":"Pages 495-515"},"PeriodicalIF":0.0,"publicationDate":"1997-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S0950-3579(97)80017-9","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20297803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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