Musculoskeletal and connective tissue disorders:
Gespeichert in:
| Format: | Buch |
|---|---|
| Sprache: | English |
| Veröffentlicht: |
Philadelphia [u.a.]
Saunders
1998
|
| Schriftenreihe: | Clinics in geriatric medicine
14,3 |
| Schlagworte: | |
| Online-Zugang: | Inhaltsverzeichnis |
| Beschreibung: | XII S., S. 401 - 667 Ill., graph. Darst. |
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| 245 | 1 | 0 | |a Musculoskeletal and connective tissue disorders |c Richard F. Loeser, guest ed. |
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| 650 | 4 | |a Connective tissue diseases in old age | |
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MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS
CONTENTS
Preface xi
Richard F. Loeser, Jr
Evaluation of Musculoskeletal Complaints
in the Older Adult 401
Richard F. Loeser, Jr
During the evaluation of older adults with musculoskeletal com¬
plaints, it is necessary to differentiate periarticular conditions from
intraarticular or arthritic conditions. It also is useful to classify the
symptoms as acute or chronic and as mono , oligo , or polyartic
ular. Close attention should be paid to the history and physical
exam findings, while laboratory tests and radiographs should only
be used as supporting evidence of a clinical diagnosis. A search for
the presence of joint inflammation is particularly important in the
diagnostic process. Urgent evaluation is necessary in a patient with
an acutely warm and swollen joint to rule out the presence of in¬
fection.
Biology of the Aging Joint 417
David Hamerman
Aging implies changes in joint components over a continuum of
time that contribute later in life to an increasing frequency of clini¬
cal complaints and impairments in function and mobility. This ar¬
ticle considers how aging appears to modify the articular cartilage,
subchondral bone, muscle, the soft tissues, synovial membrane,
and synovial fluid. Whether the changes in aging inevitably pro¬
gress through an intermediary phase of "degenerated cartilage" to
the fibrillated state of osteoarthritis is not clear.
Management of Osteoarthritis in Older Adults 435
Paul Creamer, Raymond Flores, and Marc C. Hochberg
Management of osteoarthritis (OA) is directed primarily towards
relief of pain and functional limitation. This article discusses a
CLINICS IN GERIATRIC MEDICINE
VOLUME 14 • NUMBER 3 • AUGUST 1998 V
range of nonpharmacologic modalities, including education, social
support, weight reduction, and exercise. Drug treatment should
begin with adequate doses of acetaminophen. Guidelines for ap¬
propriate use of NSAIDs also are suggested in this article. Intraar
ticular steroids help a proportion of patients, particularly those
with OA of the knee or thumb base; the role of intraarticular ther¬
apies remains uncertain. Surgery (total joint replacement) remains
an excellent treatment for patients in whom medical treatment has
failed to provide adequate symptom relief. Future developments
are likely to include earlier intervention using drugs with the po¬
tential to modify the course of the disease.
Polymyalgia Rheumatica and Giant Cell Arteritis 455
Jonathan M. Evans and Gene G. Hunder
Giant cell (temporal) arteritis and polymyalgia rheumatica are re¬
lated conditions that primarily affect older persons. They are
among the most common chronic inflammatory disorders in this
age group. In recent years, several new insights have been gained
about the clinical features of these illnesses as well as their under¬
lying pathophysiology. In addition, a great deal of study is under¬
way to find better ways of detecting, monitoring, and treating
them. This article provides a general review of these conditions,
including their diagnosis and treatment.
Rheumatoid Arthritis in Older Adults 475
K. Lea Sewell
Rheumatoid arthritis is a common problem in older adults with
varied clinical presentations, which can present a diagnostic chal¬
lenge. Patients experience a significant functional decline and are
placed at increased risk of institutionalization. Multidisciplinary
care should focus on all factors contributing to disability, including
pain management and depression. Current therapeutic modalities
offer an array of choices to the geriatrician. Drug selection should
be individualized to reflect each patient's level of disease activity
and risk for specific toxicities.
Crystal Associated Arthritis 495
Carlos A. Agudelo and Christopher M. Wise
Since the original descriptions of the involvement of crystals in
arthritis, understanding of the clinical syndromes of gout and pseu
dogout and the role of basic calcium crystals in arthritis has in¬
creased. Gout is a common problem in middle aged males but has
an increasing prevalence in older patients, particularly women.
Calcium pyrophosphate dihydrate (CPPD) crystal deposition dis
vi CONTENTS
ease is now a well recognized problem in older patients. The di¬
agnosis of both of these common forms of arthritis and the need to
individualize therapy in patients with other medical problems re¬
main important clinical challenges to the practicing physician.
Clinical Expression of Autoimmune Diseases
in Older Adults 515
Nilamadhab Mishra and Gary M. Kammer
Aging modifies the clinical presentation and course of autoimmune
disorders. In the older person who carries a complement of pre¬
disposing genes, environmental factors may alter a senescent im¬
mune system and trigger the onset of autoimmunity. In this article
about autoimmune diseases of the older adult, the authors discuss
the epidemiology, clinical presentations, laboratory and radio
graphic findings, and management of systemic lupus erythemato
sus, primary Sjogren's syndrome, and idiopathic inflammatory
myopathies.
Back and Leg Pain in Older Adults 543
Leon J. Grobler
Back and leg pain in the older population are of diagnostic and
therapeutic importance for both primary and tertiary care provid¬
ers. Careful assessment of the clinical presentation, potential dif¬
ferential diagnosis, and treatment options are essential to optimize
outcome results. Well proven conservative treatment modalities al¬
ways should be the first regimen after confirmatory diagnostic
studies. The available surgical treatment options must be used ju¬
diciously for the correct indications in suitable patients. A team
approach in taking care of this group of patients is both essential
and rewarding.
Osteoporosis: Pathogenesis, Diagnosis, and Treatment
in Older Adults 577
Karen M. Prestwood and Anne M. Kenny
Prevention of osteoporosis is a major health concern. Bone loss
occurs throughout life in both women and men due to calcium
deficiency, hormonal deficiency, and changes in bone formation.
The diagnosis of osteoporosis can now be made prior to fragility
fracture, allowing for prevention as well as treatment. Criteria for
diagnosis of osteoporosis are reviewed, and a plan for the evalu¬
ation of secondary causes of osteoporosis is discussed. Also re¬
viewed are prevention and treatment options such as exercise,
calcium supplementation, hormone replacement, and new and in
vestigational drugs.
CONTENTS vii
Soft Tissue Problems in Older Adults 601
N. Wilson Holland and Emilio B. Gonzalez
This article describes common soft tissue problems encountered in
older adults, including fibromyalgia, selected bursitis/tendinitis
syndromes, nerve entrapment syndromes, and miscellaneous top¬
ics such as Dupuytren's contractures, trigger fingers, palmar fas
ciitis, and reflex sympathetic dystrophy. Clinical presentations, di¬
agnosis, and treatment are emphasized. These are conditions that
are frequently encountered but are generally diagnosed as arthritis
or normal age related problems. This article will hopefully en¬
lighten the reader in distinguishing between these conditions.
Surgical Management of Osteoarthritis 613
Paul E. Di Cesare
The surgical management of osteoarthritis has progressed greatly
in the past 30 years and often is indicated when noninvasive mea¬
sures can no longer provide sufficient pain relief and maintenance
of function. Physicians can choose from a variety of surgical pro¬
cedures, depending on patient age, the joint involved, functional
expectations, patient activity demands, and degree of cartilaginous
loss. Surgical procedures for arthritic joints can be classified in two
broad categories: those that are cartilage sparing, such as osteot¬
omy, and those that are cartilage sacrificing, such as arthroplasty.
This article discusses those procedures most commonly used for
the major weightbearing joints of the lower extremities (hip, knee,
ankle) as well as the large joints of the upper extremity (shoulder,
elbow).
Physical Activity, Arthritis, and Disability in Older People 633
Walter H. Ettinger, Jr
Physical activity protects against the development of chronic dis¬
ease and disability. There appears to be little risk of damage to
joints from regular, moderate level exercise. Patients with arthritis
can safely participate in exercise programs and often have relief of
pain and disability. The most difficult problem facing practitioners
is how to get people with arthritis to start and maintain an exercise
program.
Musculoskeletal Rehabilitation 641
Alan Berman and Stephanie Studenski
Musculoskeletal problems are common, diasabling, and cause
great suffering in older adults. Rehabilitation services are fre¬
quently indicated and can usually be offered in an outpatient set¬
ting. The role of the physician is to make an accurate diagnosis,
recognize disability, and refer for rehabilitation services when in
viii CONTENTS
dicated. There are many diagnostic tests available to assist the phy¬
sician, but none is as useful and practical as the office examination,
including the functional history. Treatment goals with musculo
skeletal conditions often are modest and include reduced pain and
improved function. Frequently, conditions can flare up or persist
in smoldering forms, requiring recurrent interactions with the re¬
habilitation team. The primary care physician can make use of
many of the following resources available to treat musculoskeletal
pain and limitations: exercise, medication, physical modalities,
adaptive equipment, and arthritis education, including self help
and support groups. Used in combination, these treatments can
contribute to increased well being. The key for the physician is
knowing that these options exist and being familiar with their use.
Index 661
Subscription Information Inside back cover
CONTENTS ix |
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| spelling | Musculoskeletal and connective tissue disorders Richard F. Loeser, guest ed. Philadelphia [u.a.] Saunders 1998 XII S., S. 401 - 667 Ill., graph. Darst. txt rdacontent n rdamedia nc rdacarrier Clinics in geriatric medicine 14,3 Aged Connective Tissue Diseases Connective tissue diseases in old age Musculoskeletal Diseases Musculoskeletal diseases in old age Bewegungsapparat (DE-588)4006318-5 gnd rswk-swf Bindegewebskrankheit (DE-588)4031751-1 gnd rswk-swf Krankheit (DE-588)4032844-2 gnd rswk-swf (DE-588)4143413-4 Aufsatzsammlung gnd-content Bewegungsapparat (DE-588)4006318-5 s Krankheit (DE-588)4032844-2 s DE-604 Bindegewebskrankheit (DE-588)4031751-1 s Loeser, Richard F. Sonstige oth Clinics in geriatric medicine 14,3 (DE-604)BV000019839 14,3 HBZ Datenaustausch application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=008220823&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
| spellingShingle | Musculoskeletal and connective tissue disorders Clinics in geriatric medicine Aged Connective Tissue Diseases Connective tissue diseases in old age Musculoskeletal Diseases Musculoskeletal diseases in old age Bewegungsapparat (DE-588)4006318-5 gnd Bindegewebskrankheit (DE-588)4031751-1 gnd Krankheit (DE-588)4032844-2 gnd |
| subject_GND | (DE-588)4006318-5 (DE-588)4031751-1 (DE-588)4032844-2 (DE-588)4143413-4 |
| title | Musculoskeletal and connective tissue disorders |
| title_auth | Musculoskeletal and connective tissue disorders |
| title_exact_search | Musculoskeletal and connective tissue disorders |
| title_full | Musculoskeletal and connective tissue disorders Richard F. Loeser, guest ed. |
| title_fullStr | Musculoskeletal and connective tissue disorders Richard F. Loeser, guest ed. |
| title_full_unstemmed | Musculoskeletal and connective tissue disorders Richard F. Loeser, guest ed. |
| title_short | Musculoskeletal and connective tissue disorders |
| title_sort | musculoskeletal and connective tissue disorders |
| topic | Aged Connective Tissue Diseases Connective tissue diseases in old age Musculoskeletal Diseases Musculoskeletal diseases in old age Bewegungsapparat (DE-588)4006318-5 gnd Bindegewebskrankheit (DE-588)4031751-1 gnd Krankheit (DE-588)4032844-2 gnd |
| topic_facet | Aged Connective Tissue Diseases Connective tissue diseases in old age Musculoskeletal Diseases Musculoskeletal diseases in old age Bewegungsapparat Bindegewebskrankheit Krankheit Aufsatzsammlung |
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