Monday, March 23, 2009

Osteoarthritis and its Management

Osteoarthritis (OA) is a clinical spectrum ranging from localized chondral defects to established arthrosis resulting from hyaline cartilage failure. OA is the most common rheumatic disease found in the population. It is estimated the prevalence around 12% in the total population (USA) and about 10.0% (urban) – 13.5% (rural) in Malang, East Java, Indonesia. The radiological OA is estimated much higher (85%) compared to the clinical OA in the population by the age of 65 years. OA is characterized by progressive degradation of the components of the extra-cellular matrix (ECM) of the articular cartilage, associated with secondary inflammatory factors. The specific etiological factor is unknown, but many factors play a role in the destruction process or remodeling system. It depends on the joint involved and the factors recognized that OA would be primary or secondary. Clinically OA characterized by gradual development of joint pain, stiffness, limitation of movement and swelling. The treatment strategy comprised of two different modalities that are non-pharmacological treatment and pharmacological treatment, including surgery. The treatment depends on the patient’s age, the severity of arthrosis and physical expectations. The important things in the group of non-pharmacological approach other than weight reduction program and lifestyle changes are medical rehabilitation program, i.e. the use of assisted devices, braces and footwear modification. Non-steroidal anti-inflammatory drugs (NSAIDs) and other painkillers were the most prescribed drugs. There is some consideration in choosing of NSAIDs, including the efficacy, patient tolerance, safety, cost, drug interaction etc. Amongst them, Meloxicam is one of NSAIDs regularly used in treating OA. Some clinical trial such as MELISSA, SELECT, IMPROVED, NICE etc are looking for the efficacy, tolerability, safety profile of Meloxicam.

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