Intra-articular corticosteroid administration is extremely helpful for local flares for relief of pain and inflammatory swelling. Too-frequent use should be avoided owing to concerns regarding joint overuse and aggravation of…
NSAIDs, either traditional nonselective or COX-2–selective agents, are generally more efficacious than analgesics alone. Although all NSAIDs, selective or nonselective, have the potential for gastrointestinal complications such as peptic ulceration,…
Nonpharmacologic interventions include an umbrella-like group of approaches that should be universally considered in all patients. Advising and educating the patient as to treatment objectives and the importance of exercise,…
Hip Joint Involvement Osteoarthritis of the hip (malum coxae senilis) is a major crippling and painful form of osteoarthritis. Standing and walking often cause severe localized hip pain that may…
Neuropathies augment the clinical problems of degenerative disease of the spine. Spurs growing from vertebral margins adjacent to degenerated discs and from facet borders may narrow the foramina through which…
CLINICAL MANIFESTATIONS The signs and symptoms of osteoarthritis depend on the joint or joints affected (see Plate 5-22). Most commonly involved are the weight-bearing joints (see Plate 5-23) and small…
Many factors influence its onset and the speed of joint deterioration, including aging, gender, obesity, heredity, trauma (related to sports or occupation), joint overuse, joint instability, and malalignment. Involved basic…
For children with extended oligoarticular or polyarticular subtypes, weekly administration of methotrexate now stands as the first-line drug of choice. Methotrexate, an antimetabolite, may be administered via the oral or…
The histocompatibility of human leukocyte antigen B27 (HLA-B27) is detected in a large percentage of patients in this subgroup. Children should not be included in this subgroup solely because of…
Rheumatoid Factor–Negative Polyarthritis. Approximately 75% of patients with polyarticular-onset arthritis do not have IgM rheumatoid factor in the serum, and the rheumatoid factor test rarely becomes positive 6 months after…
