Question

1. Management for the following problems in musculoskeletal system.

a. Osteoporosis

b. Rheumatoid arthritis

c. Gout

d. Osteoarthritis

Answer 1

a. Osteoporosis is the loss of bone mass caused by increased bone resorption which makes the bones fragile and increases the risk of fracture.

The management for osteoporosis aims to strengthen the bones through exercise and adjunct therapy with calcium and vitamin D. Exercises for osteoporosis includes muscle strengthening exercises.

Pharmacological therapy includes drugs such as alendronate, risedronate, zoledronate and denosumab.

b. Rheumatoid arthritis is an systemic inflammatory disease affecting multiple joints in the body.  

The management of rheumatoid arthritis is as follows:

- use of heat and cryotherapy to reduce pain, swelling and joint inflammation.

- use of physical exercises such as active movement, stretching and strengthening exercises to improve strength and flexibility

- pharmacological therapy includes use of non biological disease modifying drugs (eg methotrexate, azathioprine), biologic tumor necrosis factor (TNF)–inhibiting DMARDs (etanercept), biologic TNF DMARDs (rituximab, anakinra).

- corticosteroid, non steroidal anti inflammatory drugsdrugs and analgesics are also used

- surgical management includes tendon reconstruction and joint Arthroplasty.

c. Gout is the joint arthroplasty caused by accumulation of monosodium urate monohydrate crystals within the joints due to hyperuricemia.

A cute attacks of gout are controlled by NSAIDs, corticosteroid, colchicine and adrenocorticotropic hormone.

Hyperuricemia which is primary cause of gout is treated through drugs such as allopurinol, probenecid and febuxostat.

Patient with gout are often advised to control the intake of proteins in diet.

d. Osteoarthritis is the non inflammatory degenerative disorder affecting the bone. As the joints undergo wear and tear, the articular cartilage erodes causing joint pain, swelling and difficulty in movement.

Management includes :

- physical exercise such as isometric exercises, stretching and strengthening exercises.

- use of heat and cold therapy and TENS to relieve pain and swelling

- pharmacological treatment includes use of topical and oral non steroidal anti inflammatory drugs and intra articular corticosteroid injection.

- surgical management includes joint arthroplasty