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  Medical Topics: 

  • Anterior Cruciate

  •         Ligament 
  • Articular cartilage

  •           Injury 
  •      Meniscus

  •        Patella

  • Degenerative Joint

  •          Disease 

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     1. Definition:   Degenerative joint disease (D.J.D.) or  
            Osteoarthritis is a degeneration of the joint surface resulting  
            from wear and tear over many years. This process usually  
            manifests itself after  age fifty, however it may begin sooner  
            if there is a history of injury to the joint. The cartilage  
            surfaces, known as articular or hyaline cartilage,  
            deteriorate by softening fissuring, fragmenting and finally  
            dissolving away. The underlying exposed bone is then  
            subjected to greatly increased stress resulting in pain,  
            swelling and gradual loss of joint function. 

    2. Treatment:  Traditional drug therapy for D.J.D. of the knee has  
            focused on the use of oral nonsteroidal anti-inflammatory  
            medications...Naprosyn, Feldene and Motrin to name a few.  
            These agents have a significant incidence of stomach  
            irritation and even ulceration and are only capable of  
            treating the symptoms...not  the disease. Cortisone and its   
            synthetic derivatives have been used by direct injection into  
            the knee joint  for decades with good relief of symptoms but,  
            again, allow the disease to progress unabated. 

            In the last decade, research in the field of D.J.D. has begun  
            to focus on restoring the damaged articular cartilage. Several 
            of these "cartilage supplements" are now available in oral  
            and indictable form. 

            Glucosamine and Chondroitin Sulfate (Cosamin DS) are  
            chemicals found in human articular cartilage. Recently, these  
            compounds have been made available for  the treatment of  
            D.J.D. When taken  in the proper oral combination, these  
            "neutraceuticals" can decrease pain and improve joint 
            function in cases of mild to moderate osteoarthritis.  
            Glucosamine is a building block used in hyaline cartilage  
            synthesis, while Chondroitin Sulfate inhibits cartilage  
            breakdown. Taken together, these chemicals are far more  
            effective than  either one taken alone. Most commercially  
            available brands contain 500 mg.  of Glucosamine and 400  
            mg. of Chondroitin Sulfate in oral form. Dosing varies with  
            the patient's weight, symptoms and duration of treatment.  4 
            to 8 weeks of treatment is usually necessary before relief of 
            symptoms is noticed. There have been NO significant side 
            effects reported to date. These products are available without 
            a prescription and can be obtained at most pharmacies and 
            health food stores. Patients should consult there physician 
            before and during treatment. 

            Hyaluronic Acid is a chemical that is found in human  
            synovial fluid and hyaline cartilage. Recently, this compound  
            has been made available in injectible form for the treatment  
            of mild to moderate osteoarthritis of the knee. It is derived    
            from rooster combs and processed into a liquid that is quite  
            viscous. This is injected directly into the knee joint and is  
            believed to work by increasing the viscosity of the synovial  
            fluid in the knee as well as by promoting cartilage synthesis.  
            The injections are given once every week for three to five  
            weeks after which patients will begin to experience relief of  
            symptoms. Pain relief and improvement of joint function can  
            last up to one year after treatment is completed. Side effects  
            include local pain and swelling at the injection site. This  
            medication is only available by prescription and should only  
            be administered by a physician experienced in giving  
            intra-articular injections. 

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