Health Care

by: Nathan Wei

Among the many treatment options available for people with osteoarthritis are injections of glucocorticoids… commonly known as cortisone injections.

Glucocorticoids, also called corticosteroids or steroids, are anti-inflammatory compounds that are synthetic copies of what the body’s adrenal glands make. When properly injected, these corticosteroids reduce the swelling, redness, heat, and pain that commonly accompany arthritis.

Traditionally, the use of glucocorticoid injections for the hip have been perceived to not work well… or at least not work as well as they do for the knee. However, the hip joint is one of the most difficult joints in the body to inject accurately.

A new study reported in Arthritis and Rheumatism (Lambert RGW, Hutchings EJ, Grace MGA, Jhangri GS, Conner-Spady B, Maksymowych WP. Steroid injection for osteoarthritis of the hip: A randomized, Double-blind, Placebo-controlled Trial. Arthritis Rheum. 2007;56:2278-2287) has demonstrated that correctly placed steroid injections can produce considerable improvement in patients with osteoarthritis (OA) of the hip.

What the researchers wanted to answer was whether the steroid was less effective because of the way it was injected. They wanted to ensure entry of the therapeutic agent into the synovial space. As a result they used fluoroscopic guidance. Fluoroscopy is a type of real time x-ray.

The investigators studied 52 symptomatic patients with hip OA who were randomized in a double-blind fashion to fluoroscopically guided intra-articular injection of bupivacaine (an anesthetic agent) and 40 mg triamcinolone (a type of long-acting glucocorticoid) or to bupivacaine and saline.

At 2 months, Western Ontario and McMaster Universities OA Index (WOMAC) pain scores fell by 49.2% in the active treatment group and by 2.5% in the placebo group. The WOMAC is considered the cornerstone of patient response in osteoarthritis clinical trials so that this response was critical to determining the effectiveness of the therapies.

In addition, 67.7% of the corticosteroid group showed a 20% WOMAC improvement, compared to 23.8% of the placebo group. Findings were similar for a 50% WOMAC improvement (61.3% versus 14.3%).

These differences were maintained at 3 months.

The trial confirmed that when the steroid is injected under image guidance and can be certain that the steroid is in the right place, the steroids work very well for most patients with moderately advanced or severe hip OA.

A potentially even more useful technique for localization of the hip joint is ultrasound (US). US has the advantages of being fast, of showing soft tissue as well as bone, and of having no radiation associated with it. Fluoroscopy has comparatively much radiation exposure both to the patient as well as to the physician doing the injection.

In our clinic we use US as opposed to fluoroscopy. In any event, though, one or the other should be used to ensure proper placement of the needle.

Cortisone injection into the hip is also a procedure that should be done using sterile techniques.

In patients who respond to corticosteroid injections, these can be repeated as often as three times per year. Another therapeutic option is injection of viscosupplements into the hip. These are gel-like lubricants that also help reduce pain and allow the joint to glide better. Examples of these are compounds such as Supartz, Hyalgan, and Synvisc. In patients who are not considered surgical candidates or who do not want surgery, this is a viable option to consider.

About the Author:

Nathan Wei, MD FACP FACR is a rheumatologist and Director of the Arthritis and Osteoporosis Center of Maryland. For more info: Cortisone Shot Side Effects

Article Source: www.iSnare.com

By: Andy Lim

When pus forms in your gums but not in the bone, you have gum or periodontal abscess. It ranks second in dental emergencies. It is the result of periodontitis, a severe gum disease. It usually needs to be treated immediately.

When inflammation spreads into the supporting structure of the teeth, it will result in periodontal abscess. This will subsequently destroy the supporting structure of the teeth,the bone and the tissue (periodontium). The destruction will then lead to the formation of pockets. Food particles will accumulate in the pockets to form plaque and tartar. This creates a conducive environment for the bacteria to live and multiply. In the end, infection sets in and pus develops in the gums.

Gum abscess can form around a living tooth. Beginning from the gum, the pus works itself into the bone by creating a hole in the bone around the teeth. This will eventually destroy the underlying bone. The problem can only get worse. That's why periodontal disease cannot be left untreated.

Unlike a toothache, you can't feel the pain when the infection sets in. When the pus begins to take form in the gum, you will experience continuous throbbing and burning sensations. Usually overnight, the infected area will swell. You may notice a white spot on the gum. If you push the gum around your teeth, it hurts. You may have difficulty in opening your mouth because of the swelling and inflammation of gums close to your teeth. Your taste bud will be affected also because of the draining of the pus. Bear in mind that the infection can spread to other gum areas if you don't get proper treatment.

You can use salt water and clove oil to reduce the pain temporarily before you seek dental help. Pain relieving medication with anti-inflammatory such as ibuprofen, motrin or acetaminophen may also help. Sometimes after using mouthwashes and peroxide flushes, the pus will form again. They can only relieve the pain but cannot treat the infection. You should see a dentist right away to have it treated.

Antibiotic therapy is the best temporary relief for periodontal abscess. It is administered during a dental emergency. You should get relief between 24 to 48 hours.

Dentists usually use scaling and root planing to remove the abscess. To get rid of the infection, they will thoroughly clean the canal system within the tooth. They also remove the debris to allow the pus to drain. But you may need periodontal surgery or even worse, selective tooth extraction if the gum disease becomes serious.

You need to keep your tooth and root surfaces clean. This can prevent the formation of pockets which gather bacteria. Then your risk of developing gum abscess is lower. You can also stop infection by removing plaque through proper oral hygiene.

Regular dental visits can help to control active gum disease by reducing the depth of periodontal pockets around the affected teeth. Regular dental cleanings can reduce bacterial growth in periodontal pockets to lower the possibility of developing periodontal abscess.

Gum abscess begins as an inflammation of the gum tissue (gingivitis). If you don't take immediate measures, it can destroy supporting structures and become periodontitis. If you need dental emergency treatment, you are already in the acute phase of gum disease. Proper dental hygiene and regular dental visits can stop gum abscess from developing.

Andy Lim gives away more tips on how totreat gum disease at his web site. You can prevent periodontal infection by applyingreversing gum disease strategies.

Article Source: http://www.eArticlesOnline.com