Etodolac

What is arthritis of the knee?

The knee acts as hinge joint and allows flexion (bending) and extension (straightening). The knee is formed by the tibiofemoral joints, where end of the femur (thigh bone) glides over the top of the tibia (shin bone) and the patellofemoral joint where the kneecap glides over the end part of the femur. The gliding surfaces of the knee are covered with articular cartilage which helps the joint to glide smoothly. Over time the articular cartilage can become damaged or 'worn away' and this is known as osteoarthritis.

What is medial compartment arthritis?

Most people with knee arthritis have predominantly pain in the inner aspect of the knee, which is due to medial compartment arthritis. Patients who are born with varus knees (bow legs) are more likely to get medial compartment osteoarthritis. This is because the weight of their body mainly passes through the medial compartment of the knee rather than spreading the load evenly between the whole gliding surface of the knee. 

How do you diagnose medial compartment arthritis?

ClinicaFeatures, examination findings and standing X-rays of the knee joint and the patello-femoral joint are needed to diagnose medial compartment arthritis. The X-ray will often show narrowing of the joint space in the medial compartment of the knee which suggest that a patient has medial compartment osteoarthritis. Long Leg standing X-ray of the whole of both of both legs from the hip joints to the ankle joints ( Fig 2), allows us to carefully examine the overall alignment of your legs. They help to calculate the weight bearing axis of your leg and find out where most of the force is passing through your knee joint. MRI would be done too, to assess degree of cartilage damage. It is imperative to know status of other structures in the knee like meniscus and ligaments.

Non-operative treatment

Some patients are advised for a type of knee brace known as a medial offloading brace to trial. To a certain extent this mimics the result of osteotomy surgery by pushing the leg into a more normal alignment and taking the pressure of the damaged medial compartment. This is usually only a temporary solution whilst waiting for surgery. Patients who are overweight often find their knee pain is significantly improved when they lose weight. Simple analgesia such as paracetamol together with etodolac can help with pain and sleep disturbance form the pain.

Who requires surgery?

People suffering from growing cartilage lesions resulting in pain and activity restriction with proved mechanical axis deviation as the cause, would benefit from surgery. Age and extent of cartilage wear determine the nature of surgery. Younger individuals with smaller lesions are good candidates for a joint preservation surgery in the form of a High Tibial Osteotomy. With advancing age and extent of disease, Arthroplasty would be a
more beneficial option.

In case you have a concern or query you can always consult an expert & get answers to your questions!

What is arthritis of the knee?

The knee acts as hinge joint and allows flexion (bending) and extension (straightening). The knee is formed by the tibiofemoral joints, where end of the femur (thigh bone) glides over the top of the tibia (shin bone) and the patellofemoral joint where the kneecap glides over the end part of the femur. The gliding surfaces of the knee are covered with articular cartilage which helps the joint to glide smoothly. Over time the articular cartilage can become damaged or 'worn away' and this is known as osteoarthritis.

What is medial compartment arthritis?

Most people with knee arthritis have predominantly pain in the inner aspect of the knee, which is due to medial compartment arthritis. Patients who are born with varus knees (bow legs) are more likely to get medial compartment osteoarthritis. This is because the weight of their body mainly passes through the medial compartment of the knee rather than spreading the load evenly between the whole gliding surface of the knee. 

How do you diagnose medial compartment arthritis?

ClinicaFeatures, examination findings and standing X-rays of the knee joint and the patello-femoral joint are needed to diagnose medial compartment arthritis. The X-ray will often show narrowing of the joint space in the medial compartment of the knee which suggest that a patient has medial compartment osteoarthritis. Long Leg standing X-ray of the whole of both of both legs from the hip joints to the ankle joints ( Fig 2), allows us to carefully examine the overall alignment of your legs. They help to calculate the weight bearing axis of your leg and find out where most of the force is passing through your knee joint. MRI would be done too, to assess degree of cartilage damage. It is imperative to know status of other structures in the knee like meniscus and ligaments.

Non-operative treatment

Some patients are advised for a type of knee brace known as a medial offloading brace to trial. To a certain extent this mimics the result of osteotomy surgery by pushing the leg into a more normal alignment and taking the pressure of the damaged medial compartment. This is usually only a temporary solution whilst waiting for surgery. Patients who are overweight often find their knee pain is significantly improved when they lose weight. Simple analgesia such as paracetamol together with etodolac can help with pain and sleep disturbance form the pain.

Who requires surgery?

People suffering from growing cartilage lesions resulting in pain and activity restriction with proved mechanical axis deviation as the cause, would benefit from surgery. Age and extent of cartilage wear determine the nature of surgery. Younger individuals with smaller lesions are good candidates for a joint preservation surgery in the form of a High Tibial Osteotomy. With advancing age and extent of disease, Arthroplasty would be a
more beneficial option.

What is arthritis of the knee?

The knee acts as hinge joint and allows flexion (bending) and extension (straightening). The knee is formed by the tibiofemoral joints, where end of the femur (thigh bone) glides over the top of the tibia (shin bone) and the patellofemoral joint where the kneecap glides over the end part of the femur. The gliding surfaces of the knee are covered with articular cartilage which helps the joint to glide smoothly. Over time the articular cartilage can become damaged or 'worn away' and this is known as osteoarthritis.

What is medial compartment arthritis?

Most people with knee arthritis have predominantly pain in the inner aspect of the knee, which is due to medial compartment arthritis. Patients who are born with varus knees (bow legs) are more likely to get medial compartment osteoarthritis. This is because the weight of their body mainly passes through the medial compartment of the knee rather than spreading the load evenly between the whole gliding surface of the knee. 

How do you diagnose medial compartment arthritis?

ClinicaFeatures, examination findings and standing X-rays of the knee joint and the patello-femoral joint are needed to diagnose medial compartment arthritis. The X-ray will often show narrowing of the joint space in the medial compartment of the knee which suggest that a patient has medial compartment osteoarthritis. Long Leg standing X-ray of the whole of both of both legs from the hip joints to the ankle joints ( Fig 2), allows us to carefully examine the overall alignment of your legs. They help to calculate the weight bearing axis of your leg and find out where most of the force is passing through your knee joint. MRI would be done too, to assess degree of cartilage damage. It is imperative to know status of other structures in the knee like meniscus and ligaments.

Non-operative treatment

Some patients are advised for a type of knee brace known as a medial offloading brace to trial. To a certain extent this mimics the result of osteotomy surgery by pushing the leg into a more normal alignment and taking the pressure of the damaged medial compartment. This is usually only a temporary solution whilst waiting for surgery. Patients who are overweight often find their knee pain is significantly improved when they lose weight. Simple analgesia such as paracetamol together with etodolac can help with pain and sleep disturbance form the pain.

Who requires surgery?

People suffering from growing cartilage lesions resulting in pain and activity restriction with proved mechanical axis deviation as the cause, would benefit from surgery. Age and extent of cartilage wear determine the nature of surgery. Younger individuals with smaller lesions are good candidates for a joint preservation surgery in the form of a High Tibial Osteotomy. With advancing age and extent of disease, Arthroplasty would be a
more beneficial option.

In case you have a concern or query you can always consult an expert & get answers to your questions!

Peptic Ulcer Definition: 
When the lining of the lower oesophagus, small intestine, or stomach develops open pores it is called peptic ulcer. It usually forms due to inflammation caused by erosion of stomach acids. It differs from erosion due to its deeper extension into the lining and stimulates the inflammatory reaction more from the tissues involved. There are several symptoms that you may observe, such as:

-  pain in the upper abdomen, which will give you dull, sharp or hunger-like feeling

-  heartburn, or acid reflux

-  feeling discomfort

It is a fairly common health problem but can lead to internal bleeding if left untreated. This may sometimes bring to the situation that will require blood transfusions in the hospital. The formation of peptic ulcer is related to H. pylori bacteria in the stomach and NSAIDs (nonsteroidal anti-inflammatory medications) in about 50 per cent of patients. The remaining number of patients suffers from the disease due to numerous causes like severe physiological stress, drugs, genetic factors, smoking, but many times the cause remains unknown. A peptic ulcer is a type of recurrent disease, which means it can recur even after being healed unless it is treated to prevent recurrence. The pain of ulcer may not show a relation with the presence or severity of ulceration. The condition is diagnosed by endoscopy or upper GI series. It is treated to relieve the patient from pain, heal the condition and prevent complications. There are three forms of peptic ulcer:

-  oesophagal ulcer: develops inside the oesophagus

-  gastric ulcer: develops on the stomach lining

-  duodenal ulcer: develops in the upper section of small intestines

Peptic Ulcer Symptoms: 
The symptoms of peptic ulcer vary according to its types. People suffering from ulcers experience abdominal discomfort and minimal indigestion that occurs after having meals, or no discomfort at all. Many people complain of hunger pain or upper abdominal burning which extends to the chest from naval, ranging from mild to severe. The pain occurs after one to three hours of having the meal, or in some cases may wake you up at night. The symptoms often get relived from the food or antacids that defuse the stomach acid. The ulcer disease pain poorly correlates with the severity or presence of active ulceration. While some people experience persistent pin even after the complete healing of ulcer by medication, others have no pain at all. The disease often comes and go naturally and unexpectedly without letting the person know that it is present unless a serious issue occurs like perforation or bleeding. It is to be noted that poor appetite, nausea and vomiting are uncommon symptoms of peptic ulcers, and burping and bloating are not peptic ulcer symptoms.

Causes of Peptic Ulcer: 
Earlier it was believed that excess of acid is the main cause of ulcer disease. According to that, the treatment was emphasized on neutralizing and inhibiting the stomach acid secretion. While acid is still considered important for the ulcer formation and its primary treatment is still suppression, the two most crucial initiating causes of the disease are the chronic use of nonsteroidal anti-inflammatory medications (NSAIDs) that includes aspirin, and infection in the stomach due to a bacterium called Helicobacter pylori (H. pylori). Smoking cigarette is also the main reason for the cause of ulcers as well as failure in the healing of the disease. A very common infection is H. pylori which have affected more than a billion people worldwide.

Usually, the infection persists for many years, resulting in ulcer disease in 10 per cent to 15 per cent of those infected. More than 80 per cent of patients with duodenal and gastric ulcers have been found with H. pylori in the past. As the appreciation, diagnosis and treatment of this infection are increasing, the occurrence of infection with H. pylori and the proportion of ulcers caused due to bacterium has decreased. According to an estimation presently only 20 per cent of ulcers are accompanying the bacterium. The mechanism which helps H. pylori to cause ulcers is complex. But the bacterium can be eliminated by antibiotics which have clearly shown healing of the disease and prevention from recurrence.

Medications like NSAIDs cause ulcers by meddling with the production of stomach prostaglandins. These medications are used for treating painful inflammatory conditions, such as arthritis, in the body. Some examples of this category of medications are aspirin, naproxen, etodolac and ibuprofen. The linings of the stomach, duodenum and oesophagus are resisted from damage by the acidic digestive juices of the stomach with the help of prostaglandins, a substance produced by the body.

When a person smokes cigarette it not only causes the disease but also increases the risk of complications from it, such as obstruction, perforation and bleeding. It is also a leading cause of failure of the treatment for ulcers.

How is it diagnosed? 
If the doctor suspects that you might have a peptic ulcer then he will initiate your diagnosis with a physical examination and some tests to know the causes of peptic ulcer.

-  He will check your belly and ask if you have had feelings of bloating, pain or tenderness. With the help of his stethoscope, he will listen to any sounds that your stomach might be making.

-  You will be then asked to get some tests done to look for the symptoms of H. pylori bacteria. The doctor will take samples of your blood, stool, or breath for these.

-  In cases of old age and symptoms that include loss of appetite or weight loss, your doctor may use a long, flexible tube to look down your throat and into your stomach for symptoms of an ulcer. This device is called an endoscope, which can also collect a small sample of tissue from an ulcer for testing in a laboratory.

-  Before the X-ray of your stomach, your doctor may ask you to drink a milky liquid known as barium. This drink helps in showing up of problems like ulcers clearly by coating your digestive system.

Prevention from Peptic Ulcer: 
If you are worried about acquiring the disease then you must know what is the preventive measure for peptic ulcers. You need to be careful while taking painkillers. People, who are suffering from arthritis or other conditions that cause chronic pain, take NSAIDs for weeks or even months to ease their swelling and pain. Medications like these have the probability to affect the mucus which protects your stomach against acid. It makes you more likely to acquire peptic ulcers. your chances of having the disease increases if you are above 65 years of age, take more than one NSAID, infected with H. pylori bacteria, take selective serotonin reuptake inhibitor (SSRI) and have had the disease in the past. To lower the chances while taking NSAIDs you need to:

-  Lower the dose in order to control your symptoms

-  Stop its consumption as soon as it is no longer needed

-  It is recommended to take the medicine with food

-  Do not have alcohol while taking these medicines

You can take medicine while you are on NSAIDs to reduce the amount of acid that your stomach produces. Such types of drugs include proton pump inhibitors (PPIs) such as pantoprazole (Protonix), esomeprazole (Nexium) and omeprazole (Prilosec OTC), and H2 blockers like ranitidine (Zantac) and famotidine (Pepcid). Drugs like misoprostol (Cytotec) can also be taken so as to boost the protective mucus amount that your stomach produces.

Treatment of Peptic Ulcer: 
The treatment depends on the signs of a peptic ulcer and its causes. Your doctor will prescribe medications if the tests show that you have H. pylori infection. The medications are required to be taken for up to two weeks. These include PPIs that help to reduce acid in stomach and antibiotics that will assist in killing infections. There is the probability of experiencing minor side effects from antibiotic regimens such as diarrhoea or a stomach disorder. You need to talk to your doctor if these side effects do not get better over time or cause significant discomfort. In the case of H. pylori infection, your doctor may suggest PPI, like Prevacid or Prilosec, for eight weeks so as to lower the stomach acid and help to heal your disease. The stomach acid and ulcer pain can also be reduced with acid blockers like famotidine (Pepcid) and ranitidine (Zantac). To coat your stomach in order to reduce the signs of peptic ulcers your doctor may also prescribe sucralfate (Carafate).

Complications: 
Patients suffering from peptic ulcers usually function quite comfortably. Though it recurs, if taken prevention from beforehand the ulcers probably heal completely even without medications. This is why ulcer complications are related to major problems resulting from the disease. Patients complaining about bleeding ulcers may experience weakness, melena (passage of black tarry stools), vomiting blood (hematemesis) and a sense of light-headedness. The disease, if left untreated can worsen over time. It can lead to various health complications, such as:

-  Internal bleeding: Patients with bleeding ulcers can lead to significant loss of blood and will require an immediate blood transfusion. The site of bleeding is established by performing endoscopy so that active ulcer bleeding can be stopped with the help of specialized endoscopic instruments. The symptoms of a bleeding ulcer consist of dizziness, black stool and light-headedness.

-  Perforation: The lining of the small intestine or stomach acquires a hole that causes an infection. A sign of a perforated ulcer can be understood when you experience sudden and severe abdominal pain.

-  Scar tissue: After an injury, a thick tissue develops known as scar tissue. It makes the passage of food difficult through your digestive tract. Some common signs of scar tissue are vomiting and loss of weight. When such complications occur it requires surgery for the treatment.

Myths: 
With so many myths surrounding the peptic ulcer, it is important for you to know about the nature of the disease so that you receive proper treatment instead of believing various theories that don’t even have any scientific backing. Below given are some of the common facts related to the myths of peptic ulcers that will help to take the right decisions regarding your health.

-  Spicy food is the main reason for causing ulcers. The fact is it has not yet been proved that spicy foods could lead to peptic ulcers. But consuming an extremely spicy diet on having ulcers in your stomach can lead to aggravation of the existing condition.

-  Peptic ulcers cannot be treated. This is not true. When the disease is diagnosed at an early stage it can be treated and completely healed. Depending on the causes the doctor performs the treatment. It is important to continue with the course of medication till its completion even if you feel better. Having a balanced diet that has a lower amount of spice helps to prevent the pain related to an ulcer. Avoiding alcohol, positive change in lifestyle with proper medications are enough to avert recurrence of ulcers.

-  A peptic ulcer is triggered by stress. The fact is, stress is not responsible for causing the formation of an ulcer. In most of the cases, the disease is caused due to a bacterium called H. pylori. If a patient is diagnosed with no presence of bacterial infection then the cause for the disease could be regular and excessive consumption of non-steroidal anti-inflammatory drugs, such as aspirin, ibuprofen, etc. The ulcer can only be aggravated by stress by stimulating stress hormones but does not cause the formation of ulcers.

Conclusion: 
Although peptic ulcers can be healed completely, it can recur if no changes are brought into a lifestyle. Some patients get relief from gastric obstruction when the contents of the stomach are suck out with a tube for 72 hours. But patients with persistent obstruction will need surgery. You must maintain a healthy lifestyle by quitting to smoke cigarettes and use of other tobacco products. Avoid drinking alcohol and start eating a balanced diet like fruits, vegetables and whole grains as these will prevent you from developing a pelvic ulcer. Don’t ignore the situations like a pain in the upper abdomen and heartburn, and seek a doctor’s advice for proper treatment.