Health news blog

Every knee patient should have an X ray, a photographic image of inside the body. X rays are important for several reasons. First, they help to rule out other conditions such as tumors or fractures. In fact, there are several reported cases of people being treated for knee problems who in reality had tumors that went undiagnosed because they had never been X rayed. Second, because X rays provide a good view of large bones, they are excellent for diagnosing alignment problems and detailing later stages of arthritis. If the joint spaces are abnormally small, that is, if the bones are too close together, it’s a good indication that the articular cartilage is worn away and the patient is arthritic.In order for an X ray to be useful, however, it must be taken correctly, and that’s easier said than done. Many of the X rays I see are incomplete, especially those that are taken in an emergency room. Very often, they show only one or at most two views of the knee, and that simply does not offer enough information to make an intelligent diagnosis. A good set of knee X rays should include several views of the knee in various positions, extended and flexed, from the front, side, and back. In addition, in the case of an older person who might be arthritic, the X ray should be taken standing up. If the patient is sitting or lying down, the joint spaces could look normal, and only when the person is standing will the joint spaces narrow.If you are getting an X ray and the technician only takes one or two views, I think it’s a sign that something is not being done correctly. In many cases—especially if the X ray is being done in a hectic emergency room—the technician may be cutting corners or he simply may not know the right way to X ray a knee. Don’t be afraid to speak up. Ask to see an orthopedist, or at the very least say, “If you’re concerned enough to order an X ray of my knee, I want it read by a radiologist or an orthopedist.” In reality, the orthopedist is quite often more informed than a radiologist who does not have a primary interest in orthopedic radiology.X rays are good for looking at bones, but they are unable to provide a good view of soft tissue, such as ligaments and muscles. If your doctor feels that your problem is not bone related and she is unable to diagnose it with a thorough physical examination, she may order additional tests.In a bone scan, a radioactive material is injected into the bloodstream and the patient is placed on a board in a scanner—a long narrow tube—and must lie still for about 30 minutes as the scanner “picks up” the radioactive material at the appropriate sites. Some of the newer scanning machines are open and slowly move over the patient. As the radioactive material travels through the blood, the physician can scan the phases of the blood flow. From this test, the physician can see how the blood pools in any particular area as contrasted to normal values. Changes in the normal values may be indicative of infection, avascular necrosis, or some bone tumors.*14\185\2*

A longer-term study compared the effects of glucosamine and the anti-inflammatory drug ibuprofen and found that they were equally effective. This double-blind comparison trial (meaning that it compared two treatments) involved 40 participants with osteoarthritis of the knee who attended a Portuguese clinic. Over an 8-week period, 20 patients received 1,500 mg (500 mg 3 times a day) of glucosamine, while the other 20 received 1,200 mg of ibuprofen.
During the first 2 weeks of the study, ibuprofen appeared to be providing more pain relief than glucosamine. However, while the amount of relief gained from ibuprofen remained the same after that time, those in the glucosamine group continued to report gradual improvement throughout the study. It turned out to be a “tortoise and hare” situation – slow and steady won the race. By the end of the 8 weeks, the patients taking glucosamine felt significantly better than the group taking ibuprofen.
Unfortunately, the dose of ibuprofen used in this study (1,200 mg) was half what is usually prescribed for the treatment of osteoarthritis. This means that the comparison wasn’t really fair. Does glucosamine work as well as a full dose of ibuprofen? We don’t really know.
This same study design was used again in the early 1990s in a study with 200 participants, and more recently with a group of 178 individuals. Again, the comparison dose of ibuprofen was on the low side, and these studies lasted only 4 weeks. Similar results have been seen in other, smaller studies.
One study did use full doses of an anti-inflammatory drug, and a stronger NSAID at that: piroxicam (Feldene). Results suggest that glucosamine can match the full benefits of appropriate drug treatment for osteoarthritis.
This study compared 1,500 mg of glucosamine to 20 mg of piroxicam per day. There were two other groups in the study as well: one that received placebo and another that received both piroxicam and glucosamine. A total of 329 participants were enrolled, a sizable number that increases the study’s validity. Another point in this study’s favor was that the treatment lasted for 90 days.
Questionnaires given to the participants allowed the researchers to assign numeric scores representing their levels of pain and freedom of joint movement. At the end of 90 days, the participants completed the same questionnaires, and these were compared with the first set.
The results showed that glucosamine alone was at least as effective as piroxicam. Combining glucosamine and piroxicam didn’t seem to add any extra benefit over using each treatment alone.
Again the glucosamine group had about the same number of reported side effects as the placebo group. This study had one more interesting feature. All treatment was stopped after 90 days, but patients were followed for an additional 60 days. Among patients given piroxicam, pain rapidly returned. However, the relief from glucosamine persisted. This seems to indicate that glucosamine is somehow doing more than just reducing symptoms of the disease.
All together, this was a very impressive study. It does have some problems, however. It has never been published at full length in a peer-reviewed scientific journal. The most complete description was only one page long, and it was given at a conference rather than published in a scientific journal. Brief descriptions have been published in journals, but they disagree about some details!
Furthermore, numerous participants appear to have dropped out of the study before the end, somewhat decreasing the validity of the conclusions. These drawbacks are unfortunate, because this appears to be an impressive study with impressive results.
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Glucosamine is a molecule used by your body to make connective tissues. Because of its chemical structure, it can’t exist by itself but must be bound to another substance. For this reason, when you find glucosamine in stores, it is usually as glucosamine sulfate. Sometimes you may also see glucosamine hydrochloride or acetylglucosamine. The sulfate form was the first to be commercially available in Europe and has been studied most extensively.
Glucosamine is one of the primary building blocks of the substances that make up both cartilage and synovial fluid, which lubricates the joints. Even though glucosamine is primarily produced in the body, a small amount may be supplied by the diet as well.
When you swallow a capsule containing glucosamine, approximately 90% is absorbed into your body. Some of it then enters the joints, where it is incorporated into joint tissues. Your body uses glucosamine to make long-chain chemicals, called glycosaminoglycans (GAGs). These GAGs are then bound to protein cores to form proteoglycans. The end result resembles a pipe cleaner (on a microscopic scale) – the “wire” is made of the protein core, and the GAGs stick out all around. These molecules act like sponges to hold water, which makes up most of the weight of the cartilage, along with dissolved minerals and vitamins. The water acts like a shock absorber, helping connective tissue withstand forces that squeeze or stretch it.
It appears that taking supplemental glucosamine improves the health and quantity of these important parts of your joints, reducing pain and increasing mobility.
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