Kategoriarkiv: Degenerative arthritis



Relative risk of upper gastrointestinal complications among users of acetaminophen and nonsteroidal anti-inflammatory drugs.

Garcia Rodriguez LA, Hernandez-Diaz S. Epidemiology 2001 Sep;12(5):570-6

Nonsteroidal anti-inflammatory drugs (NSAIDs) have been associated with an increase in upper gastrointestinal complications. There is no agreement, however, on whether all conventional NSAIDs have a similar relative risk (RR), and epidemiologic data are limited on acetaminophen. We studied the association between these medications and the risk of upper gastrointestinal bleed/perforation in a population-based cohort of 958,397 persons in the United Kingdom between 1993 and 1998. Our nested case-control analysis included 2,105 cases and 11,500 controls. RR estimates were adjusted for several factors known to be associated with upper gastrointestinal bleed/perforation. Compared with non-users, users of acetaminophen at doses less than 2 gm did not have an increased risk of upper gastrointestinal complications. The adjusted RR for acetaminophen at doses greater than 2 gm was 3.6 [95% confidence interval (95% CI) = 2.6-5.1].
The corresponding RRs for low/medium and high doses of NSAIDs were 2.4 (95% CI = 1.9-3.1) and 4.9 (95% CI = 4.1-5.8). The RR was 3.1 (95% CI = 2.5, 3.8) for short plasma half-life, 4.5 (95% CI = 3.5-5.9) for long half-life, and 5.4 (95% CI = 4.0-7.1) for slow-release formulations of NSAIDs.
After adjusting for daily dose, the differences in RR between individual NSAIDs tended to diminish except for apazone. Users of H2 receptor antagonists, omeprazole, and misoprostol had RRs of 1.4 (95% CI = 1.2-1.8), 0.6 (95% CI = 0.4-0.9), and 0.6 (95% CI = 0.4-1.0), respectively. Among NSAID users, use of nitrates was associated with an RR of 0.6 (95% CI = 0.4-1).



Type: BIG TOE:

Objective: Support, and therefore relieve, the metarsophalangeal joint of the big toe.

Application: A tape “anchor” is applied around the forefoot behind the toe pad (A). 2-3 strips are applied from the anchor on the back of the foot around the big toe, and back to the anchor on the back of the foot (B).

Cartilage damage in the joint



The surfaces of the joints are lined with a cartilage covering of a few millimetre’s thickness which serves to reduce the load or strain on the joint surfaces.

  1. Phalanx media
  2. Tuberositas ossis metatarsalis V
  3. Os cuboideum
  4. Calcaneus
  5. Talus
  6. Os naviculare
  7. Os cuneiforme laterale
  8. Os cuneiforme intermedium
  9. Os cuneiforme mediale
  10. Os metatarsalei
  11. Os sesamoideum
  12. Phalanx proximalis
  13. Phalanx distalis


Cause: Localised cartilage injuries in the joint surfaces can occur after a vigorous twisting of the joint, where the joint surfaces impact on each other and cause cartilage damage. In some cases a piece of cartilage can be shed which can wander in the joint (joint mouse) and become jammed.

Symptoms: Pain in the joint when under load or strain. Occasional inflammation of the synovial membrane which causes concentration of fluid in the joint.

Examination: Normal medical examination is often not sufficient. To make the diagnosis correctly it is therefore necessary to perform an arthroscopic examination or an MR-scan.

Treatment: Treatment comprises relief from the painful activities until the pain is no longer experienced, after which gradual training can be commenced. There is no treatment that can restore the damaged cartilage, which has itself poor restorative ability. Different procedures to enhance the healing can be attempted using arthroscopic examination, however, the results are generally unsatisfactory (article-1) (article-2). Results from experimental cartilage transplants are still not successful enough to warrant introduction as a routine treatment in the near future. Joint mouse which provokes the symptoms must be surgically removed.

Rehabilitation: Rehabilitation is completely dependent upon the type of cartilage damage (size and position in the joint) and treatment (conservative or surgical).
Also read rehabilitation, general.

Complications: Greater cartilage injuries which are positioned on the weight-bearing parts of the joint are some of the most serious sports injuries, and often results in an end to the sporting career.

Special: As there is a risk that the injury can be permanent, all cases should be reported to your insurance company.