FARMAKOLOGI PENYAKIT-PENYAKIT DEGENERASI TULANG DAN SENDI

Prof Dr dr Jazanul Anwar SpFK

Degenerative Bone Disease

Degenerative joint disease is a progressive disorder of the bone joints. Degenerative bone disease is commonly known as degenerative osteoarthritis.

What is Degenerative Disease? Degenerative bone disease or degenerative arthritis is caused by inflammation, breakdown and loss of the cartilage of the joints. It affects the hands, feet, spine, hips and knees.

A degeneration or wear and tear of articular (joint surface) cartilage usually accompanied by an overgrowth of bone (osteophytes), narrowing of the joint space, sclerosis or hardening of bone at the joint surface, and deformity in joints. OA is not usually associated with inflammation, although swelling of the joint does frequently occur in OA.
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Age - affects people over the age of 45 years. There are exceptions where younger people or even children are affected by this disease. Sex - seen more commonly in women than men Hereditary Factors Fractures - Accidental the joints may weaken the bones and lead to degenerative bone disorders.

Other Diseases - Rheumatoid arthritis, hemochromatosis, Paget's disease and gout may affect the structure and functioning of the cartilage leading to degenerative arthritis.
Vitamin D deficiency, parathyroid disease, chronic kidney disease and senile osteoporosis may also cause degenerative bone disease. 4

Commonly Occurring Degenerative Joint Disease Degenerative disorder may affect any joint in the body. The most commonly occurring degenerative arthritis are

Spine Neck: Hands and Feet: Hip Knees

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Medication for Degenerative Joint Disease:

Corticosteroids, non-steroids and antiinflammatory drugs (NSAIDs) are prescribed to bring some relief to the pain in the joints. Glucocorticoids is an injection that may be recommended for inflamed joints. Acetaminophen and aspirin are prescribed for mild pain without inflammation.

Pathogenesis of osteoarthritis
Osteoarthritis results from articular cartilage failure induced by a complex interplay of genetic, metabolic, biochemical, and biomechanical factors with secondary components of inflammation. The process involves interactive degradation and repair processes of cartilage, bone, and synovium. According to the National Institutes of Health (NIH), degenerative bone diseases refer to multiple diseases of the bone; two of the most common degenerative bone diseases are osteoporosis and osteoarthritis.

Osteoarthritis cannot be cured, but it can be treated. Beginning treatment as early as possible can help reduce long-term damage to your joints and bones. The goal of every treatment for arthritis is to reduce pain and stiffness, allow for greater movement, and slow the progression of the disease.

Treatment options focus on treating both the bone and nearby joints. According to NIH, the goals of degenerative bone disease treatment are: increase strength, improve movement, relieve pain and reducing debilitating affects.
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Treatment
Weight Loss

Exercise Medication

Medication:
Topical pain relievers Analgesics Nonsteroidal anti-inflammatory drugs (NSAIDs) Corticosteroids

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Topical pain relievers

Some contain combinations of salicylates (the painrelieving substances in aspirin), skin irritants (which cause feelings of cold, warmth, or itching to take your attention away from the pain), or a (a substance that blocks pain messages to the brain).a

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Analgesics
acetaminophe

salicylate

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A first line of simple treatment - acetaminophen (Tylenol) is as effective and has less side effects than other non-steroidal antiinflammatory drugs (NSAIDS) such as ibuprofen, naproxen, or aspirin. Glucosamine-chondroitin sulfate may be prescribed by your doctor. This medication, when taken over a period of months, may reduce pain and symptoms by restoring or replenishing nutrition to diseased cartilage cells. It tends to be more effective in earlier stages of OA. Patients who fail to improve on acetaminophen or glucosamine may be treated with salicylates and other oral anti-inflammatories ( NSAIDs). Previously, medications such as Vioxx, Celebrex, and Bextra (Cox-2 NSAIDS) were preferred due to less gastrointestinal side effects (ulcers) and improved pain relief for arthritis. H
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OSTEOPOROSIS
Diagnosis

What Is Bone Mineral Density? Almost 80% of bone density is determined by heredity, and 20% by lifestyle. Bone mineral density tests (BMD) shows how dense bones are and whether you have osteoporosis. This information helps determine which prevention or treatment steps are needed. Learn more.

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Antiresorptive Medications
Bisphosphonates, calcitonin, denosumab, estrogen and estrogen agonists/antagonists are antiresorptive medicines. They slow the bone loss that occurs in the breakdown part of the remodeling cycle. When people first start taking these medicines, they stop losing bone as quickly as before, but still make new bone at the same pace. Therefore, bone density may increase. The goal of treatment with antiresorptive medicines is to prevent bone loss and lower the risk of breaking bones.
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Anabolic Drugs
Teriparatide, a form of parathyroid hormone, increases the rate of bone formation and is in a distinct category of osteoporosis medicines called anabolic drugs. This is currently the only osteoporosis medicine approved by the FDA that rebuilds bone. The goal of treatment with teriparatide is to build bone and lower the risk of breaking bones. Special Note

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When you are young, new bone replaces old bone quickly. This makes your bones solid and strong. As you get older, your body loses bone tissue faster than it can be replaced. This makes your bones less solid and weaker. Most people's bones get weaker as they get older. Whether or not a person has osteopenia or osteoporosis depends on how much of their bone density is lost. In osteoporosis, the bone mineral density (BMD) is reduced, The underlying mechanism in all cases of osteoporosis is an imbalance between bone resorption and bone formation.

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Medications
Most bisphosphonates are effective in preventing fractures of the vertebrae, nonvertebral bones and hips[63] when taken for three to four years.[64] They have not been compared directly to each other, though, so it is not known if one is better than the others.[63] Fracture risk reduction is between 25 and 70% depending on the bone involved.[6

These drugs effectively preserve or maintain bone density during menopause

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Osteoporosis Medications
Alendronate Sodium or Alendronate Sodium plus Vitamin D3 Ibandronate Sodium Risedronate Sodium or Risedronate Sodium with Calcium Carbonate Zoledronic Acid

Side Effects of Bisphosphonates

(Alendronate, Ibandronate, Risedronate and Zoledronic Acid)
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