Questions

1. What does the term “osteoarthritis” mean?

2. What age groups of population are most often affected by osteoarthritis?

3. What is known about pathogenesis of osteoarthritis?

4. What factors are considered as predisposing to osteoarthritis?

5. What joints are more commonly affected in females, and what in males?

6. What joints tend to be affected in athletes and dancers?

7. What is gender factor?

8. Why is obesity an important predisposing factor of osteoarthritis?

9. In whom does the disease appear earlier, in males or females?

10. What tissue is destroyed in osteoarthritis?

11. What is accumulated in the articular cartilage in osteoarthritis? What does it suggest?

12. At what stage is osteoarthritis asymptomatic?

13. What are the first signs and symptoms of osteoarthritis?

14. What signs are characteristic for the advanced stage of osteoarthritis?

15. What joints are most often involved?

16. What are osteophytes? What are the other names for them?

17. What follows bone spur formation?

18. What is an early manifestation of the disease in females? What symptoms may follow this manifestation?

19. What is the character of pain in osteoarthritis? What may accompany the pain?

20. Are the affected joints swollen as a rule?

21. How may osteoarthritis be classified according to the number of joints involved? What type is the commonest?

22. What are conventional ways of examination?

23. What is obviously seen on X-ray film?

24. In what cases is surgery applied?

25. What brings relief in osteoarthritis?

Additional Questions. Something to Think about

1. May the disease be cured?

2. What is another name for the pain-killers?

3. What methods of physiotherapy do you know?

4. Why is aging associated with osteoarthritis?

5. Do you know what condition is called ankylosis?

6. What is the cause of joint crepitation?

7. What is obesity and how does it affect the joints?

8. What branch of medicine deals with skeletal disorders?

9. Why is the treatment of osteoarthritis mostly symptomatic?

10. May osteoarthritis result in invalidity?

Text 5. Muscular Dystrophy

The muscular distrophies constitute a family of genetically determined myopathies. They range in clinical severity from those causing mild motor weakness to those of great severity causing progressive incapacity and early death. The latter condition known as Duchenne’s dystrophy is proved to be the most common and devastating of the skeletal muscle dystrophies.

The Duchenne’s dystrophy is now known to be caused by a mutation of a gene located on the short arm of the X chromosome. Most patients are sons of carrier mothers, but some patients acquire de novo, and rarely females with inactivated X chromosome are affected. The normal gene at this locus synthesizes a protein named “dystrophin” that is present in small quantities in muscle. A mutation of this gene in Duchenne’s dystrophy lowers the level of dystrophin, leading to some perturbation in cell contraction and progressive muscle weakness.

In Duchenne’s dystrophy signs appear in early childhood in the form of difficulty in standing, walking and getting out of chair. The muscle weakness is progressive, most evident in the lower extremities. But sometimes the upper extremities may also be affected. Despite the motor weakness, there is often prominence of the calf muscle due to pseudohypertrophy. Involvement of trunk muscles leads to progressive spinal curvature that sometimes interferes with the respiratory function. In addition, degenerative changes in myocardial cells lead to cardiac failure. Deficiency of dystrophin also affects the membrane of neurons, thus the intellectual impairment is often manifested by these patients.

The diagnosis can be suspected by the distinctive clinical features observed on the physical examination. Biological tests routinely reveal markedly elevated serum of muscle enzymes. The diagnosis can be confirmed by biopsy. Electromyography is also of great help in diagnosing of the disease.

Impairment of motor muscle function results in the fact that by age of 12 years most patients become invalid and are confined to a wheelchair. Death usually occurs by age of 20 years, precipitated most often by pulmonary infections.

Treatment consists in relieving of symptoms: drug therapy, physiotherapy, moderate exercise, pain killers, etc.