Musculoskeletal disorders (MSDs) is medical
condition mostly caused by work related occupations and working
environment, affecting patients’ muscles, joints, tendons, ligaments and
nerves and developing over time. A community sample of 73 females and
32 males aged 85 and over underwent a standardised examination at home. Musculoskeletal pain was reported by 57% of those interviewed. A major restriction of joint movement range was frequent in the shoulder but uncommon in other joints. A shoulder disorder was found in 27% of subjects, rheumatoid arthritis in 1% and osteoarthritis (OA) of the hand, hip, and knee in five, seven, and 18% of subjects, respectively. Disability was frequent: a walking distance of
< 500 m was found in 60% and ADL dependency in 40% of the group.
Factors related to one or both of these disability measures included
female gender, hip and knee OA, impaired vision, cognitive impairment and neurological disease(1).
III. Rheumatoid Arthritis
Rheumatoid Arthritis is defined a chronic disorder as a result of
inflammation, affecting mostly the flexible (synovial) joints and
tissues and organs in the body. The disease affects more women than in
men and generally occurs after the ages of 40 and diminishes the quality
of life of many elders.
A. Signs and Symptoms
1. The feet
In the study to investigate the rheumatoid arthritis (RA) patients with
foot complaints to address the associations between clinical signs and
symptoms, radiographic changes, and function in connection with disease
duration, showed that pain and swelling of the ankle were correlated weakly but statistically significantly with limitation and disability (0.273 to 0.293) as measured on the 5-Foot Function Index (FFI). The clinical signs of the forefoot
joints did not influence any of the functional outcome measures.
Radiographic scores for both forefeet (SvdH) and hindfeet (Larsen) were
correlated with the total Health Assessment Questionnaire Disability
Index (HAQ DI) and the 5-FFI limitation subscale. Pain and disease duration, more than radiographic damage, influence the total HAQ DI significantly. With the progression of time, structural damage and function of the rheumatic foot worsen in RA patients. Pain and swelling of the ankle contribute more to disability than radiographic damage of the foot and ankle(2).
2. The Joints
In patients with rheumatoid arthritis, pain and range of movements of joints have the greatest impact on individual subdimensions of the HAQ. Extent of radiographic damage in peripheral joints and the number of swollen and tender joints are of lesser importance for function(3).
3. The Muscle strength
Dr. Häkkinen A and the research team at Jyväskylä Central Hospital, in
the assessment to study the extent to which muscle strength and
performance, pain, and disease activity are associated with the total
Health Assessment Questionnaire (HAQ) disability index and its
subdimensions in male and female patients with rheumatoid arthritis,
indicated that women reported greater disability than men both in the
total HAQ and in the majority of its eight subdimensions. In addition to
disease activity and pain, muscle strength has a major impact on
disability especially in female rheumatoid patients(4).
4. Rheumatoid nodules
Rheumatoid nodules affect the joints of patients with rheumatoid nodules
and are a lesion commonly found under the skin as a result of
microchimerism(5).
5. Conjunctival nodule
Although is rare in patients with rheumatoid arthritis. There is a
49-year-old woman with seropositive rheumatoid arthritis, who was being
treated only with oral steroids and hydroxychloroquine, developed
diffuse anterior scleritis in the right eye. In addition, examination
showed a focal raised yellow/tan conjunctival nodule. The nodule was
within the bulbar conjunctiva with no attachments to the underlying
tissue, which is different from nodular scleritis(6).
6. Morning stiffness
Morning stiffness is a very common symptoms of patients in early
rheumatoid arthritis. Some researchers suggested that the degree of
morning stiffness appears to reflect functional disability and pain more
than traditional markers of inflammation such as joint counts and ESR
in patients with early RA. Inclusion of morning stiffness as a marker of
inflammatory activity in classification criteria for RA, inclusion
criteria for most clinical trials in RA, and RA remission criteria, may
be open to reassessment(7).
7. Quality of life
7.1. Physical disability
In the study to 1) investigate the degrees of correlations between
different disease activity scores (DASs) and health-related quality of
life (HRQoL), and 2) determine if DASs correlate with either physical or
mental HRQoL, showed that SF-36 total score showed a significant
inverse correlation with the DAS4-ESR, DAS-3 ESR, DAS4-CRP, DAS3-CRP,
DAS4-28 ESR, DAS3-28 ESR, DAS4-28 CRP, and DAS3-28 CRP, with correlation
coefficients of -0.320, -0.314, -0.330, -0.323, -0.327, -0.318, -0.360
and -0.348, respectively (P < 0.01 for all). The correlation
coefficients between different DAS indices and the HRQoL score were not
significantly different. In addition, all DASs showed significant
correlations with physical HRQoL, but not with mental HRQoL(8).
7.2. Concurrent psychiatric disorders
Dr. Mok C, and the scientists at the Tuen Mun Hospital in the study to
investigate the effect of concurrent psychiatric disorders on
health-related quality of life (HRQOL) in patients with rheumatoid
arthritis (RA), indicated that in forty-seven (23.5%) patients diagnosed
with a psychiatric disorder, depressive disorders in 29 patients and anxiety disorders in 26 patients. Patients with either condition had significantly higher fatigue scores (26 ± 8.8 vs. 16 ± 6.9, p < 0.001) and were more likely to be unemployed (p
= 0.02) and dependent on government subsidy for living (p < 0.001)
than those without. The scores of the eight domains and the physical and mental components of the SF-36 were significantly lower in RA patients with psychiatric disorders (p < 0.001 in all). In a linear regression model, the presence of either depressive or anxiety disorders (β = -0.23, p < 0.001), older age (β = -0.16, p = 0.006), self-perceived pain (β = -0.25, p < 0.001) and fatigue (β
= -0.42, p < 0.001) were independently and inversely associated with
the total SF-36 score after adjustment for disease activity and other
sociodemographic variables. Conclusions: Concomitant depressive or
anxiety disorders in RA patients are associated with significantly
poorer HRQOL. Early identification and treatment of psychiatric
disorders in RA patients are warranted(9).
8. Etc.
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Sources
(2) http://www.ncbi.nlm.nih.gov/pubmed/21614474
(3) http://www.ncbi.nlm.nih.gov/pubmed/15130901
(4) http://www.ncbi.nlm.nih.gov/pubmed/15901635
(5) http://www.ncbi.nlm.nih.gov/pubmed/21953057
(6) http://www.ncbi.nlm.nih.gov/pubmed/22271069
(7) http://www.ncbi.nlm.nih.gov/pubmed/15338490
(8) http://www.ncbi.nlm.nih.gov/pubmed/22279457
(9) http://www.ncbi.nlm.nih.gov/pubmed/22657161
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