Sunday, 24 November 2013

Polymalagia Arthritis - The Signs and Symptoms

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).
Types of Musculo-Skeletal disorders in elder(2)
1. Osteoarthritis
2. Gout
3. Rheumatoid Arthritis
4. Polymalagia Arthritis
5. Cervical myleopathy and spinal canal stenosis
6. Osteoporosis
7. Low back pain
8. Fibromyalgia
IV. Polymalagia Arthritis
Polymalagia Arthritis is defined as a condition a common inflammatory rheumatic disease which cause pain, stiffness and tenderness in large muscles, including muscles shoulders and pelvic girdleas a result of the presence of a synovitis in proximal joints and periarticular structures, causing musculoskeletal symptoms in PMR.
A. Signs and Symptoms
1. In the study in Assessment and management of polymyalgia rheumatica in older adults, Dr. Kennedy-Malone LM, and Dr. Enevold GL. at the University of North Carolina School of Nursing in Greensbor, showed that Polymyalgia rheumatica (PMR) is a periarticular rheumatic condition characterized by pain and stiffness, primarily in the neck, shoulders, hips, and pelvic girdle. Temporal arteritis (TA) or giant cell arteritis, the most common primary vasculitis in older adults, is found in approximately 10% to 30% of people who have PMR. Left untreated, TA can result in sudden, irreversible blindness. Geriatric nurses need to familiarize themselves with these disorders to accurately assess and manage people with them(3).
2. Other symptoms include
a. Fever and lumbar pain
There is a report of a71-year-old man consulted our Department of Orthopedics for fever and lumbar pain, which initially developed in early September 2000. Administration of NSAIDs resulted in the disappearance of lumbar pain. However, fever persisted. Administration of NSAIDs resulted in the disappearance of lumbar pain. However, fever persisted. The C-reactive protein (CRP) level was persistently high. Therefore, on October 5, 2000, the patient was referred to our department. At the outpatient clinic, a detailed examination was performed. However, the etiology could not be determined. Repeated administration of NSAIDs resulted in pyretolysis, and the dose of NSAIDs was decreased from January 31, 2001. Severe fever appeared again, and inflammatory reaction also exacerbated. On March 11, 2001, muscular pain involving the bilateral shoulders and forearms suddenly developed. For diagnostic treatment, administration of prednisolone (PSL) at 10 mg/day was started. Muscular pain rapidly disappeared(4).
b. In the study of Polymyalgia rheumatica(PMR), Dr. Kwiatkowska B,and Dr. Filipowicz-Sosnowska A. at the  Eleonora Reicher Rheumatology Institute, Warszawa, Poland indicated that PMR is a rheumatic disease which mainly affects the elderly, and is seldom diagnosed in patients <50 years of age. The prevalence of polymyalgia rheumatica is approximately 16.8 to 53.7 per 100,000 of the population >50 years of age. Patients may present with spiking fever, malaise, fatigue, weight loss and other features suggesting inflammation, which in each case requires differential diagnosis from malignancies(5). Others indicated that Polymyalgia rheumatica is a common disease affecting the elderly population. Symptoms and signs are often nonspecific, including pain and stiffness in the proximal muscles, anorexia, fatigue, depression, weight loss, fever and temporal headaches(6).
c. Etc.

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