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Saturday, 16 January 2016

Most Common Disease of elder: The Clinical trials and Studies of Musculo-Skeletal disorders(MSDs) - Rheumatoid Arthritis: The Signs and Symptoms

Kyle J. Norton (Scholar, Master of Nutrients, All right reserved)
Health article writer and researcher; Over 10.000 articles and research papers have been written and published on line, including world wide health, ezine articles, article base, healthblogs, selfgrowth, best before it's news, the karate GB daily, etc.,.
Named TOP 50 MEDICAL ESSAYS FOR ARTISTS & AUTHORS TO READ by Disilgold.com Named 50 of the best health Tweeters Canada - Huffington Post
Nominated for shorty award over last 4 years
Some articles have been used as references in medical research, such as international journal Pharma and Bio science, ISSN 0975-6299.

Musculoskeletal disorders (MSDs) are 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(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

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 men and generally occurs after the ages of 40, causing diminished quality of life of many elders(1). According to CDC, Musculoskeletal disorders (MSDs)  affects over 52 millions of adults in the US alone, including 294,000 children under age 18 with some form of arthritis or rheumatic conditions(2). Rheumatoid Arthritis can induced bone loss through elevating bone resorption without increasing bone formation(4). A cross-sectional population-based study of 1042 patients with rheumatoid arthritis showed that RA patients had an increased risk of death from various causes(4a).

                            Signs and Symptoms


1. The feet and joints
Patient with rheumatoid arthritis (RA) often associate to valgus deformities of the feet and deformities of gait due to body function in effort to support the collapsing longitudinal arch of the foot(3). According to Dr. Brooks F and Dr. Hariharan K., feet demortities, effecting over 90% of the patient, behind only the hand, leading to painful callosities and dislocation of the metatarsophalangeal joints(5). Because of its severity, regardless to "....pharmacological management of rheumatoid arthritis and its impact upon disease progression, forefoot deformity and pain remain common manifestations requiring reconstruction from orthopadic surgeons" Dr. Amin A. and the reaserch team at the Royal National Orthopaedic Hospital, said(6).
In fact, the prevalence of deformations of hands, feet and gait can be seen among patient with rheumatoid arthritis among aging population may be depending to the severity and time factors which can lead to enormous pain and swelling of the ankle of which correlated weakly but statistically significantly with limitation and disability(7). The Jyväskylä Central Hospital, suggested that radiographic damage of hand and foot joints, and the number of tender and swollen joints are frequent found in patient with Rheumatoid Arthritis(8)(9).

2. The gait
Dr. Weiss RJ. and the research team at the Karolinska Institutet, showed that the kinematic and kinetic gait changes in rheumatoid arthritis (RA) patients are the result of a significant reduction in joint motions, joint moments, such as decreased hip flexion-extension range, hip abduction, knee flexion-extension range,...(9). The valgus deformities of the feet in patient withRA may be the main contribution to deformities of gait, including revealed decreases in velocity, stride length, and single-limb-support time(10). Used as characterise dysfunction of the lower limb and foot in people, gait also expressed its effects mainly in RA's patient with conditions of of a slower walk, longer double support time, and avoidance of extreme positions(11).

3. The hands
The affects of deformation of RA's hands can be described through the defects of bone ankylosis as a result of bone damage of the prolonged onset of the disease(12). These deformities of hand and wrist and small peripheral joints (such as fingers and wrist) due to chronic inflammation can be treated by transelectrical nerve stimulation, the University of Ottawa suggested(14).
According to the joint study lead by the University of Warwick, strengthening and stretching have been found effectively in reduced pain and dysfunction of the hands and/or wrists in RA patient with stable medication for at least 3 months(13)

4. The Muscle strength
The effects of muscle strength in patient with RA may contribute to the prevalence of functional limitations physically of that cdan effects daily living and quality of lifeDr. Häkkinen A and the research team at Jyväskylä Central Hospital, suggested that 2-year program of strength training showed a statistically significant improvement in clinical disease activity parameters, walking speed and physical function(15). Some researchers suggested that muscle strength was found inversely and independently associated with all-cause mortality, including the levels of physical activity or even cardiorespiratory fitness(16).
Dr. Brodin N and Dr. Swärdh said"... short-term land-based aerobic and strengthening exercise on moderate to high intensity results in positive effects on oxygen uptake and muscular strength, but not pain,..." (17).of that may be necessary for patient with RA.

5. Rheumatoid nodules
Rheumatoid nodules, lump on the skin, closed to the joint have been found to affect the joints of patients with rheumatoid nodules(18). Treatment of rheumatoid nodules are necessary in odd cases if the patient are experiencing pain or interference of mechanical function, according to Dr. Tilstra JS and Dr.Lienesch DW.(19). Use of methotrexate (MTX) in patient with RA may accelerate the occurance of nodulosis in the fingers. but nodules will be resolved after methotrexate was discontinued and recurred after methotrexate was reintroduced(20).
5. Conjunctival nodule
Although is rare in patients with rheumatoid arthritis, the appreance of the nodules may exhibit the
severity of the underlying disease, according to the Tehran University of Medical Sciences(21), including Pityriasis Lichenoides et Varioliformis Acuta(22), Epstein-Barr virus(23)

6. Morning stiffness
Morning stiffness, as a marker of inflammatory activity in reflecting functional disability and pain is a very common symptoms of patients in early rheumatoid arthritis(24). Use of glucocorticoid is found effectively in pain relief over 70 percent of patient with RA(25).
According to the Charité University Medicine, in a 12-week, multicentre, randomised, double-blind trial, 288 patients with active rheumatoid arthritis, treatment of modified-release prednisone exhibited a clinically relevant reduction of morningstiffness of the joint in comparison of immediate-release prednisone(26).

7. Quality of life
7.1. Physical disability
Although psychological distress and physical disability have been decreased with the cautious approach with respect to prescribing medication and physical exercise progressed toward RA patient(27), but tools necessary to measure RA disease activity are often incomplete, imprecise, or rely on a combination of physician and patient subjective evaluations(28)
Dr. Motl RW and Dr. McAuley E.said" The rationale and the associated onset of chronic disease conditions that influence function, disability, and quality of life (QOL) is embedded in the "Graying of America""(29), including patient with RA.

7.2. Concurrent psychiatric disorders
Concurrent psychiatric disorders, such as depression or anxiety in patient with Rheumatoid Arthritis is found to associate to poor quality of life, according to  Dr. Mok C, and the scientists at the Tuen
Mun Hospital(30). Patients with RA is found to associate to Neurologic (N) and psychiatric (P) syndromes including depression and anxiety and symptoms of cognitive dysfunction, etc.,....of that induced poorer quality of life, according to the Lby the SF-36 and fatigue by a 10 point Likert scale(32).
Dr. Arnold LM said" Chronic widespread pain is associated with several medical and psychiatric disorders,....,careful and comprehensive differential diagnosis must be performed to ensure a correct diagnosis before an appropriate treatment can be selected"(31).

References
(1) 8 Areas of Age-Related Change(NIH)
(2) Arthritis-Related Statistics(CDC)
(3) Valgus deformities of the feet and characteristics of gait in patients who have rheumatoid arthritis by Keenan MA1, Peabody TD, Gronley JK, Perry J.(PubMed)
(4) Serum Sclerostin Level Among Egyptian Rheumatoid Arthritis Patients: Relation to Disease Activity ,Bone Mineral Density and Radiological Grading by Mehaney DA, Eissa M, Anwar S, El-Din SF(PubMed)
(4a) Death rates and causes of death in patients with rheumatoid arthritis: a population-based study by Sihvonen S1, Korpela M, Laippala P, Mustonen J, Pasternack A(PubMed)
(5) The rheumatoid forefoot by Brooks F1, Hariharan K.(PubMed)
(6) Rheumatoid forefoot reconstruction by Amin A1, Cullen N, Singh D.(PubMed)
(7) We should not forget the foot: relations between signs and symptoms, damage, and function in rheumatoid arthritis by Baan H1, Drossaers-Bakker W, Dubbeldam R, van de Laar M.(PubMed)
(8) Pain and joint mobility explain individual subdimensions of the health assessment questionnaire (HAQ) disability index in patients with rheumatoid arthritis by Häkkinen A1, Kautiainen H, Hannonen P, Ylinen J, Arkela-Kautiainen M, Sokka T.(PubMed)
(9) Gait pattern in rheumatoid arthritis by Weiss RJ1, Wretenberg P, Stark A, Palmblad K, Larsson P, Gröndal L, Broström E.(PubMed)
(10) Valgus deformities of the feet and characteristics of gait in patients who have rheumatoid arthritis by Keenan MA1, Peabody TD, Gronley JK, Perry J.(PubMed)
(11) Gait analysis of the lower limb in patients with rheumatoid arthritis: a systematic review by Baan H1, Dubbeldam R, Nene AV, van de Laar MA.(PubMed)
(12) Ankylosis of the wrist bones in patients with rheumatoid arthritis: a study with extremity-dedicated MRI by Barbieri F1, Zampogna G1, Camellino D1, Paparo F2, Cutolo M1, Garlaschi G3, Cimmino MA4.(PubMed)
(13) Strengthening And stretching for Rheumatoid Arthritis of the Hand (SARAH). A randomised controlled trial and economic evaluation by Williams MA1, Williamson EM1, Heine PJ1, Nichols V1, Glover MJ2, Dritsaki M2, Adams J3, Dosanjh S1, Underwood M1, Rahman A4, McConkey C1, Lord J1,Lamb SE1.(PubMed)
(14) Transcutaneous electrical nerve stimulation (TENS) for the treatment of rheumatoid arthritis in the hand by Brosseau L1, Judd MG, Marchand S, Robinson VA, Tugwell P, Wells G, Yonge K(PubMed)
(15) A randomized two-year study of the effects of dynamic strength training on muscle strength, disease activity, functional capacity, and bone mineral density in early rheumatoid arthritis by Häkkinen A1, Sokka T, Kotaniemi A, Hannonen P.(PubMed)
(16) Muscular strength as a strong predictor of mortality: A narrative review by Volaklis KA1, Halle M2, Meisinger C3.(PubMed)
(17) Personer med reumatoid artrit bör uppmanas till fysisk aktivitet.[Article in Swedish]by Brodin N1, Swärdh E1.(PubMed)
(18) Microchimerism in the rheumatoid nodules of patients with rheumatoid arthritis by Chan WF1, Atkins CJ, Naysmith D, van der Westhuizen N, Woo J, Nelson JL.(PubMed)
(19) Rheumatoid Nodules by Tilstra JS1, Lienesch DW2.(PubMed)
(20)Accelerated cutaneous nodulosis during methotrexate therapy in a patient with rheumatoid arthritis by Williams FM1, Cohen PR, Arnett FC.(PubMed)
(21) Conjunctival nodule in rheumatoid arthritis by Kheirkhah A1, Amoli FA, Azari AA, Molaei S, Roozbahani M.(PubMed)
(22) Conjunctival Inflammatory Nodule in a Patient with Pityriasis Lichenoides et Varioliformis Acuta by Elad Moisseiev* and David Varssano(PMC)
(23) Conjunctival lymphocytic nodule associated with the Epstein-Barr virus by Gardner BP1, Margolis TP, Mondino BJ.(PubMed)
(24) Morning stiffness in patients with early rheumatoid arthritis is associated more strongly with functional disability than with joint swelling and erythrocyte sedimentation rate by Yazici Y1, Pincus T, Kautiainen H, Sokka T.(PubMed)(25) Improvement Thresholds for Morning Stiffness Duration in Patients Receiving Delayed- Versus Immediate-Release Prednisone for Rheumatoid Arthritis by Buttgereit F, Kent JD, Holt RJ, Grahn AY, Rice P, Alten R, Yazici Y.(PubMed)
(26) Efficacy of modified-release versus standard prednisone to reduce duration of morning stiffness of the joints inrheumatoid arthritis (CAPRA-1): a double-blind, randomised controlled trial by Buttgereit F1, Doering G, Schaeffler A, Witte S, Sierakowski S, Gromnica-Ihle E, Jeka S, Krueger K, Szechinski J, Alten R.(PubMed)
(27) Change of psychological distress and physical disability in patients with rheumatoid arthritis over the last two decades by Overman CL1, Jurgens MS, Bossema ER, Jacobs JW, Bijlsma JW, Geenen R.(PubMed)
(28) Optimizing Rheumatoid Arthritis Therapy: Using Objective Measures of Disease Activity to Guide Treatment by Owens GM1(PubMed)
(29) Physical activity, disability, and quality of life in older adults by Motl RW1, McAuley E.(PubMed)
(30) Concurrent psychiatric disorders are associated with significantly poorer quality of life in patients with rheumatoid arthritis by Mok CC1, Lok EY, Cheung EF(PubMed)
(31) Pain and the brain: chronic widespread pain by Arnold LM1(PubMed)