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Wednesday, 20 January 2016

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

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).

 The Diagnosis


If you are experience certain subtle symptoms, such as achy joints or a morning stiffness, etc,....you may be at the early stage onset of rheumatoid arthritis. If your doctor suspect that have develop RA because of some RA symptoms such as such as warmth, swelling and pain in the joints, after physical exam, certain blood tests may be necessary, including
1. Erythrocyte sedimentation rate
ESR is a a common hematology test to calculate the rate of red blood cells sediment in a period of one hour. According to Dr. Wolfe F said " ESR is sensitive to immunoglobulins and rheumatoid factor (RF),... but a a poorer measure of inflammation"(64a) and may be effected by other factors. Other clinical findings, the individual's health history, and results from laboratory tests are necessary, such as C-reactive protein(64a) to rule out a suspected diagnosis for the confirmation of the result. Dr Sokka T and Dr. Pincus T. normal ESR and CRPC-reactive protein, are seen in a substantial proportion of patients with RA.(65a)


2.  C-reactive protein
A group of "acute phase reactants" protein produced by liver and found in patient with rheumatoid arthritis.,tends to elevate in case of inflammation. According to the Copenhagen University Hospital, oral nonsteroidal antiinflammatory drugs (NSAIDs) does not effects the levels of protein but may be constituted to the influence of NSAIDs on cardiovascular complications in patient with RA(66).


3. Test for Anemia
According to statistic, the prevalence of mild anemia characterized by low serum iron concentration ranged between 33% and 60% are found in patient with rheumatoid arthritis(67), such as aplastic anemia and iron deficiency anemia. In fact, patient with combination of RA and amenia are mostly experience severe forms of joint disease and improvement of anemia is found to contribute to over all quality of life (QOL) and response to RA therapy(67).

4. Anti-cyclic citrullinate d peptide (anti-CCP antibodies)
Cyclic citrullinated peptides (CCP) in most cases is ordered in conjunction with the test of rheumatoid factor in patient with RA. The positive find of anti-citrullinated peptide/protein antibodies may contribute to the presence of the early event in the disease(68). Dr van Venrooij WJ and the research team at the Radboud University said"...., the presence of these antibodies was highly predictive of and specific for RA, and illustrating the importance of ACPA"(69).

5. Rheumatoid factor
Rheumatoid factor test is a blood test to measure the antibody in patient with rheumatoid arthritis.
The study of 71 patients with rheumatoid arthritis and 25 control subjects. AIF-1 is found to associated with the pathogenesis of RA involved in the immunological process underlying RA(70).
Others such as elevation of interleukin-7 receptor (IL-7Ralpha)(71), interleukin-18(72),.... also involve in the presence of RA.
6. X ray
X ray may be important to determine the changes of bone mineral density. Patient with RA are found to have an lower BMD of that can lead to increased risk of major fracture and hip fracture(73). The family notebook suggested the relative change of  Rheumatoid Arthritis found in X ray according to Dr. Kirwan J and Dr. Byron M, Watt I. include soft tissue swelling, joint space narrowing and erosive damage(74).

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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)
(64) Risk of rheumatoid arthritis following vaccination with tetanus, influenza and hepatitis B vaccines among persons 15-59 years of age by Ray P1, Black S, Shinefield H, Dillon A, Carpenter D, Lewis E, Ross P, Chen RT, Klein NP, Baxter R; Vaccine Safety Datalink Team.(PubMed)
(65) Can immunisation trigger rheumatoid arthritis? by D P Symmons and K Chakravarty(PubMed)
(64a) Comparative usefulness of C-reactive protein and erythrocyte sedimentation rate in patients with rheumatoid arthritis by Wolfe F1.(PubMed)
(65a) Erythrocyte sedimentation rate, C-reactive protein, or rheumatoid factor are normal at presentation in 35%-45% of patients with rheumatoid arthritis seen between 1980 and 2004: analyses from Finland and the United States by Sokka T1, Pincus T.(PubMed)
(66) Effect of nonsteroidal antiinflammatory drugs on the C-reactive protein level in rheumatoid arthritis: a meta-analysis of randomized controlled trials by Tarp S1, Bartels EM, Bliddal H, Furst DE, Boers M, Danneskiold-Sams√łe B, Rasmussen M, Christensen R.(PubMed)
(67) Prevalence and outcomes of anemia in rheumatoid arthritis: a systematic review of the literature by Wilson A1, Yu HT, Goodnough LT, Nissenson AR.(PubMed)
(68) Anti-CCP antibodies: the past, the present and the future by van Venrooij WJ1, van Beers JJ, Pruijn GJ.(PubMed)
(69) Anti-citrullinated protein antibodies (ACPA) in early rheumatoid arthritis by Suwannalai P1, Trouw LA, Toes RE, Huizinga TW(PubMed)
(70) Expression of allograft inflammatory factor-1 in peripheral blood monocytes and synovial membranes in patients with rheumatoid arthritis by Pawlik A1, Kotrych D2, Paczkowska E3, Roginska D3, Dziedziejko V4, Safranow K4, Machalinski B5.(PubMed)
(71) Elevated expression of interleukin-7 receptor in inflamed joints mediates interleukin-7-induced immune activation in rheumatoid arthritis by Hartgring SA1, van Roon JA, Wenting-van Wijk M, Jacobs KM, Jahangier ZN, Willis CR, Bijlsma JW, Lafeber FP.(PubMed)
(72) Interferon-gamma-inducing activity of interleukin-18 in the joint with rheumatoid arthritis by Yamamura M1, Kawashima M, Taniai M, Yamauchi H, Tanimoto T, Kurimoto M, Morita Y, Ohmoto Y, Makino H.(PubMed)
(73) [Risk factors for bone mineral density changes in patients with rheumatoid arthritis and fracture risk assessment].[Article in Chinese] by Wang Y1, Hao YJ1, Deng XR1, Li GT1, Geng Y1, Zhao J1, Zhou W1, Zhang ZL1.(PubMed)
(74) The relationship between soft tissue swelling, joint space narrowing and erosive damage in hand X-rays of patients with rheumatoid arthritis by Kirwan J1, Byron M, Watt I.(PubMed)