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Thursday, 21 January 2016

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

 Misdiagnosis and Delay diagnosis

1. Polyarticular gout
 Polyarticular gout, a inflammatory condition with painful crystals forming in the joints has been found to be misdiagnosed as Rheumatoid Arthritis in elderly of that can constitute to poor treatment as well as failure to recognize underlying renal insufficiency, and increased cardiac risks(75), according to the Albert Einstein College of Medicine.

2. Hypercalcemia and Lytic Bone Lesions Masquerading Inflammatory Arthritis 
According to the Mashhad University of Medical Sciences,  a 50-year-old woman with hypercalcemia, lytic bone lesions and inflammatory arthritis of both hands was misdiagnosed as rheumatoid arthritis due to the presence of perparathyroidism in rheumatologic manifestations(76).

3. Systemic sclerosis
Systemic sclerosis (SSc) is an autoimmune disease of the connective tissue may be misdiagnosed as rheumatoid arthritis. According to the Dr. Horimoto AM and Dr. Costa IP, arthritis, clinically observed, may be a feature often found in patient with Systemic sclerosis, often leading to early misdiagnosis with rheumatoid arthritis (RA)(77).

4. Jaccoud's arthropathy (JA)
Jaccoud's arthropathy (JA), a clinical situation foundt mostly in patient withsystemic lupus erythematosus (SLE) is found to be misdiagnosed as RA, due to swan neck," ulnar deviation and "Z-thumb which overlap with symptoms of patient with RA, according to the joint study lead by the Universidade Federal da Bahia, Salvador(78).

In fact, according to the joint study by the University of Texas Southwestern Medical Center and Victoria Hospital, the misdiagnosis of the atypical Infections versus Inflammatory Conditions of the Hand due to some similarity to inflammatory conditions regarding their clinical and imaging finding is rare but delay diagnosis can increase risk of severe bone and joint destruction, and higher morbidity(79).


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You Can Eliminate Osteoarthritis
By addressing the Underlying Causes through Clinical Trials and Studies

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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)
(75) Misdiagnosis of rheumatoid arthritis in an elderly woman with gout by Sewell KL1, Petrucci R, Keiser HD(PubMed)
(76) Hypercalcemia and Lytic Bone Lesions Masquerading Inflammatory Arthritis Treated as Rheumatoid Arthritis by Salari M1, Aboutorabi RB2, Rezaieyazdi Z1(PubMed)
(77) [Overlap between systemic sclerosis and rheumatoid arthritis: a distinct clinical entity?][Article in Portuguese] by Horimoto AM1, Costa IP2.(PubMed)
(78) Severe Jaccoud's arthropathy in systemic lupus erythematosus by Santiago MB1,2, Galvão V3, Ribeiro DS3, Santos WD3, da Hora PR3, Mota AP3, Pimenta E3, Oliveira I4, Atta AM4, Reis MG5, Reis EA5, Lins C3(PubMed)
(79) Atypical Infections versus Inflammatory Conditions of the Hand: The Role of Imaging in Diagnosis by Soldatos T1, Omar H, Sammer D, Chhabra A.(PubMed)