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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)
3. Rheumatoid Arthritis
4. Polymalagia Arthritis
5. Cervical myleopathy and spinal canal stenosis
7. Low back pain
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 condition of gradually loss of bone mineral density due to aging has found to be associate to the complication of rheumatoid arthritis. It mat be result of bone weakening induced by the progression of the disease.
Dr Lee SG, and the research team at the Pusan National University School of Medicine, suggest, the prevalence of osteoporosis in the RA patients was 1.9 times higher than in healthy subjects. Glucocorticoid use for treatment of osteoporosis was a risk factor for generalized bone loss in female RA patients(80). In the study of Italian Study Group on Bone Mass in patient with Rheumatoid Arthritis, Dr. Insignia L and his team concluded "... osteoporosis and its dramatic complications in RA the therapeutic challenge is to preserve functional capacity using the lowest possible dosage of corticosteroids"(81).
2. Lymphoproliferative diseases
The use of Methotrexate (MTX) as a first choice of medicine for treatment of RA has been found to induced complication of MTX-related lymphoproliferative diseases (MTX-LPDs). The joint study by the Niigata Rheumatic Center suggests the cytological examinations of the synovial fluid followed by knee operation are important and effective for early diagnosis of MTX-LPD(82). The study 589 RA outpatients examined at the National Center for Global Health and Medicine in the period from January 1990 to October 2010 conducted by the Osaka University Graduate School of Medicine also supported of the above claim and expressed the concern of the therapeutic challenge is to preserve functional capacity using the lowest possible dosage of corticosteroids.(83).
The Ipswich Hospital NHS Trust, of which insisted that Late-onset neutropenia (LON) occurs infrequently after treatment with RTX, but can present with infection(86).
4. Carpal tunnel syndrome
Carpal tunnel syndrome is defined as a condition of pressure on the nerve in the wrist that supplies Carpal tunnel syndrome caused by volar dislocation of the lunate, associated with median nerve neuropathy has found in a patient with rheumatoid arthritis(87).
Scabies is highly contagious skin disease caused by an infestation by the itch mite Sarcoptes is found to be another complication of medication use cause of disease(89).
6. Dry eye syndrome and Sjogren’s syndrome
According to 61 patients with rheumatoid arthritis recruited at Siriraj Hospital during March 2009-September 2010. the prevalence of secondary Sjogren's syndrome and dry eye were found with astonished rate of 28%(90). The awareness and detection of dry eye syndrome and secondary Sjogren’s syndrome in rheumatoid arthritis may has constituted the importantevaluation of their severity and proper management(91), the Mahidol University suggested.
7. Cerebral vasculitis
Cerebral vasculitis is a condition of inflammation of blood vessel wall involving the nervous system.
The diseases also share some characteristics with RA such as elevated levels of white blood cells, erythrocyte sedimentation rate, C-reactive protein, IgG-rheumatoid factor and immune complex(92). Dr. Ohno T and the reaserch team at the Ohtsu Red Cross Hospital reported that methotrexate is found effectively in treatment of long lasting rheumatoid cerebral vasculitis(93).
8. Other complications
According to 10 relevant studies out of 2326 bibliographic citations found by the University of Palermo, complication associate to RA, include ericardial effusion (OR 10.7; 95% CI 5.0-23.0), valvular nodules (OR 12.5; 95% CI 2.8-55.4), tricuspidal valve insufficiency (OR 5.3; 95% CI 2.4-11.6), aortic valve stenosis (OR 5.2; 95% CI 1.1-24.1), mitral valve insufficiency (OR 3.4; 95% CI 1.7-6.7), aortic valve insufficiency (OR 1.7; 95% CI 1.0-2.7), combined valvular alterations (OR 4.3; 95% CI 2.3-8.0), mitral valve thickening and/or calcification (OR 5.0; 95% CI 2.0-12.7), aortic valve thickening and/or calcification (OR 4.4; 95% CI 1.1-17.4), valvular thickening and/or calcification (OR 4.8; 95% CI 2.2-10.5), and mitral valve prolapse (OR 2.2; 95% CI 1.2-4.0)(88).
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(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)
(81) A multicenter cross sectional study on bone mineral density in rheumatoid arthritis. Italian Study Group on Bone Mass in Rheumatoid Arthritis by Sinigaglia L1, Nervetti A, Mela Q, Bianchi G, Del Puente A, Di Munno O, Frediani B, Cantatore F, Pellerito R, Bartolone S, La Montagna G, Adami S.(PubMed)
(82) A case of rheumatoid arthritis with methotrexate related lymphoproliferative diseases of the knee by Abe A1, Wakaki K2, Ishikawa H1, Ito S1, Murasawa A1.(PubMed)
(83) Clinical characteristics and incidence of methotrexate-related lymphoproliferative disorders of patients withrheumatoid arthritis by Yoshida Y1, Takahashi Y, Yamashita H, Kano T, Kaneko H, Mimori A(PubMed)
(84) Neurologic complications of systemic lupus erythematosus, sjögren syndrome, and rheumatoid arthritis by Bhattacharyya S1, Helfgott SM2.(PubMed)
(85) Late-onset neutropenia after treatment with rituximab for rheumatoid arthritis and other autoimmune diseases: data from the AutoImmunity and Rituximab registry by Salmon JH1, Cacoub P2, Combe B3, Sibilia J4, Pallot-Prades B5, Fain O6, Cantagrel A7, Dougados M8, Andres E9, Meyer O10, Carli P11, Pertuiset E12, Pane I13, Maurier F14, Ravaud P13, Mariette X15, Gottenberg JE16.(PubMed)
(86) Late-onset neutropenia in patients with rheumatoid arthritis after treatment with rituximab by Abdulkader R1, Dharmapalaiah C, Rose G, Shand LM, Clunie GP, Watts RA.(PubMed)
(87) Carpal tunnel syndrome caused by volar dislocation of the lunate in a patient with rheumatoid arthritis by Oka Y1, Tokunaga D, Fujiwara H, Hojo T, Takatori R, Kubo T.(PubMed)
(88) Heart involvement in rheumatoid arthritis: systematic review and meta-analysis by Corrao S1, Messina S, Pistone G, Calvo L, Scaglione R, Licata G.(PubMed)
(90) Prevalence of dry eye syndrome and Sjogren's syndrome in patients with rheumatoid arthritis by Kosrirukvongs P1, Ngowyutagon P, Pusuwan P, Koolvisoot A, Nilganuwong S.(PubMed)
(91) A study of the prevalence of sicca symptoms and secondary Sjögren's syndrome in patients with rheumatoid arthritis, and its association to disease activity and treatment profile by Haga HJ1, Naderi Y, Moreno AM, Peen E.(PubMed)
(92) [Multiple cerebral infarction associated with cerebral vasculitis in rheumatoid arthritis].[Article in Japanese]by Ohta K1, Tanaka M, Funaki M, Sakauchi M, Suzuki N.(PubMed)
(93) Recovery from rheumatoid cerebral vasculitis by low-dose methotrexate by Ohno T1, Matsuda I, Furukawa H, Kanoh T.(PubMed)