Tuesday, 15 March 2016

Most Common Disease of elder: The Clinical trials and Studies of Musculo-Skeletal disorders(MSDs) - Polymyalagia Arthritis (Rheumatica): The Complications(1)

Kyle J. Norton (Scholar)

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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(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


                  Polymyalagia Arthritis (Rheumatica)

Polymalagia Arthritis is defined as a condition a common inflammatory rheumatic disease which causes pain, stiffness and tenderness in large muscles, including muscles shoulders and pelvic girdle as a result of the presence of a synovitis in proximal joints and periarticular structures.
                               The Complications(1)

Patient with Polymyalgia Rheumatica(PMR) are limited to number daily physical functions and daily physical activities in most cases, according to Keele University and Mayo Clinic, the primary complications of PMR patients aref pain, stiffness and functioning(33)(34). Other more prevalence of complications of Polymyalgia Rheumatica(PMR) may include

1. Visual loss
Due to the nature of an inflammatory vasculopathy that involves large- and medium-sized arteries, patient with Polymyalgia Rheumatica(PMR) are associated to the complication of visual loss, according to the study by Dr. Schmidt J and Dr. Warrington KJ.(35). Dr.Hart FD. in the study of Visual complications of polymyalgia rheumatica (polymyalgia arteritica) siad," patients with polymyalgia rheumatica (polymyalgia arteritic) developed evidence of cranial arteritis (in one case two years and in one six months) following withdrawal of steroid therapy after apparent cure"(36).

2. Stroke
Polymyalgia rheumatica (PMR), a relatively common rheumatic disease, particularly in the elderly effecting the medium and large arteries causes of stroke(35). According to Taipei Medical University, PMR was associated with a significantly higher risk of stroke in the three-year follow-up period, in a study included 781 patients with PMR from the Taiwan Longitudinal Health Insurance Database between 2001 and 2005(37).
Dr. Narváez J and the research team at the Hospitalet de Llobregat said,"Patients with GCA presenting with apparently isolated PMR have a significant risk of developing transient or permanent disease-related ischemic complications; these complications occurred in 50% of the cases"(38).

3. Low back pain 
Interspinous bursitis associated with lower back pain, a frequent finding in the lumbar spine of patients with PMR may be as a result of Inflammation of lumbar bursae, according to Istituto di Ricovero e Cura a Carattere Scientifico in the finding by using magnetic resonance imaging (MRI)(39). The joint study lead by the University of Cantabri said,"The most common clinical manifestations at diagnosis were: PMR features, often with atypical clinical presentation (n=23 patients, 72%); diffuse lower limb pain (n=16 patients, 50%); constitutional symptoms (n=12 patients, 37%), inflammatory low back pain (n=9 patients, 28%) and fever (n=7 patients, 22%)(40).

4. Cervical interspinous bursitis
Cervical interspinous bursitis, an active inflammatory involvement of cervical bursae is likely to cause discomfort in the neck of patients(41) and also a frequent finding in the lumbar spine of patients with PMR(42). Although it is not associated with clinical symptoms, it has been found to associate to the spinal pain reported by the patients(42).

5. Renal failure
Patient with Polymyalgia rheumatica (PMR) may be important of monitoring renal function due to renel failure is found to associate to a few cases of AA amyloidosis(43), the King's College Hospital NHS Foundation Trust suggested.
According to the reports of Hospital Universitario 12 de Octubre, "two patients with PMR (one with associated GCA) who developed nephrotic syndrome and end-stage renal failure caused by massive amyloid deposition"(44)

6. Perforated colonic diverticular disease
The association of Polymyalgia Rheumatica(PMR) and perforated colonic diverticular disease may be result of proinflammatory expression and high incidence of other co-morbidities including colonic pathology(45), according to the joint study lead by the James Paget University Hospital.

7. Cancers
The investigation of a total of 185 patients with polymyalgia rheumatica (PMR) and temporal arteritis (TA) diagnosed during 1978-83 and their 925 matched controls with the data files at the Cancer Registry of Norway at the end of 1987, indicated that the malignancy of cancer are found to associate with 24% in patient with PMR(46).
Dr. Ji J and the research team at the Lund University said," Patients hospitalized for PMR and GCA had a marginally increased risk of cancer, with the highest risk noted for the first year after hospitalization. However, for specific cancers, such as skin cancer and leukaemia, the increases were still significant for patients diagnosed later than 1 year after hospitalization"(47).

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(33) The epidemiology of polymyalgia rheumatica in primary care: a research protocol.by Muller S1, Hider S, Helliwell T, Bailey J, Barraclough K, Cope L, Dasgupta B, Foskett R, Hughes R, Mayson Z, Purcell C, Roddy E, Wathall S, Zwierska I, Mallen CD.(PubMed)
(34) Patient-reported outcomes in polymyalgia rheumatica. by Matteson EL1, Maradit-Kremers H, Cimmino MA, Schmidt WA, Schirmer M, Salvarani C, Bachta A, Dejaco C, Duftner C, Slott Jensen H, Poór G, Kaposi NP,Mandl P, Balint PV, Schmidt Z, Iagnocco A, Cantini F, Nannini C, Macchioni P, Pipitone N, Del Amo M, Espígol-Frigolé G, Cid MC, Martínez-Taboada VM,Nordborg E, Direskeneli H, Aydin SZ, Ahmed K, Hazelman B, Pease C, Wakefield RJ, Luqmani R, Abril A, Marcus R, Gonter NJ, Maz M, Crowson CS, Dasgupta B.(PubMed)
(35) Polymyalgia rheumatica and giant cell arteritis in older patients: diagnosis and pharmacological management by Schmidt J1, Warrington KJ.(PubMed)
(36) Visual complications of polymyalgia rheumatica (polymyalgia arteritica) by Hart FD(PubMed)
(37) Polymyalgia rheumatica and the risk of stroke: a three-year follow-up study by Kang JH1, Sheu JJ, Lin HC.(PubMed)
(38) Prevalence of ischemic complications in patients with giant cell arteritis presenting with apparently isolatedpolymyalgia rheumatica by Narváez J1, Estrada P2, López-Vives L2, Ricse M2, Zacarías A2, Heredia S2, Gómez-Vaquero C2, Nolla JM2.(PubMed)
(39) Lumbar interspinous bursitis in active polymyalgia rheumatica by Salvarani C1, Barozzi L, Boiardi L, Pipitone N, Bajocchi GL, Macchioni PL, Catanoso M, Pazzola G, Valentino M, De Luca C, Hunder GG(PubMed)
(40) Non-infectious aortitis: a report of 32 cases from a single tertiary centre in a 4-year period and literature review by Loricera J1, Blanco R1, Hernández JL2, Carril JM3, Martínez-Rodríguez I3, Canga A4, Peiró E1, Alonso-Gutiérrez J2, Calvo-Río V1, Ortiz-Sanjuán F1, Mata C1,Pina T1, González-Vela MC5, Martínez-Amador N3, González-Gay MA6.(PubMed)
(41) Cervical interspinous bursitis in active polymyalgia rheumatica by Salvarani C1, Barozzi L, Cantini F, Niccoli L, Boiardi L, Valentino M, Pipitone N, Bajocchi G, Macchioni P, Catanoso MG, Olivieri I, Hunder GG.(PubMed)
(42) Interspinous bursitis is common in polymyalgia rheumatica, but is not associated with spinal pain by Camellino D, Paparo F, Morbelli S, Cutolo M, Sambuceti G, Cimmino MA.(PubMed)
(43) Rapid development of renal failure secondary to AA-type amyloidosis in a patient with polymyalgia rheumatica by Javaid MM1, Kamalanathan M, Kon SP.(PubMed)
(44) Secondary (AA-type) amyloidosis in patients with polymyalgia rheumatica by Escribá A1, Morales E, Albizúa E, Herrero JC, Ortuño T, Carreño A, Dominguez-Gil B, Praga M.(PubMed)
(45) Presentations of perforated colonic pathology in patients with polymyalgia rheumatica: two case reports by de Silva P1, Pranesh N, Vautier G.(PubMed)
(46) Cancer in association with polymyalgia rheumatica and temporal arteritis by Haga HJ1, Eide GE, Brun J, Johansen A, Langmark F.(PubMed)
(47) Cancer risk in patients hospitalized with polymyalgia rheumatica and giant cell arteritis: a follow-up study in Sweden by Ji J1, Liu X, Sundquist K, Sundquist J, Hemminki K.(PubMed)

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