Wednesday, 16 March 2016

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

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.

         Diseases associated with Polymyalgia Rheumatica(PMR)

1. Giant cell arteritis
 Giant cell arteritis shares many similarities with Polymyalgia rheumatica, according to the statistics
Patient with  Giant cell arteritis is associated to 50% higher risk of  polymyalgia rheumatica. On the other hand, there are 20% risk of development of Giant cell arteritis in patient polymyalgia, rheumatica. But the clinical manifestations, the relationship between GCA and PMR is not yet clearly established(48).
Medication and therapies used for treatment of polymyalgia rheumatica are also found effectively for giant cell arteritis as well, including Corticosteroids and anti-interleukin-6 receptor therapy(50).

2. Autoimmune thyroid disease and thyroid diseases
Autoimmune thyroid disease is defined as a condition in which the immune system wrongly viewed the thyroid gland and hormones produced as a foreign substances, thereby, producing antibodies to destroy them.  In a study of 250 patients with autoimmune thyroid disease, seven (2.8%) were found to have polymyalgia rheumatica. Female patient with age over 60 are found to have an increased risk of over 9.3% (49). Autoimmune thyroiditis is often related to Rheumatoid Arthritis due to other non-specific autoimmune organ diseases(51)
But according to the Service de Médecine Interne B, there is no evidences in support that the giant cell arteritis or polymyalgia rheumatica patients are at increased risk for hypothyroidism or hyperthyroidism(52)

3. Stroke
Besides cancer and heart diseases, stroke is the third leading cause of death. Approximate 1/4 of all stroke victims die as a direct result of the stroke or it's complications. The study of a total of 781 patients with PMR from the Taiwan Longitudinal Health Insurance Database between 2001 and 2005, patients with PMR are associated to an increased of stroke in comparison to controls(53).
Dr,.Hernández-Rodríguez J and the research team at the University of Barcelona suggested that Patients with GCA with apparently isolated PMR have a significant risk of developing ischemic complication(54).

4. Gastroesophageal reflux disease (GERD)

The prevalence of upper gastrointestinal (GI) diseases is increasing in subjects aged 65 years and over. Pathophysiological changes in esophageal functions that occur with aging may, at least in part, be responsible for the high prevalence of the disease. Use of medication of proton pump inhibitors (PPIs) are found to reduced risk of GERD in patient with polymyalgia rheumatica(55) in comparison to those without.

5. Vasculitis
Vasculitis is diseases associated to the inflammation of blood vessels. Patient with Polymyalgia Rheumatica(PMR) may present together with large vessel vasculitis (LVV) as a result of the inflammatory impact(56). Tocilizumab showed to improve symptoms of disease and inhibit inflammatory markers(57).Methotrexate effectively reduces relapse rate and lowers the cumulative dose of glucocorticoid therapy in patient with Polymyalgia Rheumatica(PMR)(58).

6. Peripheral vascular disease
Patient with Polymyalgia rheumatica, the most common inflammatory rheumatologic conditions in older adults are associated with an excess risk of vascular disease in comparison to the onset of vascular event in patients with and without polymyalgia rheumatica(59). Dr. Warrington KJ and the research team at the Mayo Clinic, Rochester said. "Patients with PMR appear to have an increased risk of PAD" in an inception cohort of all Olmsted County, Minnesota residents diagnosed with PMR between 1 January 1970 and 31 December 1999(60).

7. Renal function impairment 
Renal function impairment may associate rarely to patient with Polymyalgia Rheumatica(PMR). Only a few cases of AA amyloidosis secondary to PMR have been described in the literary data bases,according to the King's College Hospital NHS Foundation Trust(61). Dr. Escribá A and the research team at the Hospital Universitario 12 de Octubre, also expressed concerns of several cases of systemic amyloidosis associated with polymyalgia rheumatica (PMR) caused by massive amyloid deposition(62).

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(48) Polymyalgia Rheumatica by  Ehab R Saad, MD, MA, FACP, FASN; Chief Editor: Herbert S Diamond, MD(Medscape)
(49) Autoimmune thyroid disease and the polymyalgia rheumatica-giant cell arteritis syndrome by Dent RG, Edwards OM.(PubMed)
(50) Giant cell arteritis and polymyalgia rheumatica: an update by González-Gay MA1, Pina T.(PubMed)
(51) [Chronic autoimmune thyroiditis and connective tissue system diseases].[Article in Slovak]by Macejová Z1, Benhatchi K, Lazúrová I.(PubMed)
(52) [Prevalence of hypothyroidism and hyperthyroidism in temporal arteritis and rhizomelic pseudopolyarthritis. A controlled study of 104 cases].[Article in French] by Juchet H1, Labarthe MP, Ollier S, Vilain C, Arlet P.(PubMed)
(53) Polymyalgia rheumatica and the risk of stroke: a three-year follow-up study by Kang JH1, Sheu JJ, Lin HC.(PubMed)
(54) Development of ischemic complications in patients with giant cell arteritis presenting with apparently isolatedpolymyalgia rheumatica: study of a series of 100 patients by Hernández-Rodríguez J1, Font C, García-Martínez A, Espígol-Frigolé G, Sanmartí R, Cañete JD, Grau JM, Cid MC(PubMed)
(55) Estimation of the symptoms for GERD by GerdQ in the patients with rheumatic diseases by Nozaki Y1, Kinoshita K1, Ri J1, Sakai K1, Shiga T1, Hino S1, Hirooka Y1, Sugiyama M1, Funauchi M1, Matsumura I1.(PubMed)
(56) (18)F-FDG PET/CT for the detection of large vessel vasculitis in patients with polymyalgia rheumatica by Lavado-Pérez C1, Martínez-Rodríguez I2, Martínez-Amador N1, Banzo I1, Quirce R1, Jiménez-Bonilla J1, De Arcocha-Torres M1, Bravo-Ferrer Z1, Jiménez-Alonso M1, López-Defilló JL1, Blanco R3, González-Gay MA3, Carril JM1.(PubMed)
(57) Tocilizumab for the treatment of large-vessel vasculitis (giant cell arteritis, Takayasu arteritis) and polymyalgia rheumatica by Unizony S1, Arias-Urdaneta L, Miloslavsky E, Arvikar S, Khosroshahi A, Keroack B, Stone JR, Stone JH.(PubMed)
(58) Methotrexate treatment in large vessel vasculitis and polymyalgia rheumatica by Spies CM1, Burmester GR, Buttgereit F.(PubMed)
(59) Risk of vascular events in patients with polymyalgia rheumatica by Hancock AT1, Mallen CD2, Muller S1, Belcher J1, Roddy E1, Helliwell T1, Hider SL1.(PubMed)
(60) Increased risk of peripheral arterial disease in polymyalgia rheumatica: a population-based cohort study by Warrington KJ1, Jarpa EP, Crowson CS, Cooper LT, Hunder GG, Matteson EL, Gabriel SE.(PubMed)
(61) Rapid development of renal failure secondary to AA-type amyloidosis in a patient with polymyalgia rheumatica by Javaid MM1, Kamalanathan M, Kon SP.(PubMed)
(62) 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)

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