Thursday, 17 March 2016

Most Common Disease of elder: The Clinical trials and Studies of Musculo-Skeletal disorders(MSDs) - Polymyalagia Arthritis (Rheumatica): The Complications(2)

Kyle J. Norton (Scholar)

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.,.
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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(2)

The Most common complications for people with Polymyalgia Rheumatica(PMR)
1. Ischemic complications
Patient with Polymyalgia Rheumatica(PMR) are found to have an lower risk of developing ischemic events, according to University of Barcelona(63). Dr. Narváez J and the research team at the joint study lead by Hospital Universitario de Bellvitge-IDIBELL said," Patients with GCA presenting with apparently isolated PMR have a significant risk of developing transient or permanent disease-related ischemic complications" and "these complications occurred in 50% of the cases"(64). Some patient of PMR with thrombocytosis also are found to at greatest risk for the development of stroke as well(65).

2. Vascular events
DR. Staud R. said," Patients with polymyalgia rheumatica had a 2.6-fold increased risk for vascular events at a median 7.8 y"(66). Youngest age groups patient with Polymyalgia Rheumatica(PMR) are associated to the greatest risk of vascular events in comparison to other age group(67).

3. Interspinous bursitis
Interspinous bursitis, a frequent finding in the lumbar spine of patients with PMR is found to have a potential cause of spinal symptoms probably due to the presence of cervical and lumbar bursitis(68). Other study suggested that the complications of low back pain reported by patients with PMR may also be result of Inflammation of lumbar bursae, the Istituto di Ricovero e Cura a Carattere Scientifico study suggested(69).

4. Shoulder inflammation

Shoulder inflammation is found common in 50%patient with PMR(70). But according to the research lead by Dr. Curran JF , shoulder arthritis may be result of inflammatory, degenerative, and septic arthritis and rarely the initial joint involved in rheumatoid arthritis and generally the symptoms is respond to the basic management for rheumatoid arthritis(71).
5. Stress fractures
One of the complication of rheumatic disease, including Polymyalgia Rheumatica(PMR) may often be delayed or missed in diagnosis, leading to improper treatment, the Sourasky Medical Center suggested(72). Dr. Mäenpää HM and the research team at the Rheumatism Foundation Hospital said,"a patient with rheumatic disease experiences sudden and unexplained pain localised in the forefoot, above the ankle, below the knee, or in the pelvis, a stress fracture should be suspected"(73).

6. Infection diseases
Patient with Polymyalgia Rheumatica(PMR) are found to be susceptible to the complications of infectious diseases, such as Chronic Epstein-Barr virus infection(74), Mycoplasma pneumoniae infection(75),........

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(63) 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)
(64) 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)
(65) Thrombocytosis in polymyalgia rheumatica: an additional diagnostic criterion and possible risk factor for ischemic complications?by Harten P, Seyfarth B, Löffler H.(PubMed)
(66) Patients with polymyalgia rheumatica had a 2.6-fold increased risk for vascular events at a median 7.8 y by Staud R.(PubMed)
(67) 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)
(68) 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)
(69) 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)
(70)Shoulder arthritis. Distinguishing among the many causes of inflammation by Ellman MH, Brown NL, Curran JJ.(PubMed)
(71) Rheumatologic aspects of painful conditions affecting the shoulder by Curran JF, Ellman MH, Brown NL.(PubMed)
(72) Insufficiency fractures in rheumatic patients: misdiagnosis and underlying characteristics by Elkayam O1, Paran D, Flusser G, Wigler I, Yaron M, Caspi D.(PubMed)
(73) Insufficiency fractures in patients with chronic inflammatory joint diseases by Mäenpää HM1, Soini I, Lehto MU, Belt EA.(PubMed)
(74) "Chronic Epstein-Barr virus infection" syndrome and polymyalgia rheumatica by Buchwald D1, Sullivan JL, Leddy S, Komaroff AL.(PubMed)
(75) Synchronous variations of the incidence of temporal arteritis and polymyalgia rheumatica in different regions of Denmark; association with epidemics of Mycoplasma pneumoniae infection by Elling P1, Olsson AT, Elling H.(PubMed)

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