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Monday, 25 November 2013

Musculo-Skeletal Disorders – Gout – The symptoms, Causes and Risk Factors

Musculoskeletal disorders (MSDs) is 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. A shoulder disorder was found in 27% of subjects, rheumatoid arthritis in 1% and osteoarthritis (OA) of the hand, hip, and knee in five, seven, and 18% of subjects, respectively. Disability was frequent: a walking distance of < 500 m was found in 60% and ADL dependency in 40% of the group. Factors related to one or both of these disability measures included female gender, hip and knee OA, impaired vision, cognitive impairment and neurological disease(1a).
Types of Musculo-Skeletal disorders in elder(2a)
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
Gout
I. Gout mostly effected one joint is defined as a acute and recurrent condition of arthritis as a result of uric acid builds up in blood cause of joint inflammation.
II. Symptoms
In the study carry out a cross-sectional survey on prevalence of musculoskeletal symptoms, rheumatoid arthritis (RA), ankylosing spondylitis (AS), and gout, Dr. Dai SM, and the research team at the Second Military Medical University, in the interviewe a total of 6584 adults (3394 women, 3190 men) with the response rate of 86.6%. showed that symptoms occurred more frequently in the following sites: knee 7.0% (95% CI 6.4-7.6%), lower back 5.6% (95% CI 5.0-6.2%), shoulder 4.7% (95% CI 4.2-5.2%), and neck 2.4% (95% CI 2.0-2.8%). Women complained of rheumatic symptoms more frequently than men. The standardized rates of RA, AS, gout, symptomatic knee osteoarthritis, and soft tissue rheumatism were 0.28% (95% CI 0.15-0.41%), 0.11% (95% CI 0.03-0.19%), 0.22% (95% CI 0.11-0.33%), 4.1% (95% CI 3.6-4.6%), and 3.4% (95% CI 3.0-3.8%), respectively(1a).
In fact, symptoms are quite noticeable, you may feel well when you go to bed but wake up during the night with intense pain in one or few joints and sometime with fever. The symptoms may go away in a few days, but can return from time to time. Chronic gout can cause lumps below the skin around joints.
III. Causes and risk factors 
A. Causes
The causes of gout is as the result of high levels of uric acid in the body that can lead to forming of crystals causes of inflammation due to your body can not get rid of uric acid or have made too much uric acid.
B. Risk factors
 1. If you body can not get rid uric acid quickly, intake foods with high levels of purine such as Alcohol,  Beverages, Beer, Anchovies, Smelt, Fish, Eggs, Herring, Mackerel, Sardine, Sweetbread, Liver, Kidney, etc., is at increased risk of gout.
2. Dr. Singh JA and scientists at the Birmingham VA Medical Centre, indicated that of the 751 titles and abstracts, 53 studies met the criteria and were included in the review. Several risk factors were studied. Alcohol consumption increased the risk of incident gout, especially beer and hard liquor. Several dietary factors increased the risk of incident gout, including meat intake, seafood intake, sugar sweetened soft drinks, and consumption of foods high in fructose. Diary intake, folate intake, and coffee consumption were each associated with a lower risk of incident gout and in some cases a lower rate of gout flares. Thiazide and loop diuretics were associated with higher risk of incident gout and higher rate of gout flares. Hypertension, renal insufficiency, hypertriglyceridemia, hypercholesterolemia, hyperuricemia, diabetes, obesity, and early menopause were each associated with a higher risk of incident gout and/or gout flares(2). Others suggested that combined with their activities as urate transporters and their strong associations with serum uric acid concentrations,  
4. Genetics
GLUT9 and ABCG2 appeared to be important modulators of uric acid levels and likely of the risk of gout. Together with a growing list of environmental risk factors, these genetic data add considerably to our understanding of the pathogenesis of hyperuricemia and gout(3).
5. Medication
Thiazide and loop diuretics users are at increased risk of gout(4)
6. Obesity, weight change, hypertension
Higher adiposity and weight gain are strong risk factors for gout in men, while weight loss is protective. Hypertension and diuretic use are also important independent risk factors for gout(5). Others showed that Gout is also drug-related and associated with increased obesity, hypertension, insulin resistance and metabolic syndrome(6). In other study, researchers found that women often have endocrine pathology (artificial menopause, dysmenorrhea, euthyroid goiter). In women gout runs a more severe course manifesting in early chronization, polyarticularity, lingering arthritis, rapid formation of tophuses. Both groups demonstrated marked polymorbidity with accumulation of the diseases related to atherosclerosis. Distinct group differences by content of uric acid seem to arise from early onset of chronic renal failure in women.
7. Chronic kidney disease
Patient with Chronic kidney disease are at higher risk of gout as a result of Serum uric acid control in gout was poor among patients without CKD and even worse among those with CKD(7).
8. Menopause, postmenopausal hormone use 
In a study of 16 years of follow-up (1 240 231 person-years), 1703 incident gout cases were recorded. ,the incidence rate of gout increased from 0.6 per 1000 person-years in women <45 years of age to 2.5 in women > or =75 years of age (p for trend <0.001). Compared with premenopausal women, postmenopausal women had a higher risk of incident gout (multivariate-adjusted relative risk (RR)=1.26; 95% confidence interval (CI) 1.03 to 1.55). Among women with a natural menopause, women with age at menopause <45 years had a RR of 1.62 (95% CI 1.12 to 2.33) of gout compared with women with age at menopause 50-54 years. Postmenopausal hormone users had a reduced risk of gout (RR=0.82; 95% CI 0.70 to 0.96). Menopause increases the risk of gout, whereas postmenopausal hormone therapy modestly reduces gout risk(8).
9. Etc.
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Sources
(1) http://www.ncbi.nlm.nih.gov/pubmed/7864688
(1a) http://www.ncbi.nlm.nih.gov/pubmed/14528524
(2) http://www.ncbi.nlm.nih.gov/pubmed/21285714
(2a) http://health.yahoo.net/channel/musculoskeletal-disorders.html
(3) http://www.ncbi.nlm.nih.gov/pubmed/20110790
(4) http://www.ncbi.nlm.nih.gov/pubmed/22031222
(5) http://www.ncbi.nlm.nih.gov/pubmed/15824292
(6) http://www.ncbi.nlm.nih.gov/pubmed/21949921
(7) http://www.ncbi.nlm.nih.gov/pubmed/21812963
(8) http://www.ncbi.nlm.nih.gov/pubmed/19592386