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Monday, 25 November 2013

Musculo-Skeletal Disorders – Rheumatoid Arthritis- Signs and Symptoms

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(1).
III. Rheumatoid Arthritis
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 in men and generally occurs after the ages of 40 and diminishes the quality of life of many elders.
A. Signs and Symptoms
1. The feet
In the study to investigate the rheumatoid arthritis (RA) patients with foot complaints to address the associations between clinical signs and symptoms, radiographic changes, and function in connection with disease duration, showed that pain and swelling of the ankle were correlated weakly but statistically significantly with limitation and disability (0.273 to 0.293) as measured on the 5-Foot Function Index (FFI). The clinical signs of the forefoot joints did not influence any of the functional outcome measures. Radiographic scores for both forefeet (SvdH) and hindfeet (Larsen) were correlated with the total Health Assessment Questionnaire Disability Index (HAQ DI) and the 5-FFI limitation subscale. Pain and disease duration, more than radiographic damage, influence the total HAQ DI significantly. With the progression of time, structural damage and function of the rheumatic foot worsen in RA patients. Pain and swelling of the ankle contribute more to disability than radiographic damage of the foot and ankle(2).
2. The Joints
In patients with rheumatoid arthritis, pain and range of movements of joints have the greatest impact on individual subdimensions of the HAQ. Extent of radiographic damage in peripheral joints and the number of swollen and tender joints are of lesser importance for function(3).
3. The Muscle strength
Dr. Häkkinen A and the research team at Jyväskylä Central Hospital, in the assessment to study the extent to which muscle strength and performance, pain, and disease activity are associated with the total Health Assessment Questionnaire (HAQ) disability index and its subdimensions in male and female patients with rheumatoid arthritis, indicated that women reported greater disability than men both in the total HAQ and in the majority of its eight subdimensions. In addition to disease activity and pain, muscle strength has a major impact on disability especially in female rheumatoid patients(4).
4. Rheumatoid nodules 
Rheumatoid nodules affect the joints of patients with rheumatoid nodules and are  a lesion commonly found under the skin as a result of microchimerism(5).
5. Conjunctival nodule
Although is rare in patients with rheumatoid arthritis. There is a 49-year-old woman with seropositive rheumatoid arthritis, who was being treated only with oral steroids and hydroxychloroquine, developed diffuse anterior scleritis in the right eye. In addition, examination showed a focal raised yellow/tan conjunctival nodule. The nodule was within the bulbar conjunctiva with no attachments to the underlying tissue, which is different from nodular scleritis(6).
6. Morning stiffness
Morning stiffness is a very common symptoms of patients in early rheumatoid arthritis. Some researchers suggested that the degree of morning stiffness appears to reflect functional disability and pain more than traditional markers of inflammation such as joint counts and ESR in patients with early RA. Inclusion of morning stiffness as a marker of inflammatory activity in classification criteria for RA, inclusion criteria for most clinical trials in RA, and RA remission criteria, may be open to reassessment(7).
7. Quality of life
7.1. Physical disability
In the study to 1) investigate the degrees of correlations between different disease activity scores (DASs) and health-related quality of life (HRQoL), and 2) determine if DASs correlate with either physical or mental HRQoL, showed that SF-36 total score showed a significant inverse correlation with the DAS4-ESR, DAS-3 ESR, DAS4-CRP, DAS3-CRP, DAS4-28 ESR, DAS3-28 ESR, DAS4-28 CRP, and DAS3-28 CRP, with correlation coefficients of -0.320, -0.314, -0.330, -0.323, -0.327, -0.318, -0.360 and -0.348, respectively (P < 0.01 for all). The correlation coefficients between different DAS indices and the HRQoL score were not significantly different. In addition, all DASs showed significant correlations with physical HRQoL, but not with mental HRQoL(8).
7.2. Concurrent psychiatric disorders
Dr. Mok C, and the scientists at the Tuen Mun Hospital in the study to investigate the effect of concurrent psychiatric disorders on health-related quality of life (HRQOL) in patients with rheumatoid arthritis (RA), indicated that in forty-seven (23.5%) patients diagnosed with a psychiatric disorder, depressive disorders in 29 patients and anxiety disorders in 26 patients. Patients with either condition had significantly higher fatigue scores (26 ± 8.8 vs. 16 ± 6.9, p < 0.001) and were more likely to be unemployed (p = 0.02) and dependent on government subsidy for living (p < 0.001) than those without. The scores of the eight domains and the physical and mental components of the SF-36 were significantly lower in RA patients with psychiatric disorders (p < 0.001 in all). In a linear regression model, the presence of either depressive or anxiety disorders (β = -0.23, p < 0.001), older age (β = -0.16, p = 0.006), self-perceived pain (β = -0.25, p < 0.001) and fatigue (β = -0.42, p < 0.001) were independently and inversely associated with the total SF-36 score after adjustment for disease activity and other sociodemographic variables. Conclusions: Concomitant depressive or anxiety disorders in RA patients are associated with significantly poorer HRQOL. Early identification and treatment of psychiatric disorders in RA patients are warranted(9).
8. Etc.

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Sources
(2) http://www.ncbi.nlm.nih.gov/pubmed/21614474
(3) http://www.ncbi.nlm.nih.gov/pubmed/15130901
(4) http://www.ncbi.nlm.nih.gov/pubmed/15901635
(5) http://www.ncbi.nlm.nih.gov/pubmed/21953057
(6) http://www.ncbi.nlm.nih.gov/pubmed/22271069
(7) http://www.ncbi.nlm.nih.gov/pubmed/15338490
(8) http://www.ncbi.nlm.nih.gov/pubmed/22279457
(9) http://www.ncbi.nlm.nih.gov/pubmed/22657161