Category: Arthritis

Osteoarthritis is a disease that affects people all over the world, but is frequently mishandled within the healthcare system. It is one of the most common causes of disability in older persons, resulting in pain, loss of function, and a lower quality of life. On a societal level, the condition is predicted to cost $303 billion in medical bills and lost wages each year (Abramoff & Caldera, 2020). This chronic, severe disease requires continued efforts to limit its incidence, pain, and loss of function.

Osteoarthritis is known for its degenerative effects on articular cartilage, which becomes significantly damaged over time. The smooth cartilage at the ends of long bones and within the intervertebral discs is known as articular cartilage. It provides a low-friction articulation surface while being able to transmit large loads. Even while the collagen in cartilage has a lengthy half-life, it repairs slowly, if at all, even with slight injuries. Although the cartilage transforms the most, the entire joint, including the synovium, joint ligaments, and subchondral bone, is impacted.

Osteoarthritis is often overlooked, despite its significant personal, economic, and societal costs. Even though osteoarthritis frequently coexists with heart disease, diabetes, and mental health issues, and can aggravate the morbidity and mortality associated with these ailments, it is not included in worldwide strategic plans for noncommunicable diseases. Patients and practitioners may be affected by therapeutic nihilism, with misconceptions that osteoarthritis is an unavoidable component of aging and that there are no viable therapies (Abramoff & Caldera, 2020). The affected people are frequently misinformed about treatment options. Current health-care approaches can range from ignoring essential treatments like exercise, weight loss, and education to using expensive, unproven medications for late-stage disease. I find this issue to be the most interesting, although unfortunate, element of both the article and the conditions perception. I believe that rehabilitation counselling could combine physical and psychological aid to help patients with osteoarthritis and its various consequences.

Reference

Abramoff, B., & Caldera, F. (2020). Osteoarthritis: Pathology, diagnosis, and treatment options.Medical Clinics of North America, 104(2), 293-311.

“It just seemed so pointless,” recalls Helen, who has lived with rheumatoid arthritis (RA) for decades. “I couldn’t lift my arms above shoulder height, so it was easy to explain why I wasn’t washing my hair. Then I developed nodules on my feet, so it was a simple matter to stop taking walks. Then it was difficult to open cans, so it seemed simplest to just stop eating. It all seemed absolutely logical to me at the time. It never occurred to me that I was in the middle of clinical depression.”

It didn’t occur to her many doctors, either, until finally a young clinician, whose own mother had dealt with a mood disorder, analyzed Helen’s symptoms and came to a clear diagnosis of major depression. (Helen also learned that she had an anxiety disorder — click here to learn about anxiety disorders.)

Stories like Helen’s are all too common. People with arthritis are more likely to have depression than people without arthritis, and depression can make it more difficult for them to cope with arthritis and control pain. But depression can be difficult to recognize in people with chronic pain, so many people don’t get the treatment they need. If you have arthritis, you need to know how to recognize the signs of depression so that you can get the help you need to feel better — and better manage your arthritis.

What is depression?

People often say they “feel depressed” when they are feeling low, but clinical depression is more than a period of sadness or of being “down in the dumps.” It is a medical condition that involves changes in brain chemistry and that interferes with a person‘s daily life. There are several different types of depression, but major depression, also called major depressive disorder, is the most common. Different people experience different symptoms of major depression, but some of the most common are the following:

• Prolonged feelings of sadness or unhappiness
• A loss of interest in activities you used to enjoy
• Insomnia or sleeping too much
• Changes in appetite, which may lead to weight loss or weight gain
• Difficulty concentrating or making decisions
• Fatigue
• Feelings of agitation or restlessness
• A sense of guilt or worthlessness

People may experience some of these symptoms periodically throughout their lives without having depression. But when you have several of these symptoms, they are prolonged or intense, and they interfere with your life or your relationships, you may have major depression. In another common form of depression, called dysthymic disorder or dysthymia, the above symptoms may be mild but long lasting. People with dysthymic disorder may not find their symptoms disabling most of the time, but they may experience an episode of major depression at some point in their lives.

An oft-overlooked condition

As mentioned above, people with arthritis are at increased risk of developing depression. Whereas about 10% of American adults are affected by depression in any given year, conservative estimates place that figure at 20% for people with arthritis. People whose physical and social activities are limited by arthritis are at especially high risk.

Despite how common depression is among people with arthritis, the condition can be easy for doctors to overlook. Along with mood-related symptoms, depression can cause some of the very same physical symptoms that arthritis causes, including joint pain, back pain, muscle aches, fatigue, and sleep disturbances. As a result, doctors all too often miss the signs of depression that might be self-evident in a person who did not have chronic pain. A study published in Arthritis Care & Research in 2008 found that of 200 people with RA who had an appointment with 1 of 8 rheumatologists, only 7 people discussed depression during their appointment. Of the 21 participants who had moderate to severe symptoms of depression, only 4 talked to their rheumatologist about the condition. Each time depression was discussed, it was the patient who brought up the topic, not the doctor.

But it can be difficult to talk about depression, even if you’re aware that you’re experiencing it. Tara, an adolescent with RA, describes her feelings this way: “Everything hurt all the time, and I was embarrassed by my physical condition. I almost ­didn’t even focus on what hurt, or how, or even why. I was not at all in tune with my mind–body connection.… Depression felt like the straw that would break my back. It was easier to ignore it.”

The symptoms of depression are obviously very daunting, and it can be easy to feel helpless. The good news is that getting help can change your life for the better.

The elderly people are one of the most vulnerable minority group towards Arthritis and Musculoskeletal conditions. To be an elderly, the individual must be 65 years or over, according to the Social Security Administration (Katie. 24th July 2017). The most common reason for arthritis in elderly people is due to stress and strain on the joints over the years. The body undergoes a lot of wear and tear as you age (Sharma. B. 12th October 2015).

Arthritis is a joint disorder which features inflammation of one or more joints. The two main types of arthritis are Osteoarthritis and Rheumatoid arthritis. Osteoarthritis causes cartilage to break down, and Rheumatoid arthritis is a disease in which the immune system attacks the joints (Mayo Clinic. 19th July 2019). Its symptoms are joint pain, swelling, redness in the joints. The diagnosis consists of a blood test and imaging tests including MRI and X-ray scans to help show the severity of inflammation. Treatment may include, anti-inflammatory tablets and pain relievers. Musculoskeletal conditions are conditions that involve the muscle, bones, tendons, ligaments, joints and nerves (GoodPx. N. d). Examples may include, spinal discs, ACL etc. common signs and symptoms include, pain, weakness, joint noises/clicks/pops (Villa-Forte. A. September 2019). Similar to arthritis, musculoskeletal conditions diagnosis consists of, imaging tests including MRI and X-ray scans. This is also diagnosed by the doctor by testing joint movement. Treatments to this health issue may include, exercise including muscle strengthening, physiotherapy, chiropractic care (DerSarkissian. C 25th April 2019). Arthritis falls in the category of chronic diseases (Sharma. B. 12th October 2015). Musculoskeletal conditions may be acute and chronic, it all depends on the effected part of the body.

Between 2017-2018, 12.1% of males had a type of arthritis and 17.9% of women had arthritis. Almost 1 in 3 (29%) of Australians had a musculoskeletal condition in 2017–18, around 7.0 million people (Australian Institute of Health and Welfare. 30th August 2019). Overall, an estimated 22.7% (54.4 million) of adults had doctor-diagnosed arthritis, with significantly higher age-adjusted prevalence in women (23.5%) than in men (18.1%). Arthritis prevalence increased with age (Centers for Disease Control and Prevention. 7th February 2018). An estimated 126.6 million Americans (one in two adults) are affected by a musculoskeletal condition (Science Daily. 1st March 2016). The comparison between Australia and America in terms of arthritis, there’s a huge gap. Australia’s percentage of arthritis in men is only 12.1% compared to the 18.1% in America and 17.9% of Australian women have arthritis compared to the 23.5% in America. As Australia has almost 1 in 3 people (around 7 million people) with musculoskeletal condition, America has 1 in 2 adults (estimated around 126.6 million people) with musculoskeletal condition.

Osteoarthritis (OA) is more common in older people because OA usually occurs when the individual grows older. This is because as we grow older, the cartilage begins to become ragged and wears away (a Place for Mom. January 2018). The most widely recognized explanation behind arthritis in old individuals is because of anxiety on the joints throughout the years. The body, all in all, experiences a great deal of distance as you age (Sharma. B. 12th October 2015). As the individual works, plays sports and does heavy and does direct activities they are using their muscles, ligaments, joints and etc, when they grow older the different body parts that get affected by arthritis start to tear and wear down. With age, musculoskeletal tissues show increased bone fragility, loss of cartilage resilience, reduced ligament elasticity, loss of muscular strength, and fat redistribution decreasing the ability of the tissues to carry out their normal functions. (Gheno. R, Cepparo. J, Rosca C, Cotten. A. 28th July 2012).

Physical therapy is the suggested act for improving muscle strength around the joints. When Rheumatoid arthritis is severe, a Rheumatologist, a health professional that specializes in the treatment of arthritis, autoimmune diseases, pain disorders affecting joints, and osteoporosis is required for treatment to the patient with Rheumatoid arthritis. Surgery may be needed for certain patients with severe cases of spinal arthritis that leads to instability of the joint or nerve root pinching. (Mooney. V. 25th May 2005). When an individual has a musculoskeletal condition, many health professionals are able to help, but the most common are chiropractors and physiotherapists. Chiropractors duty to help with musculoskeletal conditions is to ask the patient where the pain is and begins to release tension and helps reduce the pain on the patient. This is done by cracking the individuals body releasing stress and tension in different techniques. The Physiotherapist helps the patient with musculoskeletal condition by massaging, and working through and providing a range of exercises to help strengthen the muscles around the joints. When the pain is severe, an Orthopaedist is required. An Orthopaedist provides services to the postoperative treatment of diseases and injuries of the musculoskeletal system.

Abstract

Patients of rheumatoid arthritis, who were already diagnosed as per 2010 ACR / EULAR ( American college of Rheumatology / European League Against Rheumatism ) classification criteria were included in the study. Red cell band width was determined in all the patients from laboratory of own hospital. Severity of rheumatoid arthritis was determined on the basis of Disease Activity Score-28 (DAS-28). Age, gender, duration of rheumatoid arthritis and red cell band width were correlated with the severity of rheumatoid arthritis.

Mean age of the study participants was 36.37±7.822 years. 187 (74.8%) patients were female while 63 (25.2%) were male. 99 (39.6%) patients had mild activity disease, 115 (46%) had moderate while 36 (14.4%) had severe activity of illness. 137 (54.8%) had red cell band width within normal range while 113 (45.2%) had increased with. Pearson chi-square test revealed that increasing age, long duration of illness and increased red cell band width had a statistically significant association with severity of illness among the patients suffering from rheumatoid arthritis (p-value 3.2 — ≤ 5.1, and High disease activity: DAS-28 >5.1 13

Statistical analysis was performed by using the SPSS 23.0. Frequency and percentage were calculated for the qualitative variables like gender, patients with mild, moderate or severe activity of disease or patients with and without the increased red cell band width. Mean and standard deviation was calculated for the age of the patients and duration of illness. Pearson chi-square test was used to see the association between the age, gender, presence of increased RDW and duration of RA with the severity of illness. p-value less than or equal to 0.05 was considered as significant for this study.

Results

Two hundred and fifty patients of rheumatoid arthritis were recruited in the analysis after inclusion and exclusion criteria were applied. Mean age of the study participants was 36.37±7.822 years. Mean duration of rheumatoid arthritis among the study participants was 3.57±6.125 years. Table I shows that 187 (74.8%) patients were female while 63 (25.2%) were male. 99 (39.6%) patients had mild activity disease, 115 (46%) had moderate while 36 (14.4%) had severe activity of illness. 137 (54.8%) and red cell band width within normal range while 113 (45.2%) had increased with. Pearson chi-square test (Table II) revealed that increasing age, long duration of illness and increased red cell band width had a statistically significant association with severity of illness among the patients suffering from rheumatoid arthritis (p-value 0.05).

Discussion

Rheumatology is an emerging specialty in our country with limited number of trained doctors available to manage a huge number of patients which mostly rely on the general practitioners or the medial specialists. Adequate knowledge about all the aspects of rheumatology diseases can only enable the doctors to manage the patients effectively and screen and pick up the cases with advanced disease early for aggressive management plan. Various immune based or blood indices have been used in the diagnosis and prediction of severity of illness in rheumatoid arthtiirs.3-5 We planned this study with the rationale to determine the correlation between red cell band width and disease severity in patients suffering from rheumatoid arthritis presenting to our teaching hospital from all parts of the country.

Lee et al. in 2010 published an interesting study and concluded that RDW has a strong association with the presence and severity of rheumatoid arthritis. It has also been linked to raised CRP among the target population.14 Our findings were quite similar to them as RDW has strong association with more severe diseases in our study population. Our scope was limited so we did not study correlation of other parameters like CRP and ESR.

Salvagno et al. in 2015 and Patel et al. in 2018 published that an increased RDW mirrors a profound deregulation of erythrocyte homeostasis involving both impaired erythropoiesis and abnormal red blood cell survival, which may be attributed to a variety of underlying metabolic abnormalities such as shortening of telomere length, oxidative stress, inflammation, poor nutritional status, dyslipidemia, hypertension, erythrocyte fragmentation and alteration of erythropoietin function.15,16Our findings also suggest that RDW should be incorporated when a patient of RA is investigated because it can predict the severity of illness.

Rodríguez-Carrio et al. in 2015 did a very interesting study and incorporated the cardiovascular risk in addition to severity of RA in their study design and came up with the findings that RDW at disease onset may be used as an early marker of CV risk in RA, whereas in patients with established disease it was related to the activity of the disease. These findings suggest that RDW can be considered as a surrogate marker of inflammation and, consequently, CV risk in RA patients.17Our results supported their results from the point of view that RDW predicted disease severity in our study. For cardiovascular risk factors prediction studies with a longitudinal design need to be conducted in local population to fill the gap. Same authors in same year published another study highlighting the underlying mechanism that RDW was associated to Endothelial Progenitor Cells (EPC) depletion and increased levels of different mediators linked to endothelial damage and vascular repair failure, thereby shedding new light on the nature of RDW as cardiovascular and disease severity predictor.18

Lin et al. in 2018 and Yunchun et al. in 2016 performed studies with a similar design as that of ours and came up with the similar results that RDW had a strong link with presence of active inflammation and more severe disease among the patients suffering from RA.7,8Our results were similar to their results and showed that this phenomenon has not been different in our population and with more studies we could be able to make our local guidelines to incorporate this parameter in routine investigation of RA.

Small sample size, cross-sectional study design, ample population from a single center and lack of availability of RDW values prior to the onset of RA or at the time of diagnosis of RA are some of the limitations which need to be addressed in future studies to generate the results which could be generalized to the local population.

Conclusion

Considerable number of patients suffering from rheumatoid arthritis had severe form of illness. Increased red cell band width emerged as a predictor of severe form of illness among the study participants in addition to the advancing age of patient and long duration of illness.

References

1. Dargham SR, Zahirovic S, Hammoudeh M, et al. Epidemiology and treatment patterns of rheumatoid arthritis in a large cohort of Arab patients [published correction appears in PLoS One. 2019 Mar 18;14(3):e0214258]. PLoS One. 2018;13(12):e0208240. Published 2018 Dec 19. doi:10.1371/journal.pone.0208240
2. Naqvi AA, Hassali MA, Aftab MT. Epidemiology of rheumatoid arthritis, clinical aspects and socio-economic determinants in Pakistani patients: A systematic review and meta-analysis. J Pak Med Assoc. 2019;69(3):389-398.
3. Guo Q, Wang Y, Xu D, Nossent J, Pavlos NJ, Xu J. Rheumatoid arthritis: pathological mechanisms and modern pharmacologic therapies. Bone Res. 2018;6:15. Published 2018 Apr 27. doi:10.1038/s41413-018-0016-9
4. Edwards CJ, Kiely P, Arthanari S, et al. Predicting disease progression and poor outcomes in patients with moderately active rheumatoid arthritis: a systematic review. Rheumatol Adv Pract. 2019;3(1):rkz002. Published 2019 Feb 15. doi:10.1093/rap/rkz002
5. Said AS, Spinella PC, Hartman ME, et al. RBC Distribution Width: Biomarker for Red Cell Dysfunction and Critical Illness Outcome?. Pediatr Crit Care Med. 2017;18(2):134–142. doi:10.1097/PCC.0000000000001017
6. Bazick HS, Chang D, Mahadevappa K, Gibbons FK, Christopher KB. Red cell distribution width and all-cause mortality in critically ill patients. Crit Care Med. 2011;39(8):1913–1921. doi:10.1097/CCM.0b013e31821b85c6
7. Lin F, Wang X, Liang Y, Liu D, Zhang Y, Zhong R, Yang Z. Red Blood Cell Distribution Width in Rheumatoid Arthritis, Ankylosing Spondylitis and Osteoarthritis: True Inflammatory Index or Effect of Anemia? Ann Clin Lab Sci. 2018;48(3):301-307.
8. Yunchun L, Yue W, Jun FZ, Qizhu S, Liumei D. Clinical Significance of Red Blood Cell Distribution Width and Inflammatory Factors for the Disease Activity in Rheumatoid Arthritis. Clin Lab. 2016;62(12):2327-2331. doi: 10.7754/Clin.Lab.2016.160406.
9. Horta-Baas G, Romero-Figueroa MDS. Clinical utility of red blood cell distribution width in inflammatory and non-inflammatory joint diseases. Int J Rheum Dis. 2019 ;22(1):47-54. doi: 10.1111/1756-185X.13332.
10. Hameed K, Gibson T. A comparison of the prevalence of rheumatoid arthritis and other rheumatic diseases amongst Pakistanis living in England and Pakistan. Br J Rheumatol. 1997 ;36(7):781-5.
11. Aletaha D, Smolen JS. Diagnosis and Management of Rheumatoid Arthritis: A Review. JAMA. 2018;320(13):1360-1372. doi: 10.1001/jama.2018.13103.
12. Sarma PR. Red Cell Indices. In: Walker HK, Hall WD, Hurst JW, editors. Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition. Boston: Butterworths; 1990. Chapter 152. Available from: https://www.ncbi.nlm.nih.gov/books/NBK260/
13. Barczyńska TA, Dura M, Blumfield E, et al. DAS28 score vs. ultrasound examination for assessment of rheumatoid arthritis disease activity: comparison and discussion of pros and cons. Reumatologia. 2015;53(4):213–218. doi:10.5114/reum.2015.53999
14. Lee WS, Kim TY. Relation Between Red Blood Cell Distribution Width and Inflammatory Biomarkers in Rheumatoid Arthritis. Arch of Path and Lab Med. 2010;134(4):505-506.
15. Salvagno GL, Sanchis-Gomar F, Picanza A, Lippi G. Red blood cell distribution width: A simple parameter with multiple clinical applications. Crit Rev Clin Lab Sci. 2015;52(2):86-105. doi: 10.3109/10408363.2014.992064
16. Patel KV, Semba RD, Ferrucci L, et al. Red cell distribution width and mortality in older adults: a meta-analysis. J Gerontol A Biol Sci Med Sci. 2010;65(3):258–265. doi:10.1093/gerona/glp163
17. Rodríguez-Carrio J, Alperi-López M, López P, Alonso-Castro S, Ballina-García FJ, Suárez A. Red cell distribution width is associated with cardiovascular risk and disease parameters in rheumatoid arthritis. Rheumatology (Oxford). 2015;54(4):641-6. doi: 10.1093/rheumatology/keu345.
18. Rodríguez-Carrio J, Alperi-López M, López P, Alonso-Castro S, Carro-Esteban SR, Ballina-García FJ et al. cell distribution width is associated with endothelial progenitor cell depletion and vascular-related mediators in rheumatoid arthritis. Atherosclerosis. 2015;240(1):131-6. doi: 10.1016/j.atherosclerosis.2015.03.009

Arthritis

It is a very odd disease, affects the joint and creates miserable pain. Impact of this disorder in both the hands and feet’s (mainly to the elder person), also causes such pain in the knee, victim thinks that they have been deficient in calcium, so they start to eat vitamins and supplements’ by themselves. If pain is not reduces, most patients in that case start to take any OTC pain antagonist. Arthritis cannot cure for ever. It needs to be treated properly for through the whole life. It is possible to remain good in spite of having arthritis if the patient can maintain a healthy life style with proper treatment. (Online Dhaka Guide, 2019)

Whatever the types of arthritis are, symptoms are almost same for all. Joint pain, irritating, swelling, fever, muscle tightening etc. It can also be a reddish skin onto the affected area. Also may feel difficult to shake hands once. Determining the type of arthritis is important for proper treatment. It is diagnosed with certain blood tests.

Causes of Arthritis

• Reduction of Cartilage.
• Normal wear and tear.
• Autoimmune disorder, which further reduce the synovium.
• Genetical. (Medicine health, 2019)2

Types of arthritis

• Rheumatoid Arthritis: This type of disease is more common in younger people and is a serious form. If rheumatoid arthritis is not very necessary to be treated over time, if rheumatoid arthritis aggravates then it can be greatly damaged in body joints within a year.
• Osteoarthritis: This type of arthritis can be caused by a genetic cause. As age increases its size grows. It affects the waist, knees, and legs.
• Psoriatic Arthritis: This arthritis increases with psoriasis. The disease can be very serious if not timely and proper treatment.
• Polymyalgia Rheumatica Arthritis: This type of arthritis is more common in individuals above 5 years. The disease causes unbearable pain in the neck, shoulders and waist, and those organs have difficulty rotating. With the right treatment at the right time it is possible to reduce the pain. However, it may not be possible to recover completely.
• Ankylosing spondylitis: The disease usually occurs at the lower joints of the body. The pain is less but persistent. It is possible to cure it through treatment but with the right treatment at the right time.
• Systemic lupus arthritis This type is occurs due to an auto immune defects. Basically, while women give birth a baby, may originate this disease. It is very severe, but possible to control with proper treatment. (WebMD, 2019)3.

Symptoms of Arthritis

These symptoms below are probably the symptoms of arthritis. Therefore, if you experience these symptoms it is important to consult a doctor. Maybe we can protect ourselves from the great loss if it is not fully resolved. The symptoms of this disease are –

• At first the patient may have frequent fever.
• Pain may be felt in the muscles.
• Always feel tired, body massaged, appetite diminishes, and weight gain decreases.
• Pain in the knees, ankles, toes, fingers, hands.
• Redness around the joints, rash.
• Sometimes there is pain in the joint that causes difficulty in moving.
• Morning stiffness
• Numbness and tingling

Other early symptoms of rheumatoid arthritis:

• General weakness or a feeling of malaise.
• Dry mouth
• Dry, itchy, or inflamed eyes
• Eye discharge
• Difficulty sleeping
• Chest pain when you breathe (pleurisy)
• Hard bumps of tissue under the skin on your arms
• Loss of appetite
• Weight loss (The Healthy, 2017)4

Osteoarthritis (OA) and rheumatoid arthritis (RA) are somewhat different. OA causes pain is in the waist, knees and hands. It creates knee joints which further causes more pain. In RA, relatively less pain feels in the bone. However, severe pain in RA is more common in other parts of the body, including the arm wrists.

Treatment of arthritis

Arthritis is a long-term disease. Patient has to suffer lifetime for this disease. It is said that if not treated properly, there may be fear of being paralyzed. But do not worry if you diagnose and treat the disease at the right time, you will survive the loss. Arthritis is a disease cannot go for a severe condition with a better treatment. With proper treatment, the pain can be alleviated and patient can be live well.

First, you need to know what type of arthritis you will get by consulting a doctor. Usually the doctor will start your treatment. In addition to the medicine, various types of tests like X-rays, blood tests, serology tests etc. In addition to the medication, the doctor ordered different types of home exercises. The pain of the disease can be controlled by arthritis exercises. The doctor also recommends physiotherapy to relieve the pain. Sometimes, arthritis pain can be cure through physiotherapy. But whatever you do, of course, do at doctor’s advice.

Whatever you do to reduce arthritis pain –

• You need to keep your weight under control. Do not add extra weight. Because the knee can be stressed.
• Move body parts regularly. Stay busy evolving in work.
• Exercise regularly.
• Take the medication on time so you can get rid of the pain.
• Consult a doctor from time to time.
• It’s best not to bathe in cold water. Take a bath in warm steam or warm water.
• Eat nutritious foods regularly. (WebMd,2019)5

Medicine of arthritis

Exercise, along with some physical therapies (such as, hot, cold or others.), is a major treatment for the getting a temporary relief from rheumatoid and osteo-arthritis.

There are many different types of drugs in the treatment for this disease. Physicians generally divide these drugs into first-line and second-line drugs.

The first-line drugs:

The first-line drugs are usually tried first. These include: non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, and some prescription drugs. These drugs are used to treat osteo and rheumatoid arthritis. The first-line drugs are most effective in the treatment of RA (rheumatoid arthritis). In addition, steroid drugs such as prednisolone and cortisone are used. Steroids aren’t really considered the first drug of choice because of side effects. In the case of osteo-arthritis, steroid drugs are not one of them. Because steroids do not help in this case and there are many serious side effects of steroids.

The second-line drugs:

Since first line drugs are not effective in the treatment of osteo-arthritis, second-line drugs are used only in the treatment of rheumatoid arthritis. Second-class drugs are sometimes called Disease Modifying or Disease Remedial Drugs. Because these drugs reduce many people’s symptoms. These drugs include GoldSalt, injection or tablet form; Hydroxy Chloroquine, also used in the treatment of malaria; Penicillamine, known as the anti-antibiotic brother, and methotrexate and other immunosuppressive drugs used to treat cancer.

Arthritis with CBD

According to a report published on 2017, CBD has the efficacy and capability to reduce both the arthritis pain and joint neuropathy. So, if anybody is getting confused, about the relation of CBD with arthritis, they should know, CBD is a new hope for those arthritis attacked patent, who doesn’t like to intake any NSAIDs for long duration. CBD decrease pain, as well as protect the nerves from getting severely worse in further.

Few animal studies already established the fact that CBD can cure any inflammation which originates due to arthritis. CBD can cure relent symptoms caused by osteoarthritis.

A 2016 research has established the truth that, topical implementation of CBD can reduce any inflammation and pain which relates with all types of arthritis.

Why CBD for arthritis?

We all know very well, due to arthritis, a patient has to suffer a lot. Unexplainable irritation with lots of swelling has to face by an arthritis patient. To reduce those symptoms’s, one can intake NSAIDs every time. Fact is that, continuous consumption of NSAIDs is not safe for health. These drugs are opiates, but CBDs are natural, safe and useful. By multiple effects of CBD, any inflammatory, and metabolic arthritis can treated as well.

Side effects of CBD

“If you take pure CBD, it’s pretty safe,” said Marcel Bonn-Miller, an adjunct assistant professor at the University of Pennsylvania’s Perelman School of Medicine. However, several side effects of CBDs are showed below-

• diarrhea
• sleepiness
• fatigue
• weakness
• rash
• decreased appetite
• elevated liver enzymes
• “cotton mouth” sensation or dry mouth
• uncontrollable muscle movements
• Low blood pressure
• Drowsiness

Mechanism of action of CBD to treat arthritis

Three Symptoms of arthritis are- swelling, weakness, and fever. Mainly CBD reduce the symptoms of inflammation which creates due to arthritis. CBD attach with CB receptor and gives signals to reduce pain perception.

Most important thing is that, you don’t need to see any research report or data about the activity of CBDs. Already lots of peoples are using CBDs and getting lots of benefits from CBDs. Any further human trial is not mandatory to understand how it is works. Already much research result established all these issues very clearly. With the features to response the immune system with certain cannabinoids receptors of our body, CBD decreases pain and inflammation creates due to arthritis. (Naturesbreakthrough.com, 2018)12

Verdict

Arthritis can also come from genetically to you. Be careful if you have a family tend of bearing arthritis, you are easily at risk of becoming a victim of arthritis. The risk of arthritis increases as you get older. Women are more prone to this disease than men for physiological and hormonal reasons. This risk is especially high during or after menopause. Excess weight increases the risk of arthritis.

If you have any joint related disorder, then you are more likely to suffer arthritis later. In order to stay healthy it is not enough to cure once you attacked by it. You need to prepare as much as possible in advance, to avoid further risk of this disease. So be aware of this, stay good and healthy.

Reference

1. Everyday Health: Trusted Medical Information, Expert Health Advice, News, Tools, and Resources. (2019, October 24). Retrieved from https://www.everydayhealth.com/.
2. Experts in everyday emergencies, first aid and health information. (n.d.). Retrieved from https://www.emedicinehealth.com/script/main/hp.asp.
3. Better information. Better health. (n.d.). Retrieved from https://www.webmd.com/.
4. 4. Healthy Living with Expert-Backed Advice. (n.d.). Retrieved from https://www.thehealthy.com/.
5. Better information. Better health. (n.d.). Retrieved from https://www.webmd.com/.
6. 5 Of the Best Cannabis Strains for Arthritis Pain Relief. (2019). Retrieved from https://www.getnovusnow.com/
7. Five Best CBD Oils For Arthritis. (n.d.). Retrieved from https://www.bestchoicereviews.org/
8. What’s the Best CBD Dosage? (n.d.). Retrieved from https://medium.com/cbd-origin?source=post_page.
9. Arthritis Foundation CBD Guidance for Adults with Arthritis. (n.d.). Retrieved from https://www.arthritis.org/
10. What are the benefits of CBD oil? (n.d.). Retrieved from https://thecannabisradar.com/
11. CBD can have side effects, albeit not threatening ones. (2018). Retrieved from https://thehempoilbenefits.com/
12. Yurtoğlu, N. (2018). How CBD Goes to Work on Arthritis Pain. History Studies International Journal of History, 10(7), 241–264. Retrieved from http://naturesbreakthrough.com/

Abstract

This paper is intended to give the reader an insight of what difficulties a person diagnosed with rheumatoid arthritis can face whether its pain inflammation, swelling. This research holds various ways on how OT can help with treating, decreasing pain so that the patient can return to their daily function or close to what they use to be able to accomplish.

INTRODUCTION

Occupational therapy is a vital part of care for clients with RA, because occupational therapy practitioners work with the clients and teach individuals skills to remain independent in everyday occupations through coping strategies, joint protection, education, physical activity, adaptive devices, environmental modifications and how to use splints and restore joint function, range of motion, and mobility. Studies have shown that after a few sessions with an occupational therapist, patients are more mobile and able to regain their normal daily chores they could not do before for example cooking, cleaning, dressing, etc. There are several different approaches on educating a client to plan, simplify, and pace tasks as a way of protecting joints; reducing strain, fatigue, and pain; and avoiding joint and tissue overuse while participating in everyday activities (ADL). They observe the patient’s lifestyle and determine the areas where the quality of life can be improved by performing activities differently. Modification and adaptability go hand in hand with energy conservation and joint protection. Easy-grip handles, adjustable shelves, grab bars, a raised toilet seat, a chair with arms, and removal of clutter are examples of adaptive equipment and approaches that can be used to positively influence a client’s independence in their environment. These combined strategies address the clients’ functional needs and maintain or increase their participation in home, work, leisure, and community activities by accommodating for decreased joint motion, strength, and endurance. Occupational Therapy will not cure this disease, it will only help make it manageable to live with.

WHAT ARE JOINT PROTECTIONS AND ENERGY CONSERVATION TECHNIQUES?

The term ‘joint protection’ is used to describe ways to reduce stress and pain in your joints. This can help reduce inflammation and preserve your joints. Conserving your energy also helps to protect your joints and improve endurance. One study (Hammond, Jefferson, Jones, Gallagher, & Jones, 2002), which included two 2-hr face-to-face sessions and a home program, resulted in a significant increase in the use of joint protection behaviors after 3 months. Immediately after intervention, increases in grip strength, overall knowledge, and self-efficacy were seen. A 4-year follow-up of these same participants found that even though function decreased in both groups over time, the decline was steeper in the control group (Hammond & Freeman, 2004).

ENERGY CONSERVATION/JOINT PROTECTION TECHNIQUE BENEFITS TO PATIENT

Energy conservation and joint protection go hand in hand, they are treatment techniques used by occupational therapist to teach the clients on proper proactive ways to conserve energy and protect the joints. The client should Use the strongest/largest joints Available for the activity at hand, Large joints are stronger than smaller ones. The patient should Save their smaller, weaker joints for the specific jobs that only they can accomplish and favor large joints when possible. Carrying objects with the palm open, distributing the weight equally over your forearm will transfer excess weight throughout the whole arm. Such as carrying a purse or satchel over the shoulder instead of grasping it with their hands. If their shoulder is in pain, the client should use a backpack. Clients should spare their fingers as much work as possible. The client should try to avoid prolonged pinching or gripping motions. The client should Use less force to hold tools or equipment. The client should Rest their hands flat and open rather in a tight fist. The client should Push heavy objects using the weight of the body, rather than pulling or lifting. OT will educate the client on reducing the effort needed to complete an activity by adding leverage to items, such as reducing the force needed to operate a levered faucet, or door handles. Planning such as gathering all items needed before starting an activity or job, by managing workloads from heavy to light tasks throughout the day and week will lessen the load for the patient and promote energy conservation. The Clients should pace themselves to avoid Fatigue by Planning the day to allow for a balance of rest and activities, clients shouldn’t wait until they are tired before taking a rest period. Client should Sit when Possible, by Sitting and taking rest periods this eliminates considerable fatigue on the individual, if the client is having difficulty standing for a long period of time, they should use a seat in the shower, when dressing or whenever completing a task that requires long period of time standing. While sitting the client must Make sure they have good back and foot support. Their forearms and upper legs should be well-supported, resting level with the floor. The patient should Select an activity to improve; one that takes too long, one that increases fatigue or pain to work on simplification strategies. The Occupational therapist Determine if the activity is necessary and if the client is the best person suited to do it, by breaking down the activity into steps, getting ready, performing the activity, clean up after completion will help ease the patient in doing the task given. What is the best way to perform an activity using the energy conservation? Using Good Posture by Sitting and standing straight, Proper body alignment will balance the muscles out and decrease stress. Using Good Body Mechanics such as Pushing or pulling, rather than lifting will help alleviate the pressure on the joints. Sliding objects along the counter-top (pots and pans, gallon of milk, and other heaving items). Stand close to the object to be moved. Carry items close to the body, keeping your back straight. Avoid bending, reaching, twisting. If you must lift, you should do so with your leg muscles rather than your back

As occupational therapist we are thought to respect pain, no matter the level that it may be. If an activity causes joint pain, the OT will change the way that activity is being done or change the activity to a more tolerated one. Continuing the activity despite pain can damage the clients joint. Forging the activity altogether can lead to joint stiffness through lack of use. As a general guideline, if pain persists for one hour after doing an activity, consider changing the way its being done. For example: Taking frequent rest breaks. Using adaptive tools or furniture such as (Reacher, grab bars, chairs with handles, higher chairs) and alternate between sitting and stretching, and light and moderate activities, throughout the day. If the client has pain in their feet, they should wear proper shoes. The patient should Ask their doctor or occupational therapist for specific recommendations. The client should never give their joints the chance to become stiff by keeping them in a constant motion. When writing or doing handwork, the client should release their grip every 10 to 15 minutes, or when their hand feels tired. If the client works at a computer, they should do hand and thumb stretches for 10 seconds every hour, to relieve those joints. On long car trips, take breaks every hour or two so you can get out and stretch. If client travels a lot on the airplanes, they should choose aisle seats, so they can shift their legs more easily. When doing repetitive tasks, the client must change their body position every 20 to 40 minutes. The client should Reduce excess body weight, Excessive weight puts a strain on the patient’s body, especially the lower back, hips, knees and ankles. Losing weight is ideal when diagnosed with RA, this will help decrease their pain and increase their energy level throughout the day.

CONCLUDING SUMMARY

When managing Rheumatoid Arthritis there are several techniques and treatment intervention, that’ll help our patients manage pain and decrease inflammation and swelling in their joints. Educating the patient on energy conservation and joint protection precautions are two beneficial ways to help a patient in pain, by educating them on the proper ways to take frequent rest brake, use larger joints unless smaller joints are required, how to organize their daily activity in a manner where it lightens their workload, how to use proper body mechanics, proper body alignment, how to use adaptive devices to facilitate their everyday activities such as bathing, walking, sitting and many other activities, teaching the patient how to use step by step sequencing activities. A patient pain level should always be regarded and respected by OT practitioner, if pain is identified the task being completed should be modified or changed to an easier task that help alleviate the patients pain level. These techniques are key when it comes to a patient diagnosed with RA, they are great tools to help manage a patients pain and decrease there swelling and discomfort. With these methods a patient will be able to return to their daily activities such as work, school, leisure or any activities their lacking in because of their pain level.

REFERENCES

1. Gecht-Silver MR, et al. Overview of joint protection. http://www.uptodate.com/home. Accessed Jan. 28, 2015.
2. Hochberg MC, et al. Rheumatology: 2-volume set. 6th ed. Philadelphia, Pa.: Mosby Elsevier; 2015. https://www.clinicalkey.com. Accessed Jan. 28, 2015.
3. Kucukdeveci AA, et al. Inflammatory arthritis. The role of physical and rehabilitation medicine physicians. The European perspective based on the best evidence. A paper by the UEMS-PRM section professional practice committee. European Journal of Physical and Rehabilitation Medicine. 2013;49:551.
4. This work is based on the evidence-based literature review completed by Janet Poole, Ph.D., OTR/L, FAOTA, Patricia Siegel, OTD, OTR/L, CHT, Marian C. Arbesman, PhD, OTR/L, FAOTA, Melissa J, Tencza, B.S., MOTR/L, and Beverly Apodaca, MOTR/L.
5. Centers for Disease Control and Prevention. (2010). Arthritis: Meeting the challenge: At a glance 2010. Retrieved December 27, 2010, from
6. http://www.cdc.gov/chronicdisease/resources/publications/aag/arthritis.htm 2. Boutaugh, M. L. (2003). Arthritis Foundation community-based physical activity programs: Effectiveness and implementation issues. Arthritis Care and Research, 49(3), 463–470

Rheumatoid Arthritis is an autoimmune inflammatory disease that mainly affects joints in the hands and feet but can affect other joints such as the hips and knees [1]. An autoimmune disease is a disease where your immune system attacks its own body. In Rheumatoid arthritis the immune system attacks the synovium of the joints and can destroy the cartilage and the bone. [2]. Inflammation may become visible on the joints of the hands and feet. Rheumatoid Arthritis may also affect other organs like the heart and kidneys.

When people think rheumatoid arthritis you automatically think older people, but it occurs in people of all ages. Women are up to three times more likely to develop rheumatoid arthritis than men [3]. There is no known cause for rheumatoid arthritis, but there some risks factors that may contribute. People with this condition see a specialist called a rheumatologist.

Symptoms of rheumatoid arthritis include fatigue, swelling, stiffness in the joints [4]. Sometimes it can be very painful to do simple tasks such as holding a toothbrush or just simply getting out of bed. People with RA suffer from fatigue and tiredness. Knowing somebody very close to me struggle with this disease is very eye opening. We take a lot of things for granted something as simple as tying your shoes can be a challenge for a person with RA.

Unfortunately, there is no cure for rheumatoid arthritis. Therefore, it is best to diagnose and start treatment an early stage to be able to stop the progression of the disease. The goal is to have the disease go into remission. If not treated the hands and feet may become deformed. This may limit the ability to live a normal life as we know it.

Drugs used to treat RA include biological therapies, steroids, and combinations of biological drugs [5]. Biologics is usually the treatment of choice. Older drugs such as methotrexate may cause more side effects. At times biologics must be paired up with older drugs for them to work. The goal of biologics is to stop inflammation. Biologics reduce the number of white cells into the rheumatoid joints [6]. Biologics are usually injected or are given through an IV. Biologics may take a few weeks, or it may take days for a person to feel the change. Some people may even go into remission using biologic therapies. When a person goes into remission it means that they do not have flares. Flares usually consist of the joints becoming swollen and stiff. People may have trouble performing daily activities. People can limp when they walk, they can have trouble closing or grasping their hands. Flares can last anywhere from days to weeks. Unfortunately, biologics do not work on everybody. For Some people it may take years to find the right drugs. Like all drugs biologics may cause side effects. The immune system becomes compromised and the person is more prone to infections.

Biologic drugs are generally very expensive. Therefore, if somebody does not have health insurance or the funds to pay for it, they must find other methods that may not be as effective to treat their condition [7]. If the drugs being used to treat RA are not working and there has been joint damage surgery may be needed to alleviate pain and have better movement.

People who have RA must adjust their lifestyles because now they may have physical limitations. Some people may even adjust their diets to foods that are high in antioxidants because they may reduce inflammation [8]. Keeping a healthy weight is also very important to keep inflammation down. Some people try to find natural remedies to ease pain and inflammation. Exercise is very important to keep the joints from feeling stiff. It is also very easy for somebody who has RA to fall into depression. Being diagnosed with a chronic illness is lifechanging. For people who have this disease there are support groups that they can join. There are social media support groups, forums, blogs.

In conclusion Rheumatoid Arthritis is a chronic, debilitating autoimmune disease. If not treated on time it may cause deformation on the hands and feet. There is not a cure for this disease, but there are drugs that may help stop the diseases from progressing. There are also lifestyle changes that people can make to try and reduce the inflammation and pain. For people needing help on coping with the disease may look into support groups. Science is constantly evolving and hopefully one day there can be a cure for this disease.

Bibliography

1. Gavrilă, B. I., Ciofu, C., & Stoica, V. (2016). Biomarkers in rheumatoid arthritis, what is new?. Journal of medicine and life, 9(2), 144.
2. Feldmann, M., & Maini, R. N. (2001). Anti-TNFα therapy of rheumatoid arthritis: what have we learned?. Annual review of immunology, 19(1), 163-196.
3. Eustice, C. (2019, October 10). Why Is Arthritis More Prevalent and Rising in Women? Retrieved from https://www.verywellhealth.com/women-are-more-affected-by-arthritis-than-men-189339.
4. Gargiulo, G. (2019). TREATING PATIENTS WITH Autoimmune Conditions. PT in Motion, 11(10), 20–28. Retrieved from http://search.ebscohost.com.lscsproxy2.lonestar.edu/login.aspx?direct=true&AuthType=ip,cpid&custid=s1088435&db=rzh&AN=139298762&site=ehost-live
5. Heidari B. (2011). Rheumatoid Arthritis: Early diagnosis and treatment outcomes. Caspian journal of internal medicine, 2(1), 161–170.
6. Taylor MA, PhD, P. C. (2013). nras Nationa Rheumatoid Arthritis Society Biologics,The Story So Far. Biologic Therapies, 1–8. Retrieved from https://www.nras.org.uk/data/files/Publications/Biologics-.pdf
7. Freeman MD, J. (2018). RA Treatment Costs: What are the Costs of RA Medications and Surgery? RA Treatment Costs: What Are the Costs of RA Medications and Surgery?
8. Ezerioha, MD, M. (2018, October 27). Life with RA: What Will My Quality of Life Be Like? Retrieved from https://www.rheumatoidarthritis.org/living-with-ra/.

Reactive arthritis is a disease classified as autoimmune, which usually manifests itself through pain or inflammation of the joints. These symptoms are the main ones with which the body responds as a reaction to an infection, which usually begins in the intestine or in the urinary or genital tract. The most common are Chlamydia. Although it is also possible to have the disease by herpes zoster or salmonella.

It is usual that people with this pathology tend to have several outbreaks throughout their lives with greater or lesser intensity, having to follow the treatments over and over again. But is reactive arthritis cured?

Does reactive arthritis have a cure?

Reactive arthritis is a disease that, in reality, has no cure . The only thing that happens is that the different treatments allow treating it and alleviating its symptoms quite effectively. In this way, you can have a first outbreak and feel totally well in the maximum period of six months. However, this recovery does not mean that you have healed. Do not forget that it is an autoimmune disease.

The possibility of new buds appearing is high, although in each person they are shown with a different periodicity. In some cases the different episodes have occurred with a difference not only of months, but of years. However, in other people, the symptoms do not end up ever disappearing, even if they are better, which leads to mild arthritis. But other situations have also been detected in which the symptomatology has become chronic. At this point, arthritis is serious and can cause joint damage. Also, when you are already in this stage, it is more difficult to deal with.

Treatment of reactive arthritis

If you have reactive arthritis, it is most likely that the doctor has prescribed a treatment that will focus on alleviating the symptoms. Probably, you will be taking antibiotics to deal with the initial infection that has caused this disease.

The treatment is usually completed with non-steroidal anti-inflammatories to reduce inflammation and also reduce pain in the joints. In some cases, patients require psychological support to cope with the disease by the shock that usually causes their diagnosis.

Natural treatment for reactive arthritis

Normally, doctors also recommend following a healthy life based on exercise and following a good diet. Actually, there are no scientific studies that corroborate 100% the benefits of these guidelines, but patients indicate that they feel better.

Physical activity focuses on performing a series of exercises to keep the joints moving and muscle strength, which indicates a physiotherapist. As for food, it is recommended to take fish oils because they are considered to have a positive effect on the joints, reducing pain and inflammation.

Symptoms of reactive arthritis

In general, if reactive arthritis has been detected in time and treatment has been followed, the person will normally be ill for a couple of weeks, although most patients have to continue with their medicines for three months. In these cases, it is usual that only small discomforts remain that do not hinder the day to day.

Anyway, we must take into account that about 30% of cases develop chronic symptoms . This requires other types of treatments, which are usually applied in injectables. They are already more serious cases.

Phases and outbreaks of reactive arthritis

As we have mentioned previously, reactive arthritis is a recurrent disease. That is, its symptoms can appear several times throughout the life of the person. On the possible causes that trigger the new outbreaks, there is much ignorance.

Sometimes, they can be produced as a new reaction to another infection, although in many cases there is no direct relationship with any cause. Anyway, all people who have been diagnosed with reactive arthritis have to be careful with food to avoid poisonings in this way, as well as with sex so that new infections do not occur and cause relapses.

With these explanations, we hope in one way to have answered your question about whether reactive arthritis is cured. We recommend that you always consult a doctor and, if you have any symptoms or doubts, go quickly to a health center to carry out the necessary study and to know if you have this disease or not.

This article is merely informative, in a HOW we do not have the power to prescribe any medical treatment or make any kind of diagnosis. We invite you to go to a doctor in case of presenting any type of condition or discomfort.

Reactive arthritis or Reiter’s syndrome

The reactive arthritis, formerly known as the Reiter ‘s syndrome is a form of arthritis that affects the joints, eyes, urethra and skin.

The disease is recognized by various symptoms in different organs of the body that may or may not appear at the same time. It can manifest quickly and severely or more slowly, with sudden remissions or recurrences.

Reactive arthritis mainly affects sexually active males between the ages of 20 to 40 years. People with HIV (human immunodeficiency virus) are at particularly high risk.

What causes reactive arthritis?

The cause of reactive arthritis is still unknown, but research suggests that the disease is caused, in part, by a genetic predisposition: Approximately 75% of those with the condition have a positive blood test for the genetic marker HLA- B27

• In sexually active males, most cases of reactive arthritis follow infection with Chlamydia trachomatis or Ureaplasma urealyticum, sexually transmitted diseases transmitted by both sexes.
• In other cases, people develop symptoms after an intestinal infection with bacteria such as Shigella, Salmonella, Yersinia or Campylobacter.
• In addition to using condoms during sexual activity, a preventive measure for reactive arthritis is not known.
• The first symptoms of reactive arthritis are pain when urinating and a discharge from the penis if there is inflammation of the urethra. Diarrhea can occur if the intestines are affected.
• This is followed by arthritis from 4 to 28 days later that usually affects the fingers and toes, ankles, hips and knee joints. Usually, only one or some of these joints can be affected at the same time. Other symptoms include

Diagnosis

The diagnosis of reactive arthritis can be complicated by the fact that the symptoms often occur several weeks apart. A doctor can diagnose reactive arthritis when the patient’s arthritis occurs along with or shortly after the inflammation of the eyes and the urinary tract and lasts a month or more.

There is no specific test for the diagnosis of reactive arthritis, but the doctor can check the urethral discharge for sexually transmitted diseases. Stool samples can also be examined for signs of infection.

Blood tests of patients with reactive arthritis are usually positive for the genetic marker HLA-B27, with a high white blood cell count and an increase in the rate of erythrocyte sedimentation (ESR) – both signs of inflammation. The patient may also be slightly anemic (with very few red blood cells in the blood).

Joint X-rays do not usually reveal any abnormality unless the patient has had recurrent episodes of the disease. On an x-ray examination, joints that have been repeatedly inflamed may show areas of bone loss, signs of osteoporosis , or bone spurs.

The joints in the back and pelvis can show abnormalities and damage of reactive arthritis.

How is reactive arthritis treated?

Bacterial infections, such as chlamydia, will have to be treated with antibiotics. Joint inflammation of reactive arthritis is usually treated with nonsteroidal anti-inflammatory drugs (NSAIDs), such as naproxen, aspirin, or ibuprofen. Skin rashes and inflammation of the eye can be treated with steroids.

People with chronic diseases can choose other medications, including methotrexate. Patients with chronic arthritis can also be referred to a physical therapist and are advised to exercise regularly.

What is the perspective for people with reactive arthritis?

The prognosis of reactive arthritis varies. Most people recover in three to four months, but about half have relapses for several years.

Some people develop complications that can include inflammation of the heart muscle, inflammation with stiffness of the spine, glaucoma, progressive blindness, anomalies in the feet, or the accumulation of fluid in the lungs.

It is important to be aware of your genetic background and family health history because there may be diseases/conditions that you may not have to fully endure if you research early on. There are many ways to prevent or put off health conditions that are genetic. Two of those that are common in my family background are arthritis and high blood pressure.

The first condition I researched was arthritis. Arthritis is the inflammation of the joints, typically found in people of older age. The causes of arthritis vary from your family history, gender, age, and previous joint injury. You could just be unlucky and be more prone to developing arthritis depending on your genetic background. Your sex also plays a role in which type of arthritis you develop: it is said that women are more likely than men to get rheumatoid arthritis, and men tend to have a higher percentage of gout arthritis. Your probability of developing arthritis greatly increases as your age does. It is also generally common that people who have previously injured a joint, however, that may be, are more susceptible to developing arthritis in that joint. Signs and symptoms of arthritis mainly involve pain, stiffness, swelling, or redness of your joints, depending on which type of arthritis you have. There is a variation of long-term complications pertaining to arthritis, such as making it an unbearable task to do day-to-day activities such as bending and exercising, some as severe as comfortably sitting up straight. There are treatments that you can undergo to help with your arthritis, but there is no end-all cure to it. The main goal of arthritis treatments is to reduce the pain, manage the symptoms, and improve your quality of life based on your arthritis. There is an exponential number of things you can do to help prevent arthritis. A few are exercise, avoiding injury, and controlling your weight. Exercising helps to strengthen the muscles around your joints and release the stress of excess weight upon your joints. As you get older, your joints begin to wear out and need to be properly monitored. It would help to use the right safety equipment whether you’re playing a sport, like wearing knee pads while you skateboarding. Controlling your weight is a large factor in how severely arthritis affects you. Being overweight, or obese greatly inhibits your pain level with each step you take, the force on your knee multiplies by several factors. Overall, there are several ways that can help you to avoid/prevent the development of arthritis, but it is a crucial condition that affects millions of people worldwide.

The second health condition I researched was high blood pressure. High blood pressure is typically one of the more curable and common issues. It is when your pressure spikes to dangerous or unhealthy levels. There are two types of high blood pressure: primary hypertension and secondary hypertension. For primary hypertension, there is no evident cause of high blood pressure, it just tends to moderately develop as you get older. For secondary hypertension, it is caused by a fundamental condition. There are a few behavioral conditions that put you at risk of secondary hypertension, such as drugs (cocaine, amphetamines), over-the-counter pain relievers, and medications. You are more at risk of high blood pressure if it is common to run in your family also. Stress, greasy and salty diets, drugs and not being physically active are all underlying causes of high blood pressure. A beneficial way of curing high blood pressure is to maintain a healthy diet, salty and greasy foods put you at a high risk of high blood pressure. Exercising the right amount allows you to feel good and also keeps your heart healthy. And dealing with stress in a healthy manner, as in not relying on drugs and alcohol, also help your risk. All of these are great ways to help prevent yourself from high blood pressure.

This assignment was eye-opening and beneficial because it exposes me to the right resources to better myself in a way that I may have never thought to do. I learned that there are a lot of day-to-day things that can put me at risk for common diseases/certain conditions. To help prevent these diseases from affecting me, I could do basic things such as maintaining a healthy diet, exercising daily, staying away from harmful drugs, and being cautious in my actions and activities that may affect my health in a dangerous way.

For this essay, I chose the article called ‘Nightmare Disorder and REM Sleep Behavior Disorder in Inflammatory Arthritis: Possibility Beyond Neurodegeneration’ by Luca Baldelli because I would like to learn more about sleep behavior disorders in general, and the cases found due to sleep behavior disorders.

Back when I was in high school, I never slept late like the other kids at my school. I would sleep at 10 o’clock and wake up at 6 in the morning to get ready for school, and when I got home, I would sit on my bed while doing homework and accidentally fall asleep till 7 or 8 at night and realize I had fallen asleep. I did not know why I fell asleep when I came home from school since I had at least 8 hours of sleep, which is how much a normal person should be having every night. As time went by, during high school, I had trouble falling asleep during the night. I would stay up till 3 to 4 not knowing why I could not sleep. I did not know much about sleeping disorders, but I became interested in sleeping disorders when I started to have sleeping problems during high school, and which made me more interested was when I took an AP psychology class and learned a few things about sleeping disorders, and I picked this topic to get to know more about sleeping disorders in general.

Sleeping disorders relate to healthcare because studies show that insufficient sleep increases a person’s risk of developing serious medical conditions, such as obesity, diabetes, and cardiovascular disease, which have been associated with a shortened lifespan. The objective of this experiment is meant for patients who have inflammatory arthritis (IA) to test out if it messes up with their REM sleep behavior which is the protoconsciousness theory and ‘if RBD could be an internal red flag signaling a fluctuating state of inflammation based on the theory of ‘protoconsciousness” (Baldelli et al., 2019, para. 1). The protoconsciousness theory is the continuity of consciousness throughout life, especially during REM sleep dreaming. This experiment was conducted from April 2014 to November 2016, and they recruited 103 patients with a confirmed diagnosis of IA, attending the patient clinic of medicine and rheumatology unit and with the ages between 20 and 75 years old. They had to have a history of “alcohol or drug abuse/dependence, chronic use of antidepressants at the time of the visit, and documented neurological diseases” (Baldelli et al., 2019, para. 10). After they all underwent neurological evaluations, a neurologist investigated RBD and REM sleep parasomnias, and all patients signed the informed consent form. A neurologist investigated the temporal relationship between RBD onset and IA activity. “Sleep quality was assessed with the Pittsburgh Sleep Quality Index, while the risk of obstructive sleep apnea syndrome (OSAS) was evaluated with the Berlin questionnaire. Beck Depression Inventory-II and State‐Trait Anxiety Inventory investigated depression and anxiety” (Baldelli et al., 2019, para. 2).

The results of the experiment had a “mean age of 53.7 ± 14.6 years, 65% were women; 57.3% were in a clinically active phase of IA” (Baldelli et al., 2019, para. 3). Throughout the whole process, 31 patients had positive results of nightmare disorder, 8 patients had repetitive sleep paralysis, 65 patients reported poor sleep quality, 25 resulted in high risk of OSAS, and finally 32 patients scored positively for depression or anxiety.

After the experiment, 88 patients underwent a specific treatment for IA. 42 were in therapy with standard diseases such as drugs. 28 used biological and 18 used both, but patients who did not do the anti-inflammatory therapy showed more usage of steroids in RA patients. This experiment did not conclude whether the IA was the result of REM sleep disorders. I think they did a great job on the experiment, but it did not result in knowing if the REM sleep behavior is the effect of inflammatory arthritis.

In conclusion, to healthcare, there are no results in this experiment, but it still explains that REM sleep disorders with inflammatory arthritis do not result in REM sleep disorders.