To explain the development of fibromyalgia syndrome (FS) in mothers with the focus on its association with posttraumatic growth (PTG), it is necessary to refer to the adult attachment theory and the PTG theory that reflects the principles of the resilience theoretical model. According to the premises of the attachment theory, adults are inclined to develop stable emotional relations with people to feel support and safety. On the contrary, while coping with difficulties, people can choose the avoidant attachment style and limit their communication with relatives.
Close people’s behavioral responses play a key role in determining whether a person can feel safe (Forsythe, Romano, Jensen, & Thorn, 2012). Thus, this theory provides an appropriate framework for explaining how FS can influence the atmosphere in the family with the focus on relationships between partners, as well as relationships between parents and children. When a mother in the family suffers from FS, she can demonstrate different attachment styles depending on the presence or absence of PTG.
The problem of FS can also be discussed from the perspective of the PTG theory based on the idea of resilience. According to this theory, the recovery from pain and other symptoms is often associated with positive emotions and changes in viewing illnesses. McAllister, Vincent, Hassett, Whipple, and Oh (2015) note that this recovery or improvement in the physical and emotional state can be associated with the person’s resilience.
This theory asserts that if a person experiences many positive emotions and increases one’s resilience, psychologists can expect decreases in the pain and development of PTG. In this research, it is possible to predict that women with FS can demonstrate different attachment styles that influence the development of PTG and further positive changes in these women’s daily life.
Contributions to Theory
The research can contribute to the existing literature on FS and PTG discussed in the context of families and the role of syndromes on persons’ lifestyles and family relations. Although the literature on FS is detailed and there is research on specific features of this syndrome, a few studies can provide the answers to the relationship between FS in women, PTG, and their lifestyles, as well as relations in the family.
The current research is important to demonstrate that women or mothers with FS who have signs of PTG can recover from the illness more successfully, the level of the chronic pain can decrease, and the overall quality of the life can increase (Thieme, Turk, Gracely, & Flor, 2016). The research is also important to conclude that the adult attachment theory and the PTG theory can be used by psychologists and healthcare providers to explain how the development of PTG in female patients can lead to improving the physical and emotional state associated with FS.
Therefore, the current research contributes to the discussion of the problem of FS from the new perspective. The contribution is related to discussing not only the relationship between the syndrome and the family life but also the relationship between FS and PTG with the further effects on the daily life of females suffering from such symptoms as chronic pain, fatigue, and sleepiness among other symptoms. Recently, researchers have discussed FS while applying minimum theories and focusing on challenges experienced by women with FS in their life (Juuso, Skar, Olsson, & Soderberg, 2013). Still, the research proposes a more holistic approach to studying the problem and contributes to the theory.
Theoretical Implications
Past studies suggest that FS develops as a result of the impact of biological, psychological, and socio-cultural factors among others. Therefore, much attention should be paid to analyzing all these factors to explain what treatment can be effective to reduce symptoms (Di Tella, Castelli, Colonna, Fusaro, & Torta, 2015). In its turn, PTG is regarded by researchers as a positive change in the emotional state of persons suffering from traumas or illnesses among other problems.
PTG is discussed concerning FS only in the limited number of studies, including the research by McInnis, McQuaid, Bombay, Matheson, and Anisman (2015). This current research has important theoretical implications because it proposes a complex view regarding the relationship between FS, PTG, and women’s daily experiences in their families. Also, it is important to note that this research is focused on examining the unique experiences of mothers who suffer from FS and have problems with developing their family relationships.
This research covers the gap in the existing literature regarding the examination of the possible correlation between FS and PTG in mothers with the focus on studying the positive impact of this relationship on their daily activities and family bonds (Juuso et al., 2013). The findings of this study are important to demonstrate that such a relationship exists, and the progress in terms of PTG in women with FS can be an indicator of the further positive changes in personal life and family relations. These conclusions and implications add to the existing literature on fibromyalgia and posttraumatic growth while illustrating how positive changes in the woman’s emotional state can cause desired changes concerning FS.
Practical Implications
The results of this research have important practical implications for psychologists, therapists, and healthcare providers working with women who are diagnosed with fibromyalgia. First, it is important to note that the research is aimed to support the positive correlation between the development of PTG and reduction in symptoms associated with FS.
These results are important to be taken into account by practitioners to propose therapies to develop PTG to females who suffer from FS (Thieme et al., 2016). Currently, the information regarding the implementation of therapies to address FS concerning PTG is limited, and this research allows for paying more attention to the role of posttraumatic growth for the recovery from FS or for the reduction of symptoms.
Also, this research is important to be used to improve practices associated with working with females suffering from FS and families where women have the syndrome to affect the relationships with partners and children. The study indicates that FS can have a significant negative impact on the dynamics of family relations, and the results of the research should be used by psychologists and other practitioners to integrate PTG in the therapy and design effective counseling sessions.
The purpose of such practices should be the improvement of the family life, and this research can also be referred to by practitioners to apply the principles of the adult attachment theory to practice. Therefore, the results of this research can be helpful to guide psychologists and healthcare providers in their work with women having FS, as well as with their partners and children.
References
Di Tella, M., Castelli, L., Colonna, F., Fusaro, E., & Torta, R. (2015). Theory of Mind and emotional functioning in fibromyalgia syndrome: An investigation of the relationship between social cognition and executive function. PloS One, 10(1), 1-14.
Forsythe, L. P., Romano, J. M., Jensen, M. P., & Thorn, B. E. (2012). Attachment style is associated with perceived spouse responses and pain-related outcomes. Rehabilitation Psychology, 57(4), 290-301.
Juuso, P., Skar, L., Olsson, M., & Soderberg, S. (2013). Meanings of feeling well for women with fibromyalgia. Health Care for Women International, 34(8), 694-706.
McAllister, S. J., Vincent, A., Hassett, A. L., Whipple, M. O., & Oh, T. H. (2015). Psychological resilience, affective mechanisms and symptom burden in a tertiary‐care sample of patients with fibromyalgia. Stress and Health, 31(4), 299-305.
McInnis, O. A., McQuaid, R. J., Bombay, A., Matheson, K., & Anisman, H. (2015). Finding benefit in stressful uncertain circumstances: Relations to social support and stigma among women with unexplained illnesses. Stress, 18(2), 169-177.
Thieme, K., Turk, D. C., Gracely, R. H., & Flor, H. (2016). Differential psychophysiological effects of operant and cognitive behavioural treatments in women with fibromyalgia. European Journal of Pain, 2(3), 1-12.
Arthritis simply stands for the swelling joints in the human body. There are many incidences of arthritis (Coates, 2010). A joint refers to an anatomical position in which two or more bones meet (Angelillo, 2009).
Notably, there are approximately several kinds of arthritis. Healthcare providers regard arthritis to be a mere soreness of a joint (Eustice & Zashin, 2007).
However, public health definition of arthritis is more general. It is inclusive of approximately one hundred rheumatic complications.
These conditions exclusively attack the joints (Katz, 2005). The tissues surrounding these joints may also be affected. There are notable differences in the pattern and severity of the symptoms.
Rheumatic complications frequently present with pain (O’Keeffe, Tom & Farewell, 2011). In addition, the conditions might be associated with rigidity. Particularly, this may be eminent within and around the joints.
Some rheumatic complications may also affect the immunity system of the body (Bjorklund, 2010).
Different internal organs within the body system including the immunity system may also be affected (Eustice & Zashin, 2007). Public health endeavors to analyze the occurrences of arthritis within the general population.
There are critical diagnosis procedures set within clinical settings. This helps the clinicians to assess and determine the types of arthritis complication (Coates, 2010). Arthritis is the main complication that may affect the entire human skeletal system.
Arthritis causes severe disability among individuals with approximately fifty years in age (O’Keeffe, Tom & Farewell, 2011). This trend is largely notable within the industrialized nations. It is imperative to observe that arthritis never occurs as solitary complication.
Many forms of arthritis have been identified (Busija, Buchbinder, & Osborne, 2009). Osteoporosis remains to be the most prevalent type of arthritis. Osteoporosis predominantly affects the elderly persons. It is important to examine the various or potential causes of the arthritis condition in human beings. It is important to understand the physiology of the human joints (Fox, Taylor, Yazdany, & Brewer, 2011). This because it would enable individuals to better comprehends the processes that occur whenever an individual suffers from any kind of the complication.
A joint refers to the anatomical juncture on which a specific joint moves. This movement process normally occurs on a particular bone. The ligaments present in the bone area are very important (Busija, Buchbinder, & Osborne, 2009).
This is because they assist to clutch the bones together. Notably, these ligaments appear like the elastic bands. They have eminent basic functions:
They help to position the bones within the right places.
Furthermore, their rotation is important in the operation of the skeletal system.
Their contraction helps in initiate the joint movements (Lacaille, White, Backman & Gignac, 2007).
The cartilages are also very important elements in the physiology of the human skeleton system. They cover the surfaces of the bone. The process helps to prevent the bones from fractioning straight against one another.
Generally, the cartilage covering enables the joint to operate smoothly without any pain or hardship. A capsule plays a significant role. It helps to surround the whole join of the bones (O’Keeffe, Tom & Farewell, 2011).
There is a significant space in the joint or bone cavity. It contains the synovial fluid that has a very basic role in enhancing the movement process of the whole joint and bone.
The fluid assists in the nourishment of the joint. The nourishment process also helps the cartilage (Gignac, Sutton & Badley, 2007). The synovium assists in the production of the lubricating synovial fluid.
The victims are likely to suffer from diverse symptoms. These depend on the kind of arthritis that has affected the particular individual.
There are different kinds of complications that related with the instances of occurrence of arthritis (Busija, Buchbinder, & Osborne, 2009).
Some clinical assessments have reported the wearing off of the cartilage and deficiency of the vital fluids (Mayer, Brogan & Sandborg, 2006).
Apart from this, there is a general sense of autoimmunity realized by the entire body.
There might also be instances of severe infection.
Many factors that compromise an individual’s health might also arise (Coates, 2010). Generally, arthritis is a medical complication that has increasingly become prevalent. It is important to examine some of its features, management and prevention strategies.
Common Experiences of Those Living With Arthritis (280)
Individuals suffering from arthritis undergo many experiences. The events in the daily lifestyle of patients might be appalling:
Of significance is always their inability to undertake some physical processes (Eustice & Zashin, 2007).
The rheumatoid arthritis causes severe pain. This condition might also result into swelling, stiffness and redness of the affected joints of the human body (O’Keeffe, Tom & Farewell, 2011).
Other conditions that have been associated with the complication include tenderness, as well as deformity of several affected joints in the entire body (Busija, Buchbinder, & Osborne, 2009).
Those living with arthritis undergo intensive pain. This originates from the main affected joints in the body.
They are also unable to walk properly.
Furthermore, their capacity to handle heavy physical or manual tasks is reduced significantly (To & Petri, 2005). These patients face several challenges in accomplishing daily activities.
Most victims of arthritis have suffered the deformity of their hands. Their feet are also deformed due to this complication (Clough, 2006).
The ability of these individuals to access adequate support is critical. Particularly, this is appropriate from those persons around them (To & Petri, 2005).
They need to move around, carry on their duties and take care of their hygiene. Some of these people have reported cases of severe discrimination and prejudice.
Most of the affected people are not likely to access important social services (O’Keeffe, Tom & Farewell, 2011). This occurs only when they receive an appropriate support from their caregivers.
The caregivers are mostly the relatives, close family, friends or neighbors. Others have also been admitted in support centers. In these centers, they are able to access basic psychosocial and physical assistance.
The assistances are always from trained and devoted caregivers (To & Petri, 2005). Medical personnel are also actively involved. They have characteristically gnarled fingers. A part from this, their fingers also possesses the bumps (Eustice & Zashin, 2007).
These bumps are normally referred to as nodules. Some may also suffer fused wrists. Due to this deformity, there movement capacity is potentially compromised (Gignac & Cao, 2009). These categories of patients are also highly susceptible to other common infections.
This is especially when they are not adequately cared for or attended (Busija, Buchbinder, & Osborne, 2009). Some of the infections that these categories of patients have suffered from include water and hygiene related complications.
The Appropriate Self-Management Activities
The concept of self-management in arthritis has increasingly grown popularity. The process involves taking charge of an individual’s life (To & Petri, 2005). In this process, people learn to adopt strategies to enable them live with their conditions (Crow, 2007). This is important for an individual’s emotional as well as physical wellbeing.
The process may be life transforming.
The process also encourages a platform whereby an individual is likely to admit that they suffer from arthritis (Clough, 2006).
Self-management has enabled most people suffering from arthritis to prevent the likelihood of the complication to control their lives.
The victims have to undergo thorough counseling procedures (Kobayashi, Yasui, Ishimaru, Arakaki & Hayashi, 2004). This enables them to develop the appropriate resilience to deal with the condition at personal or individual level.
Individuals must note that assuming the obligation of arthritis management remains important (To & Petri, 2005). Indeed, it is highly liberating.
Powerful initiatives to regain the locus of control of an individual’s life are vital. This is regardless of the number of years that a person has suffered from arthritis condition.
Affected individuals must be able to access appropriate education on the personal managment of arthritis. At personal level, this process may minimize the workplace stresses and depressions (Clough, 2006).
The support centers provide critical measures for individual development and management. Weight loss is one of the appropriate self-management activities for arthritis patients. The overweight individuals are more likely to suffer from the effects of arthritis.
Obesity has been indicated as a basic factor leading to the occurrence of arthritis (O’Keeffe, Tom & Farewell, 2011). Therefore, individuals must practice undertakings aimed at reducing their weight. Individuals are encouraged to conduct regular physical exercises (Eustice & Zashin, 2007).
Diet considerations are critical for arthritis patients. These processes interlink to reduce the weight of individuals. There are several initiatives in the management of arthritis. Individuals must observe these practices (Crow, 2007).
Useful Community Services to Engage With
Living with this condition might be very challenging for most victims. However, the victims must recognize the importance of engaging in constructive community services (AIHW, 2007).
There are notable psychosocial impacts of arthritis amongst various victims.
Engagement of the victims in group therapy sessions is critical. The group therapy sessions are some of the communal services that have contributed to positive coping skills (Coates, 2010).
The victims suffering from arthritis must also engage themselves in the important services aimed at reducing weight. There is importance in engaging in services that enhance positive lifestyle (Crow, 2007). The physical training centers such physical fitness facilities within the society are some of the important services.
Hospitals are significant destinations within the society (Eustice & Zashin, 2007). This is because a variety of management strategies may be offered within these areas. Therefore, they include some of the important services for the victims.
Group therapy on safe nutrition is another critical community services that require engagement.
The victims can also engage in recreational and sports activities within the community (PSA, 2012). An example is the involvement in Paralympics. This reduces the level of depression.
Victims can also take part in advocacy and campaign projects that create awareness about the condition within the community (AIHW, 2007). It is important to participate in community health education programmes.
Angelillo, M. M. D. (2009). All about arthritis: Find updated causes, symptoms, diagnostic tests, new alternative treatments. S.l: Iuniverse Inc.
Bjorklund, R. (2010). Arthritis. Tarrytown, N.Y: Marshall Cavendish Benchmark.
Busija, L., Buchbinder, R. and Osborne, R. H. (2009). Quantifying the impact of transient joint symptoms, chronic joint symptoms, and arthritis: A population-based approach. Arthritis & Rheumatism, 61 (10), 1312–1321.
Clough, J. D. (2006). Arthritis: A Cleveland Clinic guide. Cleveland, Ohio: Cleveland Clinic Press.
Coates, P. (2010). Arthritis: Exercise plans to improve your life. London: A & C Black.
Crow, M. K. (2007). Mentors and heroes: The foundation and future of rheumatology. Arthritis & Rheumatism, 56 (4), 1037–1043.
Eustice, C. & Zashin, S. J. (2007). The everything health guide to arthritis: Professional advice on managing pain, choosing the right treatment, and leading an active lifestyle. Avon, Mass: Adams Media.
Fox, B., Taylor, N., Yazdany, J., & Brewer, S. (2011). Arthritis For Dummies. Hoboken: John Wiley & Sons.
Gignac, M. A. M., Sutton, D. and Badley, E. M. (2007). Arthritis symptoms, the work environment, and the future: measuring perceived job strain among employed persons with arthritis. Arthritis & Rheumatism, 57 (5), 738–747.
Gignac, M. A.M. and Cao, X. (2009). “Should I tell my employer and coworkers I have arthritis?” A longitudinal examination of self-disclosure in the work place. Arthritis & Rheumatism, 61 (12), 1753–1761.
Katz, P. P. (2005). Use of self-management behaviors to cope with rheumatoid arthritis stressors. Arthritis & Rheumatism, 53 (6), 939–949.
Kobayashi, M., Yasui, N., Ishimaru, N., Arakaki, R. and Hayashi, Y. (2004). Development of autoimmune arthritis with aging via bystander T cell activation in the mouse model of Sjögren’s syndrome. Arthritis & Rheumatism, 50 (12), 3974–3984.
Lacaille, D., White, M. A., Backman, C. L. and Gignac, M. A. M. (2007). Problems faced at work due to inflammatory arthritis: New insights gained from understanding patients’ perspective. Arthritis & Rheumatism, 57 (7), 1269–1279.
Mayer, M. L., Brogan, L. and Sandborg, C. I. (2006). Availability of pediatric rheumatology training in United States pediatric residencies. Arthritis & Rheumatism, 55 (6), 836–842.
O’Keeffe, A. G., Tom, B. D. M. and Farewell, V. T. (2011). A case-study in the clinical epidemiology of psoriatic arthritis: multistate models and causal arguments. Journal of the Royal Statistical Society: Series C, (Applied Statistics), 60 (5), 675–699.
PSA, (Pharmaceutical Society of Australia) (2012). 1298 – A joint effort to manage arthritis. Web.
To, C. H. and Petri, M. (2005). Is antibody clustering predictive of clinical subsets and damage in systemic lupus erythematosus?. Arthritis & Rheumatism, 52 (12), 4003–4010.
Fibromyalgia is an illness characterized by an extensive musculoskeletal discomfort accompanied by exhaustion, sleep, remembrance, and attitude issues. The majority of the investigators accept it as true that fibromyalgia intensifies painful feelings by distressing the way the human brain interprets pain indications. Warning signs habitually appear after a physical trauma, surgical procedure, contamination, and other noteworthy psychosomatic traumas. In other cases, symptoms progressively accrue over time without any causing incident. The factors mentioned above validate the fibromyalgia diagnosis. Moreover, this illness is commonly diagnosed in women aged 25 and more that were exposed to a stressful situation (Castel et al., 2013). Most probably, EP struggles for the reason that she just moved to the town. It is rather reasonable to assume that she has issues connected to the adaptation and self-realization. All of EP’s complaints are implicitly hinting at fibromyalgia, but an extensive examination might be needed to obtain detailed evidence concerning the present illness.
EP stated that she would like to continue taking hydrocodone. I would discontinue prescribing this medication for several reasons. First, even though hydrocodone is effective for severe pain, opioids (hydrocodone in this particular case) do not perform as well on enduring chronic illnesses. Furthermore, as it can be seen from EP’s case, they maximize the risk of drug dependence and have been connected to other secondary effects — for instance, intensifying the body’s response to discomfort, along with sleepiness and constipation (Marcus, Bernstein, Haq, & Breuer, 2013).
Even though hydrocodone is regularly prescribed in individuals with fibromyalgia, it seems to be of partial efficacy in the utmost patients with this complaint and is commonly not suggested. Even though this medication may decrease pain and help EP improve the quality of her life, hydrocodone prescribed by her family doctor is likely to have a much more adverse impact on her health than any other medication. In this case, my task is to progressively remove opioids (hydrocodone) from the list of prescribed medications.
My treatment plan would contain medications that can help decrease the discomfort of fibromyalgia and recover EP’s sleep pattern. More precisely, the plan would include pain relievers, antidepressants, and anti-seizure drugs. When it comes to the over-the-counter painkillers, such medications as Tylenol (325 mg daily, every six hours), Advil (400 mg daily, every six hours), or Aleve (500 mg initially, then 250 mg daily, every eight hours) may be helpful (Anthony, 2015). I might also propose the prescription of Ultram (100 mg once daily).
Cymbalta (40 mg once daily) and Savella (50 mg twice daily) may help get rid of the exhaustion and pain linked to fibromyalgia. I might also prescribe amitriptyline to help EP normalize her sleep. Another recommendation for the treatment plan would be to include medications intended to treat epilepsy as they are regularly advantageous in terms of reducing definite kinds of pain. Gralise (600 mg daily) is occasionally helpful in reducing fibromyalgia warning signs. A simple therapy approach might also be helpful (Anthony, 2015). A conversation with a therapist can help support the EP’s belief in her abilities and teach her tactics for coping with traumatic conditions.
I would not recommend any of the nontraditional therapies for the reason that there is no indication of the benefits of these methods. Because fibromyalgia is quite a debatable topic in itself, it is safe to say that prescribing any of the traditional medications mentioned earlier would result in adequate patient outcomes. The changes in the lifestyle might include a personalized diet and special physical exercises designed to help EP mitigate the effects of her stress.
References
Anthony, D. (2015). Fibromyalgia: The complete guide to fibromyalgia, understanding fibromyalgia, and reducing pain and symptoms of fibromyalgia with simple treatment methods! Seattle, WA: CreateSpace.
Castel, A., Fontova, R., Montull, S., Periñán, R., Poveda, M. J., Miralles, I.,… Rull, M. (2013). Efficacy of a multidisciplinary fibromyalgia treatment adapted for women with low educational levels: A randomized controlled trial. Arthritis Care & Research, 65(3), 421-431. Web.
Marcus, D. A., Bernstein, C. D., Haq, A., & Breuer, P. (2013). Including a range of outcome targets offers a broader view of fibromyalgia treatment outcome: Results from a retrospective review of multidisciplinary treatment. Musculoskeletal Care, 12(2), 74-81. Web.
Osteoarthritis (OA) is one of the widely observed disorders that are asymptomatic, but this disease affects the quality of people’s life significantly (1-2). The purpose of this literature review is to examine how the problem of osteoarthritis was discussed in the scholarly literature during the past ten years (2006-2016) and determine what instruments were used by researchers to measure the quality of life about OA patients. Therefore, this literature review includes sections on the problem of osteoarthritis, epidemiology, risk factors, etiology, pathogenesis, diagnosis, classification of OA, the related physical functioning and quality of life, as well as methods of OA assessments and instruments used to measure the quality of life.
Osteoarthritis
Osteoarthritis is a chronic multi-factor disorder or a group of disorders that are discussed as degenerative ones, and they affect not only joints but also articular cartilage, ligaments, synovial membrane, and the subchondral bone (3). The disorder is characterized by the progress of abnormal processes in joints, as well as by the constant pain that can cause physical disability and limitations in persons’ functioning (4-5). Fists, knees, and hips are most often affected by OA (6-7). The worldwide and national study and survey results (8-9) indicate that OA is one of the most frequent disorders that are typical of elder people.
Thus, the disease is characterized by a high level of prevalence, and the development of this condition depends on the person’s age. Even though OA is observed in persons older than 65 years, today, signs of the disease are observed in individuals aged 40-45 years (1). Researchers (10-12) report that, despite the age, limitations on physical functioning and chronic pain often lead to decreases in the quality of life, as it is stated by those patients who suffer from OA.
Epidemiology
Osteoarthritis is a type of disorder that affects the physical state and functioning of elderly people, and this fact influences the epidemiologic data (11, 13). According to the international data, the adult population usually suffers from different types of OA, and other factors that can influence the development of the disease are gender, age, ethnicity, and occupation (1). As a result, OA of different joints is typical of various groups of patients (14). While referring to the data provided by Garstang and Statik (2), “approximately 30% of adults over 30 have radiographic evidence of hand OA,” and “at least 33% … of persons over 55 have radiographic evidence of knee OA. Clinically, 6% of adults over 30 have symptomatic knee OA, and 10-15% of adults over 60 have symptoms.”
In their studies, researchers refer to the data collected from different sources and nations. According to Alrushud, El-Sobkey, Hafez, and Al-Ahaideb (15), “the rate of aged persons in the world is rapidly rising, and it is estimated that it will reach 27.4% of the total population in 2025.” Therefore, OA will affect more people in different countries. In Europe and the United States, radiographic signs of OA are observed in about 80% of persons who are aged above 75 years (16). Moreover, the data regarding the US population indicate that about 20% of Americans aged 45 years suffer from OA (17).
In the Middle Eastern region, the prevalence of OA is 20% (18). In their turn, Alamri and the group of researchers (17) focused on studying the prevalence and epidemiology of OA in Saudi Arabia. According to the researchers (17), “53.3% men and 60.9% women” in Saudi Arabia suffer from knee OA. However, there are also data that, in the central and eastern regions of Saudi Arabia, knee osteoarthritis is observed only in 3.5% of cases (17). From this point, it is necessary to state what factors are discussed by researchers as associated with the development of the disorder.
Risk Factors
Researchers (8) state that risk factors associated with the development of osteoarthritis belong to two main groups: systemic and local factors. Systemic factors can be defined as systemic qualities, and they cannot be changed. These factors include gender, age, ethnicity, genetics, as well as bone density (19). Local factors are also known as biomechanical because they can develop under the impact of other factors, and they are associated with the pressure on different joints (9). These factors include obesity that is not caused by genetics or systemic diseases, joint injuries, muscle weakness, and ligamentous laxity (9, 20). The impact of the person’s occupation and professional activities is also discussed by researchers and clinicians as a local factor (21). Zhang and Jordan (22) state that, although only several joints can be affected by the disease, the disorder has the multi-factor nature, and the combination of different systemic and local factors can lead to the development of the disease. Thus, Garstang and Statik (2) state that, for example, “genetics may increase the likelihood that joint damage will progress to OA.”
In the Gulf Cooperation Council (GCC) countries, the most prevalent local factor is obesity. Asokan and the group of researchers (23) conducted the study in Bahrain, and they have found that obesity associated with the sedentary lifestyle is a cause of OA in most reported cases. Benjamin and Donnelly (24) also concentrated on studying the Arab population, and they have found that the problem is in the limited physical activity, the lack of time to pay attention to exercises, and the geographical factors among others. Ismail, Al-Abdulwahab, and Al-Mulhim (25) and Alamri et al. (17) have accentuated obesity as a risk factor for the population of Saudi Arabia. Furthermore, Mohamed, Al-Harizi, Bedewi, and Gafar (26) added vitamin D deficiency to the list of OA risk factors in Saudi Arabia.
Etiology and Pathogenesis
The multi-factor nature of OA does not allow for focusing on the concrete causes that can lead to the development of the disease in different categories of persons. When OA is caused by mainly systemic factors, including hormonal and metabolic changes, age, gender, and genetics, it is regarded as primary, and the actual cause of the problem is difficult to be determined (27). If OA is caused by traumas and mechanical factors or associated with the style of the patient’s life and occupation, it is discussed as secondary (28-29). In many cases, OA is a result of immunologic processes, traumas of a joint, and inflammatory processes in the synovial membrane. Michael, Schlüter-Brust, and Eysel (30) note that, in this case, the role of genetics and gender should also be taken into account. OA is characterized by the degeneration of articular cartilage and the development of osteophytes among other pathological processes (31). Articular cartilage is defined as a connective smooth tissue that covers bones to guarantee the movement of joints (30).
Structural changes in the subchondral trabeculae and bone are also associated with the degeneration of articular cartilage and inflammatory processes that lead to secreting specific proteolytic enzymes (28). If articular cartilage and other parts of joints are affected, their function becomes limited, causing pain and stiffness (30). The study by Hodge, Harman, and Banks (32) have demonstrated that the pathogenesis of OA depends on the ethnicity factor significantly. The authors (32) have compared the development of the disease in North American and Saudi Arabian patients and found that differences are in the degeneration of articular cartilage. These aspects influence the procedure of diagnosing the disorder.
Diagnosis
Researchers (22) state that the diagnosis of OA is a complex process that involves both clinical and radiological testing. In Kuwait, Qatar, and other GCC and Arab countries, including Saudi Arabia, clinicians continue to use conventional methods of diagnosing OA, and the popular approach to managing the severe form of this disorder is Total Knee Arthroplasty (33-39). The localization of changes in joints determines symptoms and specific signs of the disease. Therefore, Homoud (3) has stated that the diagnosis is mainly clinical since “radiographic findings do not always correlate with symptoms.”
Clinicians examine specifics of joint movements and the muscle structure to conclude regarding the problem. To diagnose OA, clinicians also refer to the rheumatic factor and measuring C‑reactive protein (3, 28). They also examine roentgen to determine the disease stage (27). Much attention is also paid to types of pain experienced by patients. To treat and manage the disorder, clinicians prescribe symptomatic drugs and corticosteroids depending on the intensity of inflammation and associated pain (1). In Saudi Arabia, the challenges in managing OA were studied by Homoud (3) who focused on assessing the competency of Saudi physicians in coping with OA to improve the patients’ quality of life. The researcher (3) has found that many physicians in Saudi Arabia are unaware of changes in the patients’ quality of life and good approaches to managing the disease.
Classification of Osteoarthritis
The absence of widely accepted OA diagnostic criteria led to problems related to classifying osteoarthritis. Clinicians are inclined to discuss OA as having two forms, such as primary and secondary types, that are associated with specific factors that provoke the development of the disease (40). However, the variety of OA forms that depend on the localization of the disease also allows for speaking about another classification of the disorder. Thus, researchers and clinicians distinguish between knee, hip, hand, and ankle OA (41). These types of OA are usually caused by different factors, and they are typical of different genders and ages. For instance, hip OA is more common for women than for men (42). To classify OA and select the appropriate treatment, clinicians apply radiological and clinical criteria.
Radiological Criteria
Radiographs are actively used to diagnose and classify OA. Different stages of OA are marked according to the radiographic findings while using certain indices. In this case, classification depends on the observation of osteophytes, sclerosis of the subchondral bone, periarticular ossicles, and alterations in the bone (22). To determine the stage, observed signs are rated from 0 to 4 to conclude regarding the severity of pathology (43). Zhang and Jordan (22) have accentuated that the use of magnetic resonance imaging (MRI) to determine alterations and structures in joints is the more appropriate radiological method than the use of standard radiographs.
Different Methods of OA Assessment
In addition to radiological criteria, clinicians also apply different assessment instruments that are useful to evaluate the state of patients’ joints. Bauer et al. (44) have shown that OA biomarkers are important to determine the stage and severity of the disease in the concrete case. In their study, Felson et al. (45) proposed to use Whole Organ Magnetic Resonance Imaging Score (WORMS) and Boston Leeds Osteoarthritis Knee Score (BLOKS) that are based on the radiological data to receive the most complex information regarding the OA patient’s state.
Hawker, Mian, Kendzerska, and French (46) and Sanghi, Avasthi, Mishra, Singh, Agarwal, and Srivastava (43) proposed measuring pain related to OA with the help of the Visual Analog Scale (VAS) for pain. Also, the researchers (46) also promoted the focus on measuring intermittent and constant osteoarthritis pain (ICOAP) to classify OA and the use of the McGill Pain Questionnaire (MPQ) and the Numeric Rating Scale (NRS) for pain. Still, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) remains to be one of the most actively used disease-specific OA tools, and it is developed to measure the functional or physical capacity, the level of the experienced pain, and the kind of stiffness (30, 47). In the context of Saudi Arabia, Alghadir, Anwer, Iqbal, and Alsanawi (48) have found that the ArWOMAC index as the Arabic version of the tool is “a reliable and valid instrument for evaluating the severity of knee OA.”
Physical Functioning
While assessing and classifying OA, clinicians pay much attention to examining the physical function of a joint to conclude regarding the patient’s state (49).
Terminology Related to Physical Functioning
In recent articles (50-51), physical functioning associated with OA is defined as an ability to perform certain physical activities. Researchers (51) state that, while discussing the physical function in the context of OA, it is important to pay attention to the notions of ‘limitation’ and ‘disability’ to understand how the factor of physical functioning can influence OA patients’ life. The limitation in physical functioning is associated with the reduced mobility of patients and the reduced range of motion about knees, hips, or hands (50). In this case, the disability is reported as the overall restriction of joints’ functionality associated with significant pain and muscle weakness (51).
Schmitt, Fitzgerald, Reisman, and Rudolph (52) have reported that the physical functioning of OA patients is directly affected by pain and joints’ instability. As a result, patients cannot perform their daily activities. These results were supported by Kwok, Vlieland, Rosendaal, Huizinga, and Kloppenburg (53) and Montero, Mulero, Tornero, Guitart, and Serrano (54) in their studies. In their recent study, Araujo and the group of researchers (49) have also examined how restrictions in the functional independence of patients caused by OA can negatively influence the quality of life. Gomes-Neto, Araujo, Junqueira, Oliveira, Brasileiro, and Arcanjo (55) conducted the study in Brazil, and they concluded that the functional capacity of patients should be assessed to discuss persons’ quality of life and propose effective interventions.
Methods of Assessment
To assess the physical functioning of OA patients and determine how the limited physical activity is correlated with the quality of life, researchers (56) propose to use not only the WOMAC but also other instruments designed to evaluate patients’ performance. Stratford, Kennedy, and Woodhouse (57) proposed to refer to physical function items in the WOMAC to measure changes in activities. Still, Dobson and the group of researchers (50) reported the use of specific performance measures and multidimensional pain questionnaires in addition to the WOMAC to determine how the pain could lead to decreasing the physical function in OA patients. In their turn, referring to the results of the study conducted in Germany, Brandes, Schomaker, Möllenhoff, and Rosenbaum (58) have proposed using the gait analysis as an appropriate tool to measure Spatio-temporal parameters and associated physical functioning. From this perspective, the measurement of physical functioning is important to conclude regarding OA patients’ quality of life.
Health-Related Quality of Life
Osteoarthritis has a significant negative impact on the patients’ health-related quality of life because of the constant pain, limitations regarding physical and social functioning, and the decreased emotional state (10). According to Fernandez-Cuadros, Pérez-Moro, and Miron-Canelo (59), the quality of life is “expressed as the degree of perception to which the disease or its treatment affects the physical, psychic, emotional and social abilities of an individual.” Chan and Wu (60) have noted that the quality of life is also associated with a specific perception of the individual’s health and life satisfaction. Thus, according to Alkan, Fidan, Tosun, and Ardıçoğlu (61), patients with OA report the poorer quality of life in comparison with other patients and healthy people.
The researchers (62-63) agree that the reduced quality of life caused by OA is associated with limited physical functioning, the inability to participate in physical activities, the inability to perform usual occupational and daily tasks, and depression. Araujo, Castro, Daltro, and Matos (49) and Kiadaliri et al. (64) also note that the progress of OA leads to worsening the patient’s state and quality of life because of impossibility to perform effectively at work, conduct everyday tasks, and develop social relationships. Furthermore, the perception of health and quality of life can be different depending on gender (65-66). According to the results of Rosemann, Laux, and Szecsenyi’s (42) study, women and men have different perceptions of OA and the associated quality of life because of biological and emotional differences. Thus, OA influences women more significantly in terms of such aspects of the quality of life as pain, mood, and well-being, but the researchers have not discussed the causes of such differences (42).
In recent studies (67, 12), there are also many discussions of approaches to reducing OA patients’ suffering and improving the quality of life. Xie et al. (12) have found that the patients’ life can improve in terms of physical and social functioning after the total knee replacement, but the patients’ emotional or mental health can remain to be unaffected. Rat et al. (68) also conducted a similar study. The researchers (68) showed that total knee replacement could have only a partial effect regarding the improvement of the patients’ quality of life.
While referring to the situation in the GCC countries, it is important to concentrate on the study by Hassanein, Shamssain, and Hassan (18). In their study, the researchers (18) have focused on measuring the quality of life-related to those OA patients who live in the United Arab Emirates. They have discussed such approaches to improving the quality of life as pain reduction by using certain types of medications (18). These methods have positive outcomes, and they lead to improving physical functioning. The situation in Qatar is reported in the study by Gerber, Chiu, Verjee, and Ghomrawi (69). The researchers (69) have found that patients with OA in Qatar report the physical disability and the poor quality of life extremely often, and there are no adequate methods to address the problem.
Crushed, El-Sobkey, Hafez, and Al-Ahaideb (15) have examined how OA can affect the quality of life of elderly people in Saudi Arabia. The researchers (15) have shown that their findings are similar to the results demonstrated by authors from other countries in terms of accentuating the decreased levels of quality of life because of the constant joint pain and limited movements. Still, the researchers (15) have found that, for Saudi OA patients, the decreased quality of life is more associated with the affected mental and emotional health rather than with physical health. In their recent study, Alamri and the group of researchers (17) have also concentrated on the context of Saudi Arabia. The researchers (17) focused on discussing the quality of patients’ life in terms of life expectancy associated with OA and chronic pain, as well as the intensity of the experienced pain. The researchers (17) have stated that such conditions can lead not only to decreasing the quality of life but also to increased mortality among OA patients in Saudi Arabia. From this point, it is important to discuss what measures of the quality of life for OA patients are accepted to conclude regarding outcomes.
Measures of Health-Related Quality of Life
Researchers (51, 70) determine such measures related to the quality of life as the experienced pain, physical functioning, physical mobility, social functioning, social isolation, sleep, mood, levels of energy, emotional state, and mental health. It is possible to measure the quality of life with the help of generic survey instruments and questionnaires, as well as with the help of specific health and disease questionnaires. Generic instruments aim to measure the effects of any disease on the patients’ general health and activities.
Disease-specific questionnaires measure the impact of OA on specific domains of the patient’s health. The 36-Item Short-Form Health Survey (SF-36) is one of the most popular generic tools, and the WOMAC is the most widely used disease-specific tools for assessing OA patients and their experiences (11). Different translated versions of the WOMAC are available to researchers and clinicians from different countries (71). Disease-specific questionnaires can also be different depending on the type of OA. Therefore, for assessing knee OA, researchers and clinicians use the Oxford Knee Score (OKS), the Knee Society Clinical Rating Scale (KSS), and the Osteoarthritis Knee and Hip Quality of Life (OAKHQOL) questionnaire (63). Knee Injury and Osteoarthritis Outcome Score (KOOS) is another popular disease-specific tool that is appropriate to measure pain and activities related to knee joints (72-73).
In their study, Rosemann, Laux, and Szecsenyi (42) used the Patient Health Questionnaire (PHQ-9) to measure the level of depression in OA patients and conclude regarding the quality of life. Saffari and the group of researchers (63) chose to focus on the Lequesne index applied in combination with the Arthritis Impact Measurement Scale 2 (AIMS2) to analyze the quality of the patients’ life. The Nottingham Health Profile (NHP) was successfully used by Aksekili, Fidan, Alkan, Alemdar, Aksekili, and Ardıçoğlu (74). To conduct the study in Turkey, Esenyel, İçağasıoğlu, and Esenyel (75) selected the Quality of life questionnaire of the European Foundation for Osteoporosis (QALEFFO-41).
Different tools are also popular in the GCC region, and while conducting the OA study in the United Arab Emirates, Al-Jaziri and Mahmoodi (76) selected the simple pain scale. On the contrary, for the study in Saudi Arabia, Vennu and Bindawas (77) chose the KOOS and focused on measuring lifestyle characteristics using this instrument. However, disease-specific questionnaires often include only one section related to the quality of life, and many clinicians prefer to use generic instruments.
Short Form-36 Questionnaire
The 36-Item Short-Form Health Survey (SF-36) is one of the most actively used generic instruments proposed in the form of a questionnaire to measure how persons perceive their health state with the focus on eight domains, such as physical functioning, social functioning, physical role, pain, vitality, general health, mental health, and emotional health (78). Respondents are expected to rate their answers from 0 to 100, and the higher score means better health (79-81). The questionnaire is effective to be used in musculoskeletal studies, as well as the orthopedic research (82). While applying the questionnaire, it is possible to receive a detailed description of the health condition with the focus on the aspect of the quality of life (61, 83). SooHoo, Vyas, Samimi, Molina, and Lieberman (84) compared the use of the WOMAC and the SF-36 to conclude regarding the appropriateness of disease-specific and generic instruments to evaluate the quality of life in OA patients. They have found that the SF-36 can demonstrate results that are close to the WOMAC findings. Thus, researchers (59, 85) view the SF-36 questionnaire as a reliable and valid instrument because it is typically used to measure the impact of different chronic conditions with the focus on diverse population groups.
In their study, Xie et al. (12) used the SF-36 questionnaire to measure how the total knee replacement could improve the quality of life in Asian patients. Coleman, Briffa, Carroll, Inderjeeth, Cook, and McQuade (86) used the SF-36 questionnaire to test the Osteoarthritis of the Knee Self-Management Program proposed for Australian patients to improve their experience, physical functioning, and the quality of life. Fernandez-Cuadros, Pérez-Moro, and Miron-Canelo (59) applied the questionnaire for assessing the impact of knee arthroplasty on the patients’ quality of life in the context of Spain. Hassanein, Shamssain, and Hassan (18) conducted the study in the context of the United Arab Emirates, and they selected to use the SF-36 instead of the WOMAC because of the necessity to assess the variety of aspects related to the patients’ quality of life.
Summary
The review of the recent literature in the field of osteoarthritis studies conducted globally and in the GCC countries demonstrates that researchers are inclined to determine a direct relationship between OA and decreases in quality of life. Therefore, clinicians and researchers choose the variety of assessment methods to measure OA symptoms and the quality of patients’ life. Much attention is paid to assessing the health-related quality of life with the help of an SF-36 questionnaire.
References
Avdić D, Pecar D, Mujić-Skikić E, Pecar E. Osteoarthritis, application of physical therapy procedures. Bosn J Basic Med Sci. 2006 ;6(3): 84-88.
Garstang SV, Stitik TP. Osteoarthritis: epidemiology, risk factors, and pathophysiology. Am J Phys Med Rehabil. 2006 ;85(suppl 11): s2-s11.
Homoud AH. Knowledge, attitude, and practice of primary health care physicians in the management of osteoarthritis in Al-Jouf province, Saudi Arabia. Niger Med J. 2012;53(4): 213-219.
Cook C, Pietrobon R, Hegedus E. Osteoarthritis, and the impact on the quality of life health indicators. Rheumatol Int. 2007 ;27(4): 315-321.
Slatkowsky‐Christensen B, Mowinckel P, Loge JH, Kvien TK. Health‐related quality of life in women with symptomatic hand osteoarthritis: a comparison with rheumatoid arthritis patients, healthy controls, and normative data. Arthritis Care Res. 2007 57(8): 1404-1409.
Hawamdeh ZM, Al-Ajlouni JM. The clinical pattern of knee osteoarthritis in Jordan: a hospital-based study. Int J Med Sci. 2013;10(6): 790-801.
Neuprez A, Bruyère O, Maheu E, Dardenne N, Burlet N, D’Hooghe P, et al. Aesthetic discomfort in hand osteoarthritis: results from the LIège Hand Osteoarthritis Cohort (LIHOC). Arthritis Res Ther. 2015;17(1): 346-354.
Driban JB, Lo GH, Eaton CB, Price LL, Lu B, McAlindon TE. Knee pain and a prior injury are associated with increased risk of a new knee injury: data from the osteoarthritis initiative. J Rheumatol. 2015;42(8): 1463-1469.
Silverwood V, Blagojevic-Bucknall M, Jinks C, Jordan JL, Protheroe J, Jordan KP. Current evidence on risk factors for knee osteoarthritis in older adults: a systematic review and meta-analysis. Osteoarthr Cartil. 2015;23(4): 507-515.
Gonzalez Sáenz de Tejada M, Escobar A, Herrera C, García L, Aizpuru F, Sarasqueta C. Patient expectations and health-related quality of life outcomes following total joint replacement. Value Health. 2010;13(4): 447-454.
Kawano MM, Araújo IL, Castro MC, Matos MA. Assessment of quality of life in patients with knee osteoarthritis. Acta Ortop Bras. 2015;23(6): 307-310.
Xie F, Lo NN, Pullenayegum EM, Tarride JE, O’Reilly DJ, Goeree R, et al. Evaluation of health outcomes in osteoarthritis patients after total knee replacement: a two-year follow-up. Health Qual Life Outcomes. 2010;8(1): 87-93.
Blagojevic M, Jinks C, Jeffery A, Jordan KP. Risk factors for onset of osteoarthritis of the knee in older adults: a systematic review and meta-analysis. Osteoarthr Cartil. 2010;18(1): 24-33.
Johnson VL, Hunter DJ. The epidemiology of osteoarthritis. Best Pract Res Clin Rheumatol. 2014;28(1): 5-15.
Alrushud AS, El-Sobkey SB, Hafez AR, Al-Ahaideb A. Impact of knee osteoarthritis on the quality of life among Saudi elders: a comparative study. Saudi J Sports Med. 2013;13(1): 10-18.
Allen KD, Golightly YM. Epidemiology of osteoarthritis: state of the evidence. Curr Opin Rheumatol. 2015;27(3): 276-289.
Alamri WM, Alamri AJ, Aljohani LZ, Almohammdi AF, Saber MS, Jamal R. Prevalence and risk factors of osteoarthritis in Madinah, Saudi Arabia, 2015. IJSR. 2016;5(2): 5-12.
Hassanein M, Shamssain M, Hassan N. Health related quality of life among osteoarthritis patients: a comparison of traditional non-steroidal anti-inflammatory drugs and selective COX-2 inhibitors in the United Arab Emirates using the SF-36. Pharmacol Pharm. 2015;6(4): 232-240.
Reynard LN, Loughlin J. Genetics and epigenetics of osteoarthritis. Maturitas. 2012;71(3): 200-204.
Musumeci G, Aiello FC, Szychlinska MA, Di Rosa M, Castrogiovanni P, Mobasheri A. Osteoarthritis in the XXIst century: risk factors and behaviours that influence disease onset and progression. Int J Mol Sci. 2015;16(3): 6093-6112.
Fransen M, Bridgett L, March L, Hoy D, Penserga E, Brooks P. The epidemiology of osteoarthritis in Asia. Int J Rheum Dis. 2011;14(2): 113-121.
Zhang Y, Jordan JM. Epidemiology of osteoarthritis. Clin Geriatr Med. 2010;26(3): 355-369.
Asokan GV, Hussain MS, Ali EJ, Awate RV, Khadem ZK, Al-Safwan ZA. Osteoarthritis among women in Bahrain: a public health audit. Oman Med J. 2011;26(6): 426-431.
Benjamin K, Donnelly TT. Barriers and facilitators influencing the physical activity of Arabic adults: a literature review. Avicenna. 2013;8(1): 1-12.
Ismail AI, Al-Abdulwahab AH, Al-Mulhim AS. Osteoarthritis of knees and obesity in Eastern Saudi Arabia. Saudi Med J. 2006;27(11): 1742-1744.
Mohamed GA, Al-Harizi WM, Bedewi MA, Gafar HH. Vitamin D deficiency in knee osteoarthritis and its relationship with obesity in Saudi Arabia. Life Sci. 2015;12(2): 1-12.
Krasnokutsky S, Attur M, Palmer G, Samuels J, Abramson SB. Current concepts in the pathogenesis of osteoarthritis. Osteoarthr Cartil. 2008;16(suppl 1): s1-s3.
Sandell LJ. Etiology of osteoarthritis: genetics and synovial joint development. Nat Rev Rheumatol. 2012;8(2): 77-89.
Suri P, Morgenroth DC, Hunter DJ. Epidemiology of osteoarthritis and associated comorbidities. Phys Med Rehabil. 2012;4(suppl 5): s10-s19.
Michael JW, Schlüter-Brust KU, Eysel P. The epidemiology, etiology, diagnosis, and treatment of osteoarthritis of the knee. Dtsch Arztebl Int. 2010;107(9): 152-162.
Pollard TC, Gwilym SE, Carr AJ. The assessment of early osteoarthritis. Bone Joint J. 2008;90(4): 411-421.
Hodge WA, Harman MK, Banks SA. Patterns of knee osteoarthritis in Arabian and American knees. J Arthroplasty. 2009;24(3): 448-453.
Al-Omran AS, Sadat-Ali M. Arthroscopic joint lavage in osteoarthritis of the knee. Is it effective? Saudi Med J. 2009 ;30(6): 809-812.
Al-Taiar A, Al-Sabah R, Elsalawy E, Shehab D, Al-Mahmoud S. Attitudes to knee osteoarthritis and total knee replacement in Arab women: a qualitative study. BMC Res Notes. 2013 ;6(1): 406-426.
Ibrahim A. Impact of manual therapy, supervised exercises and electro acupuncture. World Appl Sci J. 2011;14(3): 378-386.
Mahmoud FF, Al-Awadhi AM, Haines DD. Amelioration of human osteoarthritis symptoms with topical ‘biotherapeutics’: a phase I human trial. Cell Stress Chaperones. 2015;20(2): 267-276.
Mohamed A, Nahid A, Zia R, Misbahullah K. A study on prescribing patterns in the management of arthritis in the department of orthopaedics. Pharm Lett. 2012;4(1): 5-27.
Mustafa HM. Osteoarthritis prescribing habits in the Western region of Saudi Arabia. Jordan Med J. 2014;48(4): 1-12.
Nasef SA, Shaaban AA, Mould-Quevedo J, Ismail TA. The cost-effectiveness of celecoxib versus non-steroidal anti-inflammatory drugs plus proton-pump inhibitors in the treatment of osteoarthritis in Saudi Arabia. Health Econ Rev. 2015;5(1): 1-8.
Luyten FP, Denti M, Filardo G, Kon E, Engebretsen L. Definition and classification of early osteoarthritis of the knee. Knee Surg Sports Traumatol Arthrosc. 2012;20(3): 401-406.
Herrero-Beaumont G, Roman-Blas JA, Castañeda S, Jimenez SA. Primary osteoarthritis no longer primary: three subsets with distinct etiological, clinical, and therapeutic characteristics. Semin Arthritis Rheum. 2009;39(2): 71-80.
Rosemann T, Laux G, Szecsenyi J. Osteoarthritis: quality of life, comorbidities, medication and health service utilization assessed in a large sample of primary care patients. J Orthop Surg Res. 2007;2(1): 1-12.
Sanghi D, Avasthi S, Mishra A, Singh A, Agarwal S, Srivastava RN. Is radiology a determinant of pain, stiffness, and functional disability in knee osteoarthritis? A cross-sectional study. J Orthop Sci. 2011;16(6): 719-725.
Bauer DC, Hunter DJ, Abramson SB, Attur M, Corr M, Felson D, et al. Classification of osteoarthritis biomarkers: a proposed approach. Osteoarthr Cartil. 2006;14(8): 723-727.
Felson DT, Lynch J, Guermazi A, Roemer FW, Niu J, McAlindon T, et al. Comparison of BLOKS and WORMS scoring systems part II. Longitudinal assessment of knee MRIs for osteoarthritis and suggested approach based on their performance: data from the Osteoarthritis Initiative. Osteoarthr Cartil. 2010 ;18(11): 1402-1407.
Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain: visual analog scale for pain (VAS pain), numeric rating scale for pain (NRS pain), McGill pain questionnaire (MPQ), short‐form McGill pain questionnaire (SF‐MPQ), chronic pain grade scale (CPGS), short form‐36 bodily pain scale (SF‐36 BPS), and measure of intermittent and constant osteoarthritis pain (ICOAP). Arthritis Care Res. 2011;63(suppl 11): s240-s252.
Neogi T. The epidemiology and impact of pain in osteoarthritis. Osteoarthr Cartil. 2013;21(9): 1145-1153.
Alghadir A, Anwer S, Iqbal ZA, Alsanawi HA. Cross-cultural adaptation, reliability and validity of the Arabic version of the reduced Western Ontario and McMaster Universities Osteoarthritis index in patients with knee osteoarthritis. Disabil Rehabil. 2016;38(7): 689-694.
Araujo IL, Castro MC, Daltro C, Matos MA. Quality of life and functional independence in patients with osteoarthritis of the knee. Knee Surg Relat Res. 2016;28(3): 219-224.
Dobson F, Hinman RS, Hall M, Terwee CB, Roos EM, Bennell KL. Measurement properties of performance-based measures to assess physical function in hip and knee osteoarthritis: a systematic review. Osteoarthr Cartil. 2012;20(12): 1548-1562.
Juhakoski R, Tenhonen S, Anttonen T, Kauppinen T, Arokoski JP. Factors affecting self-reported pain and physical function in patients with hip osteoarthritis. Arch Phys Med Rehabil. 2008;89(6): 1066-1073.
Schmitt LC, Fitzgerald GK, Reisman AS, Rudolph KS. Instability, laxity, and physical function in patients with medial knee osteoarthritis. Phys Ther. 2008;88(12): 1506-1516.
Kwok WY, Vlieland TV, Rosendaal FR, Huizinga TW, Kloppenburg M. Limitations in daily activities are the major determinant of reduced health-related quality of life in patients with hand osteoarthritis. Ann Rheum Dis. 2011;70(2): 334-336.
Montero A, Mulero JF, Tornero C, Guitart J, Serrano M. Pain, disability and health-related quality of life in osteoarthritis—joint matters: an observational, multi-specialty trans-national follow-up study. Clin Rheumatol. 2016;35(9): 2293-2305.
Gomes-Neto M, Araujo AD, Junqueira ID, Oliveira D, Brasileiro A, Arcanjo FL. Comparative study of functional capacity and quality of life among obese and non-obese elderly people with knee osteoarthritis. Rev Bras Reumatol. 2016;56(2): 126-130.
Debi R, Mor A, Segal O, Segal G, Debbi E, Agar G, et al. Differences in gait patterns, pain, function and quality of life between males and females with knee osteoarthritis: a clinical trial. BMC Musculoskelet Disord. 2009;10(1): 1-10.
Stratford PW, Kennedy DM, Woodhouse LJ, Beaton D. Performance measures provide assessments of pain and function in people with advanced osteoarthritis of the hip or knee. Phys Ther. 2006 ;86(11): 1489-1496.
Brandes M, Schomaker R, Möllenhoff G, Rosenbaum D. Quantity versus quality of gait and quality of life in patients with osteoarthritis. Gait Posture. 2008;28(1): 74-79.
Fernandez-Cuadros ME, Pérez-Moro OS, Miron-Canelo JA. Knee osteoarthritis: impact on quality of life and effectiveness of total knee arthroplasty. Women. 2016;78(1): 62-69.
Chan, K, Wu, R. Osteoarthritis (OA), principles of osteoarthritis – its definition, character, derivation and modality related recognition: symptoms, signs and Quality of Life (QoL) [Internet]. Rijeka: InTech; Web.
Alkan BM, Fidan F, Tosun A, Ardıçoğlu Ö. Quality of life and self-reported disability in patients with knee osteoarthritis. Mod Rheumatol. 2014;24(1): 166-171.
Lourenço S, Lucas R, Araújo F, Bogas M, Santos RA, Barros H. Osteoarthritis medical labelling and health-related quality of life in the general population. Health Qual Life Outcomes. 2014;12(1): 146-156.
Saffari M, Emami Meybodi MK, Koenig HG, Pakpour AH, Rshidi Jahan H. Psychometric examination of the Persian version of Osteoarthritis Knee and Hip Quality of Life questionnaire. Int J Rheum Dis. 2014;1(2): 2-14.
Kiadaliri AA, Lamm C, de Verdier MG, Engström G, Turkiewicz A, Lohmander L, et al. Association of knee pain and different definitions of knee osteoarthritis with health-related quality of life: a population-based cohort study. Osteoarthr Cartil. 2016;24(suppl 1): s236-s237.
Nunez M, Nunez E, Del Val JL, Ortega R, Segur JM, Hernández MV, et al. Health-related quality of life in patients with osteoarthritis after total knee replacement: factors influencing outcomes at 36 months of follow-up. Osteoarthr Cartil. 2007;15(9): 1001-1007.
Rabenda V, Manette C, Lemmens R, Mariani AM, Struvay N, Reginster JY. Prevalence and impact of osteoarthritis and osteoporosis on health-related quality of life among active subjects. Aging Clin Exp Res. 2007;19(1): 55-60.
Wang-Saegusa A, Cugat R, Ares O, Seijas R, Cuscó X, Garcia-Balletbó M. Infiltration of plasma rich in growth factors for osteoarthritis of the knee short-term effects on function and quality of life. Arch Orthop Trauma Surg. 2011;131(3): 311-317.
Rat AC, Guillemin F, Osnowycz G, Delagoutte JP, Cuny C, Mainard D, et al. Total hip or knee replacement for osteoarthritis: mid‐and long‐term quality of life. Arthritis Care Res. 2010;62(1): 54-62.
Gerber LM, Chiu YL, Verjee M, Ghomrawi H. Health-related quality of life in midlife women in Qatar: relation to arthritis and symptoms of joint pain. Menopause. 2016;23(3): 324-329.
Keenan AM, Mckenna SP, Doward LC, Conaghan PG, Emery P, Tennant A. Development and validation of a needs‐based quality of life instrument for osteoarthritis. Arthritis Care Res. 2008;59(6): 841-848.
Ebrahimzadeh MH, Makhmalbaf H, Birjandinejad A, Keshtan FG, Hoseini HA, Mazloumi SM. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) in Persian speaking patients with knee osteoarthritis. Arch Bone Jt Surg. 2014;2(1): 57-62.
De Groot IB, Favejee MM, Reijman M, Verhaar JA, Terwee CB. The Dutch version of the Knee Injury and Osteoarthritis Outcome Score: a validation study. Health Qual Life Outcomes. 2008;6(1): 16-24.
Nilsdotter AK, Toksvig-Larsen S, Roos EM. A 5 year prospective study of patient-relevant outcomes after total knee replacement. Osteoarthr Cartil. 2009;17(5): 601-606.
Aksekili MA, Fidan F, Alkan BM, Alemdar A, Aksekili H, Ardıçoğlu Ö. Quality of life in knee osteoarthritis; correlation with clinical measures and the knee injury and osteoarthritis outcome score. Acta Med Anatol. 2016;4(1): 1-7.
Esenyel M, İçağasıoğlu A, Esenyel CZ. Effects of calcitonin on knee osteoarthritis and quality of life. Rheumatol Int. 2013;33(2): 423-427.
Al-Jaziri AA, Mahmoodi SM. Painkilling effect of ozone-oxygen injection on spine and joint osteoarthritis. Saudi Med J. 2008;29(4): 553-557.
Vennu V, Bindawas SM. Relationship between falls, knee osteoarthritis, and health-related quality of life: data from the Osteoarthritis Initiative study. Clin Interv Aging. 2014;9(1): 793-800.
Bruyère O, Ethgen O, Neuprez A, Zegels B, Gillet P, Huskin JP, et al. Health-related quality of life after total knee or hip replacement for osteoarthritis: a 7-year prospective study. Arch Orthop Trauma Surg. 2012;132(11): 1583-1587.
Maly MR, Costigan PA, Olney SJ. Determinants of self-report outcome measures in people with knee osteoarthritis. Arch Phys Med Rehabil. 2006;87(1): 96-104.
Svensson O, Malmenäs M, Fajutrao L, Roos EM, Lohmander LS. Greater reduction of knee than hip pain in osteoarthritis treated with naproxen, as evaluated by WOMAC and SF-36. Ann Rheum Dis. 2006 ;65(6): 781-784.
Veenhof C, Bijlsma JW, Van Den Ende CH, Dijk GM, Pisters MF, Dekker J. Psychometric evaluation of osteoarthritis questionnaires: a systematic review of the literature. Arthritis Care Res. 2006;55(3): 480-492.
Aǧlamış B, Toraman NF, Yaman H. Change of quality of life due to exercise training in knee osteoarthritis: SF-36 and WOMAC. J Back Musculoskelet Rehabil. 2009;22(1): 43-48.
Dattani R, Slobogean GP, O’Brien PJ, Broekhuyse HM, Blachut PA, Guy P, et al. Psychometric analysis of measuring functional outcomes in tibial plateau fractures using the Short Form 36 (SF-36), Short Musculoskeletal Function Assessment (SMFA) and the Western Ontario McMaster Osteoarthritis (WOMAC) questionnaires. Injury. 2013;44(6): 825-829.
SooHoo NF, Vyas RM, Samimi DB, Molina R, Lieberman JR. Comparison of the responsiveness of the SF-36 and WOMAC in patients undergoing total hip arthroplasty. J Arthroplasty. 2007;22(8): 1168-1173.
Lee HJ, Park HJ, Chae Y, Kim SY, Kim SN, Kim ST, et al. Tai Chi Qigong for the quality of life of patients with knee osteoarthritis: a pilot, randomized, waiting list controlled trial. Clin Rehabil. 2009 23(6): 504-511.
Coleman S, Briffa NK, Carroll G, Inderjeeth C, Cook N, McQuade J. A randomised controlled trial of a self-management education program for osteoarthritis of the knee delivered by health care professionals. Arthritis Res Ther. 2012;14(1): 1-10.
The purpose of this research proposal is to identify the need for implementation and evaluation of a valid intervention aimed at pain reduction in osteoarthritis patients. The main symptom of osteoarthritis is pain that limits a patient’s mobility and threatens the overall quality of life. The existing methods of treatment seem to be insufficient, which imposes a need to find new ways of problem resolution. Therefore, it is essential to provide theoretical and practical reasoning for the implementation of an evidence-based intervention capable of minimizing pain and postponing surgical intrusion for adult individuals suffering from osteoarthritis.
Three recent studies in the field of electrical stimulation as a part of osteoarthritis treatment were reviewed to find the most valid evidence available about the topic. The literature analysis allowed for identifying that different types of electrical stimulation was applied to patients, but only some of them showed positive and long-term results. Patients exposed to electrical dry needling obtained positive outcomes only when the intervention was implemented in combination with exercising (Dunning et al., 2018). Transcutaneous electrical nerve stimulation (TENS) showed significant pain relief in the study conducted by Cherian et al. (2016) but was recognized as insufficient in the research by Zeng et al. (2015). According to Zeng et al. (2015), interferential current (IFC) therapy is the only effective electrical stimulation method that is capable of health improvement and pain relief. All reviewed articles proved that exercising only is insufficient for pain reduction. Thus it is important to implement the most effective electrical stimulation method to treat osteoarthritis in adult patients (Cherian et al., 2016; Dunning et al., 2018; Zeng et al., 2015).
PICOT question: In adult patients with osteoarthritis (P), how does electrical stimulation (I) compared to muscle strength training(C) affects pain reduction (O) during the treatment process within the first month (T)? Electrical stimulation in general and IFC, in particular, is a non-invasive treatment “which delivers alternating medium-frequency current … through superficial electrodes placed on the skin” (Zeng et al., 2015, p. 200). Recent evidence proves that this method provides positive results in mobility improvement and pain reduction on a long-term basis.
The implementation of the intervention should be performed for adult osteoarthritis patients in a medical setting within one month of treatment. The evaluation of the interventions should be conducted weekly throughout the implementation process using interviewing method to collect pain-characterizing feedback from the patients. Initial and final data about the level of pain and mobility impairment, as well as the frequency of medication intake, should be compared to evaluate the efficacy of the intervention.
In case of the identification of the pain level decrease, mobility improvement, and reduction of pain-relief medication consumption, the intervention should be utilized for all patients with the same symptoms. The intervention will benefit the scope of scientific data in nursing since it concentrates on the acute issues of one of the most frequently occurring reasons why adults suffer from walking-related difficulties. The evidence-based intervention will provide a practical solution to the problem via innovative methods. The current proposal is of great relevance to the current state of nursing services related to osteoarthritis treatment due to the lack of highly effective methods of pain reduction. In case of successful implementation, the research will contribute to the scope of literature and will ensure patients’ well-being and life quality.
References
Cherian, J. J., Harrison, P. E., Benjamin, S. A., Bhave, A., Harwin, S. F., & Mont, M. A. (2016). Do the effects of transcutaneous electrical nerve stimulation on knee osteoarthritis pain and function last? The Journal of Knee Surgery, 29(6), 497-501.
Dunning, J., Butts, R., Young, I., Mourad, F., Galante, V., Bliton, P.,… Fernández-de-las-Peñas, C. (2018). Periosteal electrical dry needling as an adjunct to exercise and manual therapy for knee osteoarthritis. The Clinical Journal of Pain, 34(12), 1149-1158.
Zeng, C., Li, H., Yang, T., Deng, Z., Yang, Y., Zhang, Y., & Lei, G. (2015). Electrical stimulation for pain relief in knee osteoarthritis: Systematic review and network meta-analysis. Osteoarthritis and Cartilage, 23(2), 189-202.
Rheumatoid Arthritis is considered to be a chronic disorder resulting in inflammation and possible destruction of such organs as skin and lungs. This disease leads to a completely disabling and painful state; it can be the reason for the complete loss of mobility. It is a progressive disease and can lead to serious consequences such as joint destruction and complete disability. It is considered to be a chronic disorder and its causes and symptoms have been thoroughly tested throughout whole its history.
Rheumatoid Arthritis begins to progress in the following three stages:
Synovial lining swelling (it usually causes warmth and sharp pain, redness and joint swelling);
Cells growth (this stage usually leads to the thickening of the synovium and cells division);
The release of enzymes by the inflamed cells. This stage is the most dangerous while it results in the joint’s loss of shape, causes more pain, and can lead to complete disability to move.
Rheumatoid Arthritis is also a systemic disease and it means that it can easily damage all other human organs. In some cases, chronic inflammation can lead to the destruction of bones and cartilage which can cause joints deformity. This disease lasts indefinitely and it is almost impossible to predict it.
Rheumatoid Arthritis researches have shown that early treatment of this disease can limit the damage of joints and decrease working ability. A lot of people try to live with this disease by taking new drugs and experiencing surgery to make their lives not so painful and more mobile. (Shiel, 2008)
It is difficult to identify the real causes of this disease while they are still unknown to the medicine. Different tests were carried out with the help of different infectious agents: bacteria, viruses, and fungi; but these experiments and researches did not show the real causes of the disease.
This topic is still open to physicians from the whole world. There is an opinion that Rheumatoid Arthritis is an inherited disease. Some scientists firmly believe that some particular infections existing in the environment could trigger the human immune system and affect the body’s tissues; this process leads to inflammation of such organs like eyes and lungs. It was found out that the immune system promotes joints inflammation and other organs are affected occasionally.
Lymphocytes which are considered to be immune cells, in such cases are completely activated and express different chemical messengers to the inflamed areas. Scientists state that the environment influences the development of this disease as well. Not so long time ago it was proved that one of the reasons for Rheumatoid Arthritis is smoking tobacco as it damages the lungs and increases the development of the disease in the organism.
Speaking about the symptoms of Rheumatoid Arthritis it is important to underline the fact that they depend on the degree of inflammation. When the stage of inflammation appeared, this disease begins to have an active form in the organism. Inactive stage (remission) of the disease can be observed in case of tissue inflammation being subsided.
The period of remission cannot be exactly identified as it can last weeks, or sometimes even years, but one should note that this stage occurs with some treatment or sometimes spontaneously. Remission brings calm to the patient as the pain usually disappears and the symptoms are not vivid. But when the active stage of the disease begins the patient feels all the symptoms again.
The process when the disease returns in the active stage are named a flare. It is impossible to state how long the treatment or the stage of remission could continue as it is very individual and can completely vary depending on the patient and his health condition.
During the active stage of the disease, the symptoms may appear in the form of stiffness, fatigue, joint aches, fever, and lack of appetite. Such symptoms as muscle stiffness and that of joints can be especially observed after the inactivity period or from the very morning. Rheumatoid Arthritis is usually common in the period of disease flares.
In such cases, the joins turn to be red, tender, and painful. The reason being for this is that the synovium appears to be inflamed leading to joint fluid production. As a result, the patient suffers the thickening of the synovium with inflammation. (Westwood, 2006)
Rheumatoid Arthritis usually affects both body sides; it means that joints are considered to be inflamed symmetrically. The inflammation usually affects even small joints of wrists and hands. As a result, any movements of the patient such as opening the door can be painful and difficult in these periods.
The inflammation involves feet small joints; there are some cases when only one joint appeared to be inflamed. In case one joint is inflamed the disease might mimic the inflammation which was caused by such arthritis forms as joint infection or gout. As it was noted chronic inflammation results in the damage of the bones and cartilage. This disease usually leads to weakness of the muscles and bones, to be more exact of the whole body, and results in erosion. Disability, loss of function, and partial destruction of the organism are the dangerous consequences of Rheumatoid Arthritis.
There are some cases when this disease can affect vocal cords and brings complete changes to the voice tone. The joint affected in such cases is called cricoarytenoid and leads to voice hoarseness. Sometimes people can suffer mouth and eyes inflammation; this syndrome is called Sjogren’s syndrome.
Sometimes Rheumatoid Arthritis is the reason for the sharp chest pain and it causes deep coughing. In some cases the lung can be inflamed; as a result, such form as rheumatoid nodules is developed in the organism. Inflammation of the pericardium in the heart area is also the reason for the chest pain but it can bring changes to its intensity. Rheumatoid Arthritis can also cut the number of cells in the organism both red blood and white blood.
The reduction of the white cells can be the main reason for the infection risk. Nodules which can very frequently occur near fingers and elbows are not to be the reason for the symptoms but there is a risk that they can be infected. One more complication of Rheumatoid Arthritis is closely connected with blood-vessel inflammation. It is important to state that this form is one of the most serious and dangerous. Tissues blood supply can become impaired by vasculitis ad it can result in tissue death. (Vital, 2005)
One of the most important steps in the way to disease treatment is diagnosis. The doctor is to examine the history of the patient’s symptoms and thoroughly test the inflammation of the skin and the whole organism to understand the stage of disease activity. Usually, the patient is x-rayed and blood tested as these findings can clarify the diagnosis made by the doctor.
The patient is to be examined by the doctor several times before making a diagnosis. The doctor should be completely aware of the inflammation distribution, especially in the case of joint inflammation. It is important to know the level of symmetrical inflammation distribution and the number of inflamed joints.
The doctor meets some difficulties in making a diagnosis if only two or even one joint is inflamed. In cases like this, the doctor is to make additional analysis; in most cases, nodules detection near the fingers can help to make a proper diagnosis. According to some statistical data, about 80 % of all the patients suffering from Rheumatoid Arthritis have abnormal blood antibodies. Testing blood antibodies is very effective than usual inflammation tests and usually, these results bring the necessary diagnosis.
Unfortunately, it is impossible to cure Rheumatoid Arthritis completely. The main goal of doctors is to decrease the joint inflammation level, reduce pain and prevent deformity and destruction. Modern medicine continues to examine this disease to find some proper drugs or operations for complete treatment.
The usual treatment of Rheumatoid Arthritis covers such procedures as joint protection, rest, and some useful exercises for rest and mobility. It is important to underline the fact that usually, the way the patient is treated depends on some factors such as his age, the history of his diseases, and general health. (Wolfe, 1997)
The process of Rheumatoid Arthritis treatment covers two medication classes. They are the following:
Fast-acting;
Slow-acting.
The first class, that is first-line drugs, is usually used at the very beginning of the treatment. It is very important for pain reduction and inflammation decrease. First-line drugs include cortisone and aspirin as they are considered to be the most effective at this stage of disease development.
The second stage of treatment, which is slow acting class, is aimed at disease remission promotion and joint destruction prevention. In this case, methotrexate and hydroxychloroquine are generally used. One should take into account the fact that the level of Rheumatoid Arthritis destructiveness usually depends on the patient’s general condition and his physiology.
Usually to reach more effective in treating patients are to use second-line drugs at an early stage of disease development. But every patient perceives medication differently, and some of the patients may need anti-inflammatory agents together with strong drug doses. There are some cases when Rheumatoid Arthritis develops very actively and that is why doctors use surgery to improve the condition of their patients. (Wright, 2006)
According to the statistical data Rheumatoid Arthritis affects more than 1.3 million people living in the USA. It was researched that this disease is more typical for women and affects them much often than men. It cannot be explained because modern medicine still researches causes and treatments necessary to fight this disease. (Westwood, 2006)
The research carried out provided a clear picture of Rheumatoid Arthritis. Unfortunately, it is impossible to study the cases of its cure because they were not fixed. But it is necessary to highlight the fact that nowadays a lot of international conferences are devoted to the problem of Rheumatoid Arthritis treatment.
It means that people who suffer from this disorder can hope for a better future and possible cure. The technological era covers all fields of modern life, so it would compulsory contribute to the development of new equipment helping in overcoming this disease.
One of the first steps to do for the physicians is to find out the main causes of Rheumatoid Arthritis because it is very difficult and almost impossible to find treatment without knowing the disease origin. The main task of the doctors is to make the lives of their patients suffering the Rheumatoid Arthritis more cloudless and mobile.
References
Shiel, William. Rheumatoid Arthritis History. We Bring Doctor’s Knowledge to You. 2008.
S. Wright, Ware. The treatment of Pain Caused by the Rheumatoid Arthritis. Oxford, 2006.
Vital E., Emery. Advances in the Treatment of early Rheumatoid Arthritis. Am Fam Physician. 2005.
Wolfe F, Mitchell. The Morality of Rheumatoid Arthritis. Arthritis Rheum. 1997.
Rheumatoid arthritis (RA) is an autoimmune condition that is associated with chronic inflammatory polyarthritis. The symptoms of any immunological inflammatory syndrome can be detected in several body joints. The effect of rheumatoid arthritis spreads over five or more joints. The synovial membrane is the first part of the body that feels the impact of any immunological disorder. It is from this part that the condition spreads to other body parts.
This paper narrows down to investigate the means through which age, at the onset affects the results of autoimmune maladies. Several of these conditions are affected as the effect cuts across the age bracket to affect children, the adult and the elderly. The article under analysis in this paper was written by four authors with diverse knowledge and skills in the field of human health. The paper reviews how the age at onset affects various immune disorders including rheumatoid arthritis. The article analyzed is “How Age at Onset Influences the Outcome of Autoimmune”, written by Manuel, Amador, Rodriguez and Ortiz (2011).
Introduction
Immunological disorders are the conditions that come about when the immune system attacks itself. The antibodies that are supposed to fight foreign pathogens turn against the body. This means that the immune system shows aggression towards its body tissues as if they are foreign pathogens. Autoimmune disorders consist of several conditions that are connected to different diseases and syndromes. Most of the people who are affected are women who entail more than half of the five percent of the total population that is affected (Frisancho & Rose, 2008).
With about five percent of the population affected by one or more conditions of the immunological condition, it means that the condition is prevalent and that is why a lot of time has been spent on analyzing the effects and causes of the syndromes. The effect of age on this conditions and especially rheumatoid has been delved into by several scholars among them Amador-Oataryo, Gladis Montoya-Ortiz, Manuel Alberto Rodriguez and Adriana Rojass-Vilarraga (Manuel, Amador, Rodriguez & Ortiz, 2011).
Some of these conditions of immunological disorders including rheumatoid arthritis and Sjogren’s syndrome are closely related. Historically, three causes of rheumatoid arthritis that can be traced. They include polycyclic syndrome where the intensity of the condition changes during the course of the disease. Monocyclic condition occurs once, then that diminishes within a period of five years after the first diagnoses. This type of condition does not reoccur. The other cause is the progressive condition that involves rheumatoid arthritis increasing continuously since the first diagnosis. Inflammation of the synovial membrane erodes the surface of cartilage and bones and this could lead to permanent deformity.
Rheumatoid arthritis is one of the causes of early mortality (Ballou, Khan & Kushner, 1982). It can also cause disability as well as interfering with the quality of the life of the affected individual in both the industrialized and developing countries. The age at onset is defined as the first time the symptoms of an immunological disorder are diagnosed. The symptoms that are first tested are very important especially in immunological disorders though at times they may be delicate.
The appearance of such symptoms comes during childhood, when people become adults and sometimes they are even seen in the late stages of life. What dictates the appearance of the symptoms is the age of the affected person.
Other opportunistic conditions such as the Duchene’s muscular dystrophy and atherosclerosis take advantage of the immunological infections to thrive. The opportunistic conditions are not in most cases related to autoimmune syndromes in origin.
The total impact of age at onset on all immunological conditions including rheumatoid arthritis cannot be sufficiently calculated. However, estimations are made basing on the consequences that are associated with the diseases for instance the treatment costs and the loss that result in the people affected failing to be productive. Furthermore, some of the conditions are chronic with devastating effects while others seem mild at the early stages but end up being fatal and thus calculating the overall accumulative costs to make up the loses is not easy (Bjorklund, 2010).
Age at onset is estimated to lead to loses of up to seventy billion US dollars alone on rheumatoid arthritis. The intensity of the effects can be seen from the calculated costs that are associated with the diseases. The effect of these costs have forced professionals do engage into extensive research to try to find solutions. It should be noted that rheumatoid arthritis is among the most expensive medical conditions to treat in the world today. Researchers mainly do research on this condition today from the therapeutic and gamut systems because the conditions have spread to cover a range of clinical and molecular observable facts.
Literature review
Autoimmune conditions are caused by among others the age at onset. This is an idea that various scholars have agreed on. Allan (2002) holds that several prototypes of illness affecting joints or muscles are related to antibodies and molecules. Clough (2006) calls this an autoimmune rheumatic disease. In this group, Fairweather, Frisancho and Rose (2008) include systemic lupus, systemic sclerosis, rheumatoid arthritis, Sjogren’s syndrome, and sarcoidosis.
There are other groups of diseases that fall into this group that have mentioned by Fairweather, Frisancho and Rose (2008). Autoimmune thyroid diseases have features that are closely linked to rheumatoid arthritis. Considering the fact that rheumatoid arthritis affects people of divergent ages, various features are shared across all the conditions under study. The first similarity holds that all the medical descriptions are connected in an undeviating mode to the auto-antibodies. Allan (2002) says that research in this area has eliminated the differences that had persisted for a long time over the matter.
Studies conducted on the pathways were relevant in bringing consensus on the subject. Bjorklund (2010) points out that the second similarity that all the researchers agree on is that antibodies give their own production using several means. Cooper and Stroehla (2003) say that other assumptions that exist apart from the two basic similarities those researchers agree on. One of them is that autoimmune disease is closely linked to fever. By analyzing the impact of age at Onset on the outcome of autoimmune diseases, Clough (2006) states that the timing of age at Onset is irregular and the assumption lacks sufficient evidence to be justified.
Clough (2006) also explains that specific antibodies are developed randomly. The process of formation as stated by Allan (2002) is that, the existence of self-antigens makes it possible for the produced antibodies to swim in blood and end up being recognizable. Once they released in the blood however, they will permanently be observed. Cooper and Stroehla (2003) hold that, researchers are still in the laboratory trying to comprehend why the secretion of particular antibodies is allowed.
Other articles of study by Manuel, Amador, and Rodriguez & Ortiz (2011) mention that there are high chances that reverse control mechanisms in conjunction with self stimulation is responsible for the production of the specific antibodies identified above. This connects to the subject of discussion in the sense that there are reasons to believe that diseases or conditions associated with autoantibodies are purely idiopathic.
This simply means that the conditions cause themselves. Age at Onset and its influence on the immunological disorders that include rheumatoid arthritis can be analyzed with the understanding that autoantibodies have the ability to cause serious damage to the tissues or simply interfere with proper functioning of the tissues in several ways. Raising the rate of erythrocyte sedimentation (ESR) could easily cause inflammation. Inflammation could also be because of increasing the rate at which the C-reactive protein.
Allan (2002) points out that inflammation is specific to particular causal agents that include several cytokines and complement. The complexity of the issue relates also to the origin of the term. The name was used in reference to broad-spectrum conditions of arthritis that were considered chronic. All that was an assumption that has been researched upon and now there are confirmed reports that rheumatoid arthritis and inflammatory arthritis describe particular conditions that are linked to autoantibodies. Rheumatoid arthritis impinges on the bursae, tendon sheaths and all joints. The condition is frequent among women where for every three women with the condition, one man is affected.
Lab Report
The article, how does age at Onset influence the outcome of autoimmune diseases was written by three authors who are Amador-Patarroyo, Gladis Montoya-Ortiz, Manuel and Alberto Rodriguez. All the authors were from the Centre for Autoimmune Diseases Research in the school of medicine and health sciences, Columbia. It was edited by Adriana-Rojas-Vilarraga. The authors begin by stating that immunological disorders affect various people who can add five percent of the world’s population (Bjorklund, 2010). The age at Onset which is the time the first the first symptoms appeared, depends on the type of the disease.
The authors quote reports from various sources showing that there are sixty-five percentile chances of patients suffering from the systemic lupus erythematosus (SLE) will see the first symptoms between the age of sixteen and fifty-five. The elderly age of fifty-five and above will have a paltry fifteen percent of the disease. Twenty percent are different as they feel the first symptoms below the age of sixteen percentile (Cooper & Stroehla 2003). On the other hand, the symptoms in rheumatoid arthritis do not have a particular age but is documented that they are at the apex in their mid thirties.
The article begins by assessing the impact of age at Onset by looking at the Systemic Lupus Erythematosus. The SLE condition is not selective of the people it affects depending on age as such any person of any age could be affected. An immunological disorder is prevalent among adults when compared to other age groups. The difference again in the age factor is that among children the condition has high morbidity compare to its presence among the elderly (Ballou, Khan & Kushner 1982).
The patients here have a high degree of suffering from renal diseases, pericardities, hematological alterations, and malar rashes among many other developments projects. Immunosuppressive therapies and prednisone are used in the process of treating the patients with the SLE condition. The effects of this condition among children include delayed puberty, growth failure, along with fibromyalgia. An adult has the highest risk of developing pulmonary diseases. The general complication is that patients diagnosed with the disease are very easily associated with whole life damage to disease flares and increases the mortality rate by twice the normal time (Bjorklund, 2010).
Analysis
Age at onset differs among immunological disorders and so do their appearance. MS and SS are among the uncommon immunological disorders that affect children while those that do include the T1D. Age at onset that is diagnosed early is not always the best tool to project worse scenarios. Early age at onset is a worst prognostic feature for some immunological disorders. While in others, it does not have an important manipulation on the course of disease or no unanimous consensus exists (Cooper & Stroehla, 2003).
Improving the results of research requires that the health practitioners should have adequate information of the early age indicators as well as having educational and alteration support. The role played by genes about how the age at onset is involved in the varieties of immunological disease is crucial to doctors throughout the research exercise. The researchers showed more of this information by conducting tests among non-typical types of people.
Article Discussion
The presence of this condition can easily cause another form of the condition to be helped by the other immunological disorder. There are minimal chances that SLE could lead to proteinuria in children, arthritis, hemolytic anemia, and leucopenia. The paper also reiterates the potential of the condition to lead to the diseases including seizures, proteinuria, and cellular casts. Making early diagnosis translates into a better outcome.
This has to accompanied properly recognizing the manifestations that are very specific to age and in process go ahead to administer good treatment algorithm. The authors come to the conclusion that SLE is a complex condition that entails various polymorphic genes and environmental features for long and with time, they dictate the onset and of course. MBL2 is a gene that is believed to be one of the causes of age at onset that are responsible for influencing the outcome of autoimmune disorders (Ghezzi, 2004).
The most destructive form of immunological disorder to help the mother get treatment for rheumatic arthritis is systematic and chronic. The condition is more prevalent in middle-aged people but this does not mean the children and the elderly are spared. The categorization is very different in the sense that any person diagnosed with the condition below the age of sixty-five but more than sixteen years as the young condition while the children are considered children and those more than sixty-five years.
The biggest difference according to the three fellows is that they have different semiological characteristics. What was thought to a point of difference is that rheumatoid arthritis would not be destructed.
The elderly visitors do have a cuter onset of the patients. The joints feel some pain whose symptoms are closely related to polymyaglia. Other effects include intestinal lung disease, classical limb deformities, and other elements that are associated with the disease (Bjorklund, 2010). Clinical manifestations that are shared by different members of disorders are referred to as the juvenile idiopathic arthritis. They should read from his childhood trends before assuming that she is beyond control.
References
Allan, D. (2002). Conquering arthritis: What doctors don’t tell you because they don’t know. Louis: Shining Prairie Flower Pub.
Ballou, S., Khan, M. & Kushner, I. (1982). Clinical features of systemic lupus erythematosus Arthritis and Rheumatism. Oxford: Oxford University press.
Bjorklund, R. (2010). Arthritis. New York: Marshall Cavendish Benchmark.
Clough, J. D. (2006). Arthritis: A Cleveland Clinic guide. Ohio: Cleveland Clinic Press.
Cooper, G. & Stroehla, B. (2003). The epidemiology of autoimmune diseases. Autoimmune Review Journal, 2(3), 321-331.
Fairweather, D., Frisancho, l. & Rose, R. (2008). Sex differences in autoimmune disease from a pathological perspective. American Journal of Pathology, 173(3), 600–609.
Ghezzi, A. (2004). Clinical characteristics of multiple sclerosis with early onset. Neurological Sciences, 25, S336-S339.
Manuel, J., Amador, Rodriguez, A. & Ortiz, G. (2012). How does age at Onset Influence the Outcome of autoimmune diseases? A journal of autoimmune diseases, 1(1), 1-7.
Osteoarthritis is non-inflammatory joint disorder that affects at least 16 million Americans, is characterized by the deterioration of articular cartilage, which continues to slowly progress. It is the most common of the arthritic disorders, and 90% of elders show some evidence of these changes on x-ray examination, though they are not necessarily aware of arthritic changes (Lane and Wallace 55). Elderly persons with osteoarthritis experience joint deterioration more often than younger persons because joint protective mechanisms such as neuromuscular response and muscle conditioning are impaired in elders.
Main body
In contrast to osteoarthritis, Ankylosing spondylitis is an inflammatory disorder which affects spine and sacroiliac joints. In contrast to osteoarthritis, Ankylosing spondylitis affects young people, from 15-30 years old. It may occur at any age, but it tends to become more frequent in individuals, particularly men. In contrast to osteoarthritis, where the synovial covering of a joint is worn away, in Ankylosing spondylitis the affected synovium becomes massively hypertrophic and edematous with projections of synovial tissue protruding into the joint cavity.
It is unpredictable in its course and may have periods of remission and exacerbation that seem influenced by psychosocial factors as well as changes in synovia. The course usually continues downward in spite of periods of remission (Khan 43).
In both diseases, excess weight exacerbates the problems. Many find movement restricted and joints hypertrophied, stiff, and painful. Discomfort tends to be worse in the morning after a night of inactivity, after excessive use, and when there is change in the weather. Major areas affected are hands, knees, hips, lumbar spine, and cervical spine (Lane and Wallace 58). One may hear a grinding or grating sound, particularly in the neck, when moving. Osteoarthritis of the knee occurs in about 10% of individuals over age 65 and accounts for considerable pain, disability, and costly care. Most total knee replacements are done because of osteoarthritis. Osteoarthritis of the hip is the most prevalent form of arthritis in the United States.
Persons with osteoarthritis of the hip experience pain, localized to the groin and anterior or lateral thigh, morning stiffness, and gel phenomenon (feeling that the joint is frozen in one position). While not as frequent, osteoarthritis of the hand may be particularly troublesome because so much of our daily life depends upon object manipulation. Characteristically, it limits movement at the base of the thumb and the end joints of the fingers. Ankylosing Spondylitis can be associated with such signs as iridocyclitis and photophobia, mouth ulcers and fatigue (Khan 73).
Conclusion
On contrast to Ankylosing Spondylitis, symptoms of osteoarthritis in late life tend to be acutely uncomfortable and spread throughout the joints of the body. Sometimes the disorder affects systems other than joints (Lane and Wallace 60). One man suffered intense pain for a period of 6 months, but because the physicians attending him paid little attention, he felt he was doomed to this for the remainder of his life.
Pain may be a result of inflammatory disorders, degenerative problems, fractures or contusions, shoulder separation involving the clavicle, impingement syndrome involving the rotator cuff, or biceps tendinitis or referred pain from other areas. Pain that increases with activity suggests tendon impingement or degenerative arthritis. Pain with numbness and tingling may indicate cervical radiculopathy. Pain that occurs most severely at night is often seen with rotator cuff tears.
Works Cited
Khan, M. A. Ankylosing Spondylitis: The Facts. Oxford University Press, 2002.
Lane, N. E., Wallace, D. J. All About Osteoarthritis: The Definitive Resource for Arthritis Patients and Their Families. Oxford University Press, 2002.
There exist many types of arthritis (joint pain) that develop in people of all ages, ethnicities, and environments. To treat them, one has to understand the differences in their pathophysiology and presentation. For example, osteoarthritis and rheumatoid arthritis may have similar symptoms, but their causes and prevalence vary. Thus, people’s inherent characteristics and habits also produce different effects on these conditions – age and gender change the pathophysiology and diagnosis of both osteoarthritis and rheumatoid arthritis.
Pathophysiology
Osteoarthritis can be considered one of the most wide-spread forms of arthritis (Mobasheri & Batt, 2016). The prevalence of this joint disease in relation to other types is substantial, as it is much more common than such conditions as rheumatoid arthritis. Osteoarthritis progresses with time, affecting a person’s joint tissues such as cartilage (Mobasheri & Batt, 2016). In a person without osteoarthritis, cartilage maintains its volume, having a balanced movement of water under osmotic and hydrostatic pressure. As a contrast, in joints affected by osteoarthritis, the matrix of the cartilage becomes unbalanced, losing collagen and proteoglycans – components which are responsible for the water contents of the joint (Mobasheri & Batt, 2016). The body attempts to repair the cartilage and remodels it to replace the missing elements, but fails to heal the joint in time. Thus, the cartilage may crack or erode, exposing the bone and decreasing joint space.
The primary distinction of rheumatoid arthritis is that it is an autoimmune disorder. In this case, the body starts activating “B cells, T cells, and innate immune effectors” to attack its own joint synovium (Hammer & McPhee, 2014, p. 689). Healthy synovium lubricates cartilage and provides it with nutrients. It has a very thin layer of cells and an interstitium underneath (Hammer & McPhee, 2014). When rheumatoid arthritis starts affecting the body, the synovium becomes much thicker than the healthy one, and the interstitium becomes inflamed with active cells. Cartilage and bone which are located near such highly contagious areas get damaged in the process of active cells spreading and attacking other regions. Thus, the person experiences swelling and pain in his/her joints due to inflammation. While both disorders affect joints, their progression and causes are different.
Patient Factors
Such factors as one’s age and gender may affect the progression of these disorders. Osteoarthritis, for instance, is often related to aging – it is one of the primary causes of disability in older people (Sun, Beier, & Pest, 2017). People above 60 years old can develop this disorder, although some other aspects may affect the rates as well. As a contrast, rheumatoid arthritis is not as strongly dependent on one’s age. Numerous cases of infant and adolescent patients developing this condition exist (Hammer & McPhee, 2014; Singh et al., 2016). People of all ages can have rheumatoid arthritis of varying severity. It is clear that age affects the way these disorders can be treated – children and older people react more strongly to drugs than younger adults. Therefore, their doses and types of medication need to be adjusted accordingly.
Gender is another factor which creates distinct groups of patients with these disorders. In both cases, females are affected by arthritis more often than males. However, some scholars suggest that the rate of women with the rheumatoid type is much higher than that of men with the same condition, having a prevalence of three to one (Hammer & McPhee, 2014). Nonetheless, Singh et al. (2016) do not indicate that gender affects treatment options.
Conclusion
Osteoarthritis and rheumatoid arthritis are disorders that target similar areas of one’s body but progress in different ways. Although some symptoms – joint pain and swelling – are the same for both conditions, their pathophysiology shows that they are caused by two separate reasons. Osteoarthritis occurs in older people, while rheumatoid arthritis can affect a person of any age. Nevertheless, both conditions are more prevalent in women.
References
Hammer, G. G., & McPhee, S. (2014). Pathophysiology of disease: An introduction to clinical medicine (7th ed.) New York, NY: McGraw-Hill Education.
Mobasheri, A., & Batt, M. (2016). An update on the pathophysiology of osteoarthritis. Annals of Physical and Rehabilitation Medicine, 59(5-6), 333-339.
Singh, J. A., Saag, K. G., Bridges, S. L., Jr., Akl, E. A., Bannuru, R. R., Sullivan, M. C.,… McAlindon, T. (2016). 2015 American College of Rheumatology guideline for the treatment of rheumatoid arthritis. Arthritis & Rheumatology, 68(1), 1-26.
Sun, M. M. G., Beier, F., & Pest, M. A. (2017). Recent developments in emerging therapeutic targets of osteoarthritis. Current Opinion in Rheumatology, 29(1), 96-102.
Gout is a disease characterized by acute pain and the swelling and redness of the affected articulations. This paper aims to describe the key points of gout treatment. For this purpose, it will give an overview of the disease, discuss treatment principles, and consider pharmacological treatment of gout, and monitoring patients’ adherence to it. Finally, important details as to patient variables and education will be described.
A gout is a form of inflammatory arthritis caused by a high concentration of uric acid in the blood. Urate crystals accumulate in and around joints, leading to hyperuricemia (Perez-Ruiz, Dalbeth, & Bardin, 2015). In 90% of cases, gout is caused by impaired functioning of kidneys when they fail to excrete uric acid (Engel, Just, Bleckwenn, & Weckbecker, 2017). In 10% of cases, overproduction of uric acid leads to this illness (Engel et al., 2017, p. 216). There are four phases of gout: asymptomatic deposits in tissues, acute gout, intercritical periods, and chronic gout (Engel et al., 2017). As the disease progresses, the intervals between flares shorten until the pain becomes chronic.
Gout is the form of arthritis that answers to medical treatment. Standardized guidelines prescribe not to treat asymptomatic hyperuricemia (Wüthrich, Alromaih, & So, 2016). The treatment should start in cases of established gout involving joint erosions and tophi (Wüthrich et al., 2016). The cure follows two stages: first, the urate crystals are dissolved; second, the formation of new crystals is prevented (Perez-Ruiz et al., 2015). The evidence-based recommendation includes treat-to-target, which implies setting a therapeutic goal and regularly testing the progress (Golenbiewski & Keenan, 2019). If there is no advance, the treatment should be changed. Furthermore, the cure should consist of non-pharmacological and pharmacological therapy (Engel et al., 2017). Non-pharmacological treatment includes patient education, changes to diet, and resting the joint (Engel et al., 2017). These measures are essential for the effectiveness of the prescribed medicine.
Pharmacological treatment aims at releasing the pain, reducing inflammation, and lowering the uric acid concentration. First-line medications for treating gout are “nonsteroidal anti-inflammatory drugs (NSAIDs), glucocorticoids, and colchicine” (Engel et al., 2017, p. 218-219). The most common NSAIDs used for gout treatment are naproxen (Naprosyn), indomethacin (Indocid, Indocin), tenoxicam (Mobiflex) celecoxib (Celebrex, Onsenal), etoricoxib (Arcoxia), and etodolac (Lodine SR, Eccoxolac) (Wüthrich et al., 2016). Colchicine is sold under the trade name Colcrys and is more effective when taken at the beginning of a flare (Golenbiewski & Keenan, 2019). Glucocorticoids are used when colchicine and NSAIDs are contraindicated (Wüthrich et al., 2016). The most common of them are methylprednisolone (Medrol) and triamcinolone (Kenalog) (Wüthrich et al., 2016). As mentioned above, asymptomatic hyperuricemia does not require pharmacological treatment. At the stage of acute gout, therapy should begin as soon as possible; otherwise, the flare may last between 3 days and 2 weeks (Engel et al., 2017). Xanthine oxidase inhibitors are used for treating chronic gout since they lower uric acid levels (Golenbiewski & Keenan, 2019). Thus, the medications differ depending on the stage of the disease.
Since gout treatment is long-lasting and has side effects, patients may fail to adhere to the prescriptions. Therefore, patients prescribed NSAIDs, colchicine, or xanthine oxidase inhibitors should be monitored by checking serum uric acid levels, liver, and kidney (Golenbiewski & Keenan, 2019). It is also necessary to evaluate patients’ nutrition and the state of comorbidities (Golenbiewski & Keenan, 2019). Patients should be encouraged to change their diet by avoiding the consumption of food with high purine and fructose content (Wüthrich et al., 2016). Finally, educating patients about the necessity of treatment and reminding them to take their medicines are important measures. Patient education should include explaining the need for increasing physical activity and reducing excess weight.
In conclusion, gout is a disease that should be treated as soon as possible to prevent patients from experiencing chronic pain. The medications prescribed to patients with gout include NSAIDs, colchicine, or xanthine oxidase inhibitors. Their use depends on patients’ tolerance of a particular medicine and the disease stage. To ensure the effectiveness of the treatment, monitoring patients is necessary, including medical tests and reminders.
References
Engel, B., Just, J., Bleckwenn, M., & Weckbecker, K. (2017). Treatment options for gout. Deutsches Ärzteblatt International, 114(13), 215-222.
Golenbiewski, J., & Keenan, R. T. (2019). Moving the needle: Improving the care of the gout patient. Rheumatology and Therapy, 6(2), 179-193.
Perez-Ruiz, F., Dalbeth, N., & Bardin, T. (2015). A review of uric acid, crystal deposition disease, and gout. Advances in Therapy, 32(1), 31-41.
Wüthrich, H., Alromaih, F., & So, A. (2016). Guidelines for the treatment of gout: A Swiss perspective. Swiss Medical Weekly, 146, 1-7.