Category: Arthritis

Arthritis is a usually chronic medical condition that affects the quality of the people’s life significantly. Arthritis can be viewed as the inflammation of joints that is often observed in elderly persons, but the problem is in the fact that there are many different types of arthritis, and some of them affect young people (Adams Media 12). In spite of the type of arthritis, almost all individuals suffering from this medical condition indicate such symptoms as the pain in joints, inflammation, and stiffness of joints (Schwarz 8). In addition, patients often note that the pain increases at night. Therefore, the arthritis treatment is oriented not only to avoiding the joint destruction but also to relieving the condition and reducing symptoms and pain. Although the arthritis management can be different depending on the type of the disease, there is a standard scheme of treatment that includes the following methods presented as steps: the medications therapy, the necessity of decreasing the tension on joints, the physical and manual therapy, and the diet.

If a person complains of the pain and inflammation in joints, the first step to take after consulting the doctor and making all the necessary analyses is to provide a patient with the anti-inflammatory drugs and analgesics in order to reduce the pain. According to Yazici, the preliminary medication therapy is most important for a person because certain drugs can reduce not only the pain but also the joints’ inflammation (Yazici S11). The reason is that the pain can be discussed as only a consequence of the inflammation that needs to be addressed as quickly as possible. Thus, Jankowska-Polanska, Nawrocka, and Uchmanowicz note that only the drug therapy can promote the remission of the medical condition, and when the acute pain is reduced, it is also important to use anti-inflammatory gels, anticonvulsants, and protectors of joint tissues as medications to improve the function of joints (Jankowska-Polanska, Nawrocka, and Uchmanowicz 103). Such complex therapy aims to minimize any negative health consequences of arthritis and maximize the joints’ functioning. However, the researchers also claim that the drug therapy cannot be prolonged because of “drug-induced changes” that can be “a result of long-term pharmacotherapy” (Jankowska-Polanska, Nawrocka, and Uchmanowicz 103). From this point, although the process of treating arthritis is long, it should also include more steps other than the use of medications.

The second important intervention is the change in the tension on joints. Following the ideas by Yazici, in order to start the physical and manual therapies effectively, it is often necessary to provide the rest for inflamed joints during the period of the medication therapy (Yazici 9). This note can be discussed as reasonable because the primary goal is to decrease the inflammation. Schwarz proposes to use orthopedic soles and other devices to decrease the tension on inflamed joints (Schwarz 8-9). Thus, Schwarz states that it is necessary to “invest in devices that will conserve energy and reduce stress and strain on affected joints” (Schwarz 9). These simple measures can be considered as appropriate in order to decrease the discomfort that is often experienced by a person with arthritis, and they are necessary to prepare a patient for another stage in the treatment plan.

The next step that needs to be taken by an individual who suffers from arthritis is the use of advantages associated with the physical and manual therapies. According to Schwarz, the joint deformity can be prevented if a person pays attention to special physical exercises and strategies to reduce the stiffness of joints (Schwarz 5-6). These exercises can be discussed as important to strengthen muscles that are near joints in order to guarantee their mobility. As it is stated by the author, the “gentle exercise helps to relieve pain, keep stiffness at bay, and improve your overall well-being” (Schwarz 5). From this point, such measures as the simple physical activity are important to help a person cope with the pain. In addition, the physicians focus on the significant role of the manual therapy as supportive to physical exercises in improving the joints’ mobility (Adams Media 23). These practices are effective to be used by a person with arthritis regularly in order to improve the quality of life. Still, there is one more step that needs to be proposed to a patient suffering from arthritis in order to complete the scheme of the arthritis management.

The final step and recommendation associated with treating a medical condition of arthritis is the change of the diet in order to increase the joints’ mobility and protect them from deformity and further destruction. Clinicians usually propose diets with the high content of vitamins such as A, B1, B3, B6, B12, E, and C. In addition, the food should include different microelements in order to have the high nutritional value (Adams Media 52). Thus, in order to achieve the results in the arthritis treatment and avoid the progression of joints’ inflammation, people need to eat the food that is rather balanced in terms of vitamins and microelements. Schwarz also pays much attention to the role of the diet in treating the medical condition because the changes in the diet with the focus on eating more healthy foods can influence the success of the whole treatment process that is quite complex in its nature (Schwarz 12). From this point, while treating arthritis, people should not ignore recommendations regarding the changes in their diet in spite of the fact that this step is not of a high priority. The reason is that the healthy diet contributes to improving the features of joints tissues, and it can lead to increasing the overall quality of the person’s life.

The expected results of the arthritis treatment that can be organized with the focus on the above-mentioned steps and directions are the following ones: the reduced pain and joints’ inflammation, the increased mobility of joints, the decreased risk for deformity and even destruction of affected joints, and the improved quality of life. From this perspective, in order to achieve the positive outcomes of the arthritis treatment, it is necessary to follow the physicians’ recommendations step-by-step. The persistence and patience are important qualities in order to achieve optimistic results in the process of treatment because this medical condition is typically discussed as the chronic one. The problem is in the fact that there are many different types of arthritis, and the treatment options can differ significantly. However, the proposed scheme can be discussed as rather traditional and applicable to any type of arthritis because it suggests the steps that are taken in various treatment plans as they guarantee of the positive outcomes for the patient.

Works Cited

Adams Media. Arthritis: Medical, Alternative, and Complementary Treatments: The Most Important Information You Need to Improve Your Health. Avon: Adams Media Publishing, 2012. Print.

Jankowska-Polanska, Beata, Agnieszka Nawrocka, and Izabella Uchmanowicz. “Quality of Life and Methods of Coping with Stress Depending on the Used Form of Therapy of Rheumatoid Arthritis Treatment.” Progress in Health Sciences 4.2 (2014): 102-110. Print.

Schwarz, Shelley. Arthritis: 300 Tips for Making Life Easier. New York: Demos Medical Publishing, 2008. Print.

Yazici, Yusuf. “Corticosteroids as Disease Modifying Drugs in Rheumatoid Arthritis Treatment.” Bulletin of the NYU Hospital for Joint Diseases 70.1 (2012): S11-S13. Print.

Introduction

Rheumatoid arthritis (RA) is a common, chronic, systemic autoimmune disease, characterized by symmetrical synovitis, inflammatory exudates in the joint cavity and erosion of articular cartilage and marginal bone. RA predominantly manifests in the synovial membrane of diarthrodial joints. It is exemplified by the infiltration of immune cells into the synovial membrane, ultimately resulting in the proliferation of cellular cytotoxic lymphocytes and synoviocytes, by the production of inflammatory cytokines and chemokines and by B cell activation with autoantibody production, all of which contribute to cartilage and bone destruction (El-Gabalawy, 1999; Firestein, 2003; Choy & Panayi, 2001).

Long-term prognosis is poor with 80 percent disability after 20 years of active disease and an average 3-18 year reduction in life expectancy (Scott et. al., 2000; Pincus & Sokka, 2003). Combined therapies with traditional disease modifying anti-rheumatic drugs (DMARDS) and a growing list of novel biological agents have enhanced outcomes and reduced the destructive course of the disease. Despite these advances, substantial disease activity persists in many patients, with accompanying progressive joint damage, functional loss, and occasionally toxicities (Fleischmann, 2002; Kalden, 2001).

Main Text

Arthritis, as the leading cause of physical disability in the United States comes with significant economic implications. While most patients need continual treatment to control flares, many others require joint replacements. With 2.1 million existing patients and 150,000 newly diagnosed RA patients every year, the disease has severe long term economic consequences, with direct and indirect costs of related care totaling up to $19 billion annually in the United States alone (Medical Economics, 1999).

This is further exaggerated by the advent of the biological era with the addition of expensive biological agents adds an estimated burden in excess of $ 10,000 per year. These high direct and indirect costs, together with substantial morbidity and mortality, emphasize the imperative need for more exhaustive investigations into the etiopathophsyiology of this chronic disease.

The prevalence of RA increases with age, is about 2.5 times higher in females than in males, and affects 1.5 % of the North American population (and 6% prevalence rates among the Native American population) (Klippel, Weyand & Wortmann, 2001, p. 209). The peak incidence is between the fourth and the sixth decade with an average age of diagnosis at the age of 41. Prevalence and incidence studies are based on a set of criteria with a sensitivity and specificity of approximately 90%.

This criterion, labeled as the American College of Rheumatology (ACR) 1987 criteria, has enabled the effective classification of RA and is also used later in this dissertation. According to the ACR criteria, to achieve a diagnosis of rheumatoid arthritis, an adult over 18 years of age needs to fulfill at least four of the following seven criteria:

1. a minimum of 6 weeks of morning stiffness in and around the joints lasting for at least one hour before maximal improvement,
2. a minimum of 6 weeks of soft tissue swelling or joint fluid in at least 3 joint areas of any of the proximal interphalangeal(PIPs), metacarpal phalangeal(MCPs), wrists, elbows, knees, ankles, metatarsal phalangeal(MTPs),
3. a minimum of 6 weeks of one swollen area in the wrist, MCP or PIP,
4. a minimum of 6 weeks of symmetrical joint involvement,
5. rheumatoid nodules,
6. abnormal levels of serum rheumatoid factor,
7. radiographic changes on radiographs of the wrists and hands (Myers, 2004, p. 575).

Definite diagnosis of RA is difficult due to the absence of a unique solitary clinical manifestation or laboratory test. Clinical diagnosis is usually made from the exclusion of other differential diagnosis diseases and from a range of compatible features that includes the presence of symmetrical peripheral polyarthritis, morning stiffness, rheumatoid nodules and the presence of radiographic erosions (Klippel, Weyand & Wortmann, 2001, pp. 161-167). In addition, extraarticular features, including anemia, fatigue, pericarditis, granulomatous myocarditis, neuropathy, dermatoses, scleritis, episcleritis, splenomegaly, Sjogren’s syndrome, myositis, vasculitis, and glomerulonephritis may occur during the course of the disease.

Severe disease is usually distinguished in clinical practice using clinical signs and symptoms, and non-specific laboratory tests of inflammation including C-reactive protein titer (CRP) and erythrocyte sedimentation rate (ESR) (Klippel, Weyand & Wortmann, 2001, pp. 161-167).

Additionally, the presence of high-titer rheumatoid factor (RF), antibodies against cyclic citrulinated peptide (CCP), and shared epitopes in human leukocyte antigen DRBl(HLA-DRBl) alleles have been shown to be associated with severe and erosive disease and poor outcomes in RA. However, no definitive criteria have been established to identify the subset of patients likely to require combination therapy based upon any current laboratory test or clinical symptoms and signs, leaving the clinicians without a clear framework for application.

The Health Assessment Questionnaire (HAQ) and the Disease Activity Score (DAS28) (Newton, Harney, Wordsworth & Brown, 2004) are usually calculated as secondary measures of efficacy responders/nonresponders to therapeutics. Physical function is assessed using the HAQ, a disease-specific, patient-perceived questionnaire that provides a self-assessment of functional ability in daily life for patients with RA. Efficacy is also assessed by DAS28, a validated composite index of inflammation integrating in a continuous variable ESR.

Multiple factors contribute to the initiation of polyarticular synovitis and the perpetuation of the disease process in an immunosuppressive host. Although there have been many insinuations to an underlying infectious etiology, one is yet to be isolated despite exhaustive efforts. Genetics, cigarette smoking, autoantibodies to citrulline-containing peptides (anti-CCP), glucose-6-phosphoisomerase (G6PI) and to other immunoglobulins (rheumatoid factors) and, the involvement of superantigens and heat shock proteins (molecular mimicry) have been positively identified in rheumatoid arthritis (Krishnan, Sokka & Hannonen, 2003; Rantapaa-Dahlqvist, et. al., 2003 & Nell, Machold, Eberl, Stamm, Uffmann & Smolen, 2004).

Introducing appropriate therapy early in the course of the disease before permanent damage to the joints has occurred can minimize disease severity and may limit pathologic immune system changes later in the course of the disease. The optimal window for such a strategy appears to be within the first 3 months of disease onset (Nell, Machold, Eberl, Stamm, Uffmann & Smolen, 2004). Early diagnosis and monitoring of disease activity and therapeutic response is therefore important for improvement of disease outcomes.

There are 3 apparent phases involved in the rheumatoid disease process: a. an initiation phase triggered by a variety of nonspecific events that may involve multiple pathways that produce local dendritic cell differentiation and trafficking. This ultimately resulting in the release of upstream distinct cytokines into the synovium. During the initiation phase, the early rheumatoid synovium consists of major mediators and cells of the innate immune system which may be involved in the initiation of inflammation through non-antigen-specific mechanisms. It is hypothesized that the natural regulatory mechanisms of the innate immune system may not be adequate to counter the stimulatory influences and prevent the development of the active rheumatoid synovitis (Arend, 2001).

Following the propagation of a successful initiation phase, a perpetuation phase results, causing the effects of an adaptive immune response, manifested by the priming of autoreactive T cells from dendrtic cells. The effectual production and local activation of memory T cells in the joint further causes the differentiation of synovial T cells to stimulate B cells and macrophages. Finally a chronic inflammation phase results from the effects of multiple cells in a dysregulated manner primarily due to abnormal fibroblast growth and T cell responses to altered self-antigens, effectually causing pannus formation, polycellular dysregulation, deformities and erosions (Arend, 2001).

Understanding the factors responsible for the initiation and perpetuation of RA has been facilitated by the functional characterization of a number of regulators and effectors of disease activity. Cytokines are small protein mediators that bind to cognate receptors and regulate cell proliferation, activation, chemotaxis, death, and differentiation. These mediators are important both in stimulation of innate immune cells and as products of these cells in modulating inflammation and adaptive immune responses. The cytokines involved in the innate immune system include molecules that mediate the inflammatory response, such as IL-1, TNF-a, and IL-6(2).

The cytokine network in RA is a complex and dynamic system in which cellular and humoral cytokines, chemokines, and growth factors regulate initiation and perpetuation of inflammation(). In RA, these agents regulate the immune and inflammatory responses of tissue-invading leukocytes, and the activation of endothelial cells, chondrocytes, and osteocytes in a complex and coordinated manner (El-Gabalawy, 1999; Firestein, 2003; Choy & Panayi, 2001).

Numerous cytokines have been identified in the rheumatoid synovium, the network of which is tightly controlled by an imbalance between pro-inflammatory and anti-inflammatory cytokines that leaves inflammation unchecked, resulting in cellular damage, manifested by the destruction of cartilage and bone. A notable example, the role of TNF-a as an upstream regulator of disease activity is underscored by the success of “TNF-a blockade” with biologic agents such as etanercept (Enbrel®), infliximab (Remicade®), and adalimumab (Humira®) in RA treatment.

Effects of TNF-a blockade are pleiotropic including amelioration of joint inflammation, systemic aspects of disease, and erosions (Pincus, Ferraccioli, Sokka, Larsen, Rau, Kushner & Wolfe, 2002). This is explained by the fact that TNF-a directly activates cells and modulates the expression of an array of disease mediators such as IL-1, IL-6, IL-8, and IL-18, which in conjunction, regulate many aspects of cellular pathology including: T and B cell activity, neutrophil infiltration, synoviocyte, chondrocyte and osteoclast activation, and release of matrix metalloproteinases, such as MMP-1 MMP-3, and MMP-13. While extremely efficacious, TNF-blockade is only partially effective in the majority of patients.

Accordingly, key regulators such as IL-1, IL-6, and IL-8 while attenuated are not fully suppressed. Agents targeting these and other cytokines may play a useful role in mono- and combination therapy and a variety of these biologic agents are approved, in clinical trials, or in preclinical development. For example, B cell and T cell depletion agents (rituximab and abatacept respectively) and an IL-6 signaling blocker when used in combination with methotrexate(MTX), have recently demonstrated significant clinical efficacy and minimal toxicity in phase 3 RA clinical trials.

Conclusion

There are many additional biologies currently in the clinical trial pipeline including agents that target: cytokines such as IL-15 and IL-18, signaling molecules such as NF-kappaB, and MAP kinase, and leukocyte trafficking molecules such as CD2 and CD1 la. With the current development of novel biologic targeted therapies, the ability to control multiple cellular and molecular mediators will provide an unprecedented opportunity for controlling disease activity, an opportunity that will be concomitant with increased treatment design complexity.

The limits of current disease assessment tools, disease heterogeneity, increasing numbers of therapeutic options available for RA, and the chronic progressive nature of the disease make it well-suited for a more evidenced-based medical approach: an approach in which individually tailored treatments are directed by direct measurements of disease regulators and effectors.

References

Arend, W.P. (2001). The innate immune system in rheumatoid arthritis. Arthritis Rheumatology, 44(10), 2224-2234.

Choy, E.H. & Panayi, G.S. (2001). Cytokine pathways and joint inflammation in rheumatoid arthritis. New England Journal of Medicine, 344, 907-16.

El-Gabalawy, H. (1999). The challenge of early synovitis: multiple pathways to a common clinical syndrome. Arthritis Research, 1,31-36.

Firestein, G.S. (2003). Evolving concepts of rheumatoid arthritis. Nature, 423, 356-61.

Fleischmann, R.M. (2002). Examining the efficacy of biologic therapy: are there real differences? Journal of Rheumatology, 65, 27-32.

Furst, D.E., Breedveld, F.C., Kalden, J.R, Smolen, J.S, Antoni, C.E., et. al. (2002). Updated consensus statement on biological agents for the treatment of rheumatoid arthritis and other rheumatic diseases. Annals of Rheumatic Diseases, 61(2), 2-7.

Kalden, J.R. (2001). How do the biologies fit into the current DMARD armamentarium? Journal of Rheumatology, 62, 27-35.

Klippel, J.H., Weyand, C.M. & Wortmann, R.L. (Eds.). (2001). Primer on the Rheumatic Diseases (12^th edition). Atlanta, GA: The Arthritis Foundation.

Krishnan, E., Sokka, T. & Hannonen, P. Smoking-gender interaction and risk for rheumatoid arthritis. (2003). Arthritis Res Ther. 5, R158-R162.

Medical Economics. (1999). 1999 Red Book. Montvale, NJ: Medical Economics Company.

Myers, A.R. (Ed.). (2004). National Medical Series for Independent Study: Medicine (5^th Edition). Philadelphia, PA: Lippincott Williams & Wilkins.

Nell, V.P., Machold, K.P., Eberl, G., Stamm, T.A., Uffmann, M. & Smolen, J.S. (2004). Benefit of very early referral and very early therapy with disease-modifying anti-rheumatic drugs in patients with early rheumatoid arthritis. Rheumatology, 43, 906-914.

Newton, J.L., Harney, S.M, Wordsworth, B.P. & Brown, M.A. (2004). A review of the MHC genetics of rheumatoid arthritis. Genes Immunology. 5(3), 151-157.

Pincus, T. & Sokka, T. (2003). Quantitative measures for assessing rheumatoid arthritis in clinical trials and clinical care. Best Pract Res Clin Rheumatol., 17, 753-81.

Pincus, T., Ferraccioli, G., Sokka, T., Larsen, A., Rau, R., Kushner, I. & Wolfe, F. (2002). Evidence from clinical trials and long-term observational studies that disease-modifying anti-rheumatic drugs slow radiographic progression in rheumatoid arthritis: updating a 1983 review. Rheumatology. 41, 1346-1356.

Rantapaa-Dahlqvist, S., de Jong, B.A., Berglin, E., Hallmans, G., Wadell, G. et al. (2003). Antibodies against cyclic citrullinated peptide and IgA rheumatoid factor predict the development of rheumatoid arthritis. Arthritis Rheumatology, 48(10), 2741-2749.

Scott, D.L., Pugner, K., Kaarela, K., Doyle, D.V., Woolf, A., Holmes, J. & Hieke, K. (2000). The links between joint damage and disability in rheumatoid arthritis. Rheumatology, 39, 122-32.

Overview

Chronic pain is a foremost health concern among the elderly, both in the community setting and within care institutions. Regrettably, most health conditions afflicting older people are relatively painful and chronic in nature, such as arthritis, back pain, prostate enlargement, osteoporosis and post-fracture complications, and this group of the population is often faced with more than one source of pain (Gudmannsdottir & Halldorsdottir, 2009).

A number of studies have adduced compelling evidence that pain in old age has been considerably under-diagnosed and under-treated in large part due to inconsistencies in patients’ and care providers comprehension of the causes of pain. The health needs of older people in the management of chronic pain are further compromised by self-assessment methodologies used by patients to describe pain in addition to the assessment done by nurses and doctors, which may end up underestimating the pain (Maly & Kropa, 2007). Hopkins et al (2006) is of the opinion that self-assessment of health is not easy to evaluate objectively since it is related to an individual’s perception of their life’s quality.

Health as a concept is multifaceted, and applied implications cannot be comprehended without taking into consideration the social and cultural backgrounds in which we live out our lives (Hopkins et al., 2006). If health is socially and culturally constructed, then perspectives and perceptions are bound to vary, shifting with age and circumstances.

Previous studies have demonstrated that men, racial minorities, the disabled and cognitively impaired, and individuals over 85 years of age stands an elevated risk of being under-diagnosed, largely due to issues of inconsistencies in understanding, gaps in self-assessment, individual perceptions and perspectives held by society (Gudmannsdottir & Halldorsdottir, 2009; Jakobsson & Hallberg, 2002). A study conducted in 2000 by Bernard and colleagues revealed that “…older people tend to view health in functional terms, emphasizing the importance of resilience and of being able to cope, rather than fitness” (Hopkins et al., 2006).

Older people suffering from conditions that cause acute pain may draw on a more holistic account of their health and wellbeing, one that is largely related to the quality of life or self-esteem (Oliver, 2009), or a prejudiced assessment of their present state in terms of mood and happiness (Hopkins et al., 2006). In addition to chronic pain, some conditions such as osteoporosis and arthritis may cause frailty and disability among the elderly, a scenario that alters their perspectives towards health.

A study by Weitzenkamp and colleagues revealed that disabled individuals altered many of the standards against which they assessed their wellbeing (Hopkins et al., 2006). According to Gudmannsdottir & Halldorsdottir (2009), the elderly can themselves be a block to professional assessment and management of the conditions by nurses and doctors by concealing their pain for some reason or by prematurely resigning to the pain due to the perception that pain unavoidably increases with age.

Hence, it becomes difficult for external assessors to classify the nature and scope of an illness affecting an elderly person without a proper grasp of how health terms are conceptualized, comprehended or experienced (Hopkins et al., 2006). As such, it is imperative for care providers to gain a comprehensive insight into the lives of the elderly, to focus on the experience of living with conditions that cause acute pain, and to explore their perspectives by not only talking to them but also sharing in their experiences (Hyde at al, 1999).

It is against this backdrop that the present study aims to fill the knowledge gap that exists on how to objectively assess the health needs of the elderly living with conditions that cause acute pain from their own experiences and perspectives. Specifically, the study will aim to assess the experiences and perspectives of older people living with arthritis.

Aims of Study

The study generally aims to critically evaluate the lived experiences of older people suffering from arthritis using the phenomenology methodology to gain a comprehensive insight into their lived experiences. The following are the specific objectives:

1. To develop a better understanding of how the lived experience of the elderly can be used by nurse professionals and doctors to avail interventions aimed at improving the quality of life of patients, both medically and psychologically
2. To gain a deeper understanding of how lived experience affects or influences the self-assessment methodologies used by the elderly in seeking healthcare assistance

Research Question

The study will be guided by the research question: What is the lived experience of older people suffering from arthritis?

Justification of Study

Arthritis is known to occasion a significant health burden to populations and health institutions worldwide, but little is known of the lived experience and the impact on the quality of life of the sufferer (Oliver, 2009). Some forms of arthritis such as rheumatoid arthritis and osteoarthritis mainly affect the elderly, causing anguish and pain in addition to limiting their mobility and ability to go about their most basic obligations (Jakobsson & Hallberg, 2002).

As demonstrated by Hopkins et al (2006), previous studies have found that this group of the population is most at risk of under-diagnosis and under-treatment due to a number of reasons, including subjective self-assessment, perception issues, concealment of pain, and premature resignation to fate. To assist this group, there is immediate need to critically evaluate the lived experience in the hope of identifying their perceptions and coping strategies, which can then be integrated into the existing treatment and management practices for arthritis to provide a holistic intervention and improve the quality of life of sufferers. Studies have also shown that older people are at a higher risk of being affected by various forms of arthritis (Jakobsson & Hallberg, 2002) and, as such, knowledge about the older people’s lived experience is critically important in the management of these conditions.

Methods

Introduction

This section purposes to discuss the methods used to evaluate the lived experience of older people suffering from arthritis. Specifically, the section will report on the study design, data collection techniques, ethical considerations, data analysis, and the limitations of the methodology and methods used.

Research Design

To gain a deeper understanding and thorough insight into the lived experience of the older people, this qualitative study utilized phenomenology as the primary methodology. Traditionally, studies into chronic illness have employed a quantitative research design to evaluate issues relating to quality of life, motivation and life satisfaction, capacity to cope with the condition, resilience, control, hope, compliance, apprehension, depression and social support (Hyde et al., 1999).

The authors are of the opinion that such quantitative studies tend to be “…reductionist in method and result in data that exclude lived experience” (p. 190). To better understand an individual’s objective and subjective accounts of living with a chronic illness, Mary & Kropa (2007) advise that it is better to perform a qualitative study, which extends to participants the opportunity to express their personal views and experiences in their own way.

Phenomenology

The phenomenology approach takes into account that certain facets of human life cannot be evaluated in the same manner as components of the physical world (Carson & Mitchell, 1998). Since the main aim of the study was to get a deeper insight into the lived experience of older people suffering from arthritis, from their own viewpoint, phenomenology was selected as the methodology of the study due to its capacity to give the phenomena under study a fuller, comprehensive, and fairer hearing than what can be accorded by traditional empiricism (Gudmannsdottir & Halldorsdottir, 2009). The phenomenological approach is particularly determined to undo the effect of habitual prototypes of thought.

There exist many schools of thought within the phenomenological approach, but this study utilized The Vancouver School of doing Phenomenology in the hope of adequately answering the key research question and the study objectives. According to Halldorsdottir (2000), this approach utilizes an interpretive constructivist phenomenological orientation, thus is exceedingly helpful when the targeted belong to a vulnerable group as is the case in this study, which targets the elderly people. Additionally, this school adapts well to the needs of this study because it not only refers to participants as persons but greatly emphasizes their lived experience.

Gudmannsdottir & Halldorsdottir (2009) states that the Vancouver School views participants as “…co-researchers as they are the experts in their own experience and the interview is seen as a research dialogue resulting in a mutual construction of reality which otherwise might have been hidden” (p. 319). More importantly, this approach is considered effective when dealing with the elderly since experience has demonstrated that this group of people needs ample time and always prefer to express their experiences in a subjective and open manner (Carson & Mitchell, 1998).

Data Collection

The study used an in-depth interview schedule to collect pertinent data on the lived experience of older people suffering from arthritis. It is imperative to describe in brief some of procedures undertaken prior to the actual data collection exercise

Sampling

Sampling was purposive since the study was interested in evaluating a specific group of the population suffering from a particular condition (Hyde et al., 1999). Purposive sampling – also known as judgment sampling – fits the focus of this study because the technique has the capacity to provide information-rich cases for in-depth study. Whitehead & Annell (2007) argues that “…purposive sampling occurs when the researcher selects people who have the required status or experience, or who are endowed with special knowledge, to provide the researcher with vital information they seek” (p. 124).

Criteria for Selecting Participant

The criteria was that:

1. participant must be at least 75 years of age and above;
2. participant must have lived with the arthritic condition for a period of not less than 12 months;
3. participant suffered at least some ‘moderate’ or ‘persistent’ pain according to own self-assessment or estimation;
4. the pain did interfere with the participant’s daily life and interactions, by nurses estimation;
5. be of either sex and able to communicate adequately

Gaining Access to Participant

Having obtained the needed authorizations, a letter was sent to the director of nursing to arrange a meeting with the relevant head nurse. In the meeting, the main aim of the study was introduced and the cooperation of ward nurses sought, especially in identifying a participant who met the standards for selection. At this stage, the head nurse advised that it was resourceful to select a female participant because elderly men seem to be less expressive about their conditions. Lastly, a 78 year-old woman with osteoarthritis was identified, and she voluntarily agreed to take part in the in-depth interview.

In-depth Interview

A semi-structured in-depth interview was used to assess the lived experience of the elderly participant suffering from osteoarthritis. The Family Health International (n.d.) describes the in-depth interview as “…a technique designed to elicit a vivid picture of the participant’s perspective on the research topic” (p. 29). The interview was designed to last 30 minutes, and was structured in a way that gave the researcher the leverage to pose the questions contained in the interview guide in any order provided they were asked in a neutral manner.

The technique obliges the researchers to listen attentively to the responses given by participants, and pose follow-up questions, clarifications and probes based on those responses (). The researchers, according to Gladhill et al (2008), should not direct participants according to any predetermined perceptions, nor should they persuade participants to present particular responses by openly demonstrating approval or disapproval of what they say. It is imperative to note that the in-depth interview was face-to-face, involving the researcher and the participant.

There are a number of reasons why in-depth interview was selected as the primary data collection technique. In-depth interview synchronizes well with the phenomenological approach by virtue of the fact that the participant is considered as the expert in the study, and both approaches are directed by the desire to learn more about the participant’s experiences related to the research topic (Gladhill et al, 2008).

In addition to being recognized as the prime technique for qualitative data collection especially in nursing-related research (Whitehead & Annell, 2007), it was generally felt that the procedure will enable the researcher to gain a deeper understanding and insight into the participant’s lived experience and expose the subjective meanings that may be linked to the condition from the participant’s viewpoint. In-depth interviews also provide the interviewer a chance to probe further to gain an ever deeper insight of the real issues under study (Whitehead & Annell, 2007), a factor that is inarguably critical in evaluating the lived experience of older people suffering from arthritis.

The Interview Guide

[Initial greetings and asking the participant where she comes from to break ice]

1. How many years have you lived with this condition [osteoarthritis]
2. If you can recall, what were your initial reactions when the condition was first diagnosed
3. if you can recall, what were the initial reactions of close family members and relatives when they learnt of your condition
4. What does it mean to you to have arthritis?
5. How has the pain associated with your condition affected your daily interactions and lifestyle over the past six months?
6. What individual interventions do you employ to manage the chronic pain associated with your condition?
7. How has your age influenced you in the management of this condition?
8. I know you have received a number of medical interventions over the course of this condition. How have they assisted you to manage the condition?
9. What changes in your life have been made or will have to be made to accommodate your condition?
10. What, in your opinion, do you believe will happen in the future?

The responses were audio-taped after the researcher requested for permission from the ward nurses and the participant. According to Hyde et al (1999), recording the conversations not only enhances the quality of the data obtained from the participant, but gives the researcher adequate time to listen to the participant’s side of the story and also note the strong points from observing the non-verbal cues presented. Such information would be missed out if the researcher engages in writing down responses as opposed to recording. In addition, recording the responses quickens the interview process, an important factor when dealing with frail elderly people by virtue of the fact that they get tired quickly (Maly & Krupa, 2007; Spiegelberg, 1983)

Ethical Considerations

Many qualitative studies in the nurse practice involves the use of human subjects, hence the need to ensure conformance to ethical principles (Minichiello et al., 2008). Approval for the study was obtained through the research ethics committee of the health facility, and the hospital administrator, head nurse, and the ward nurses were briefed about the nature and scope of the study. The participant was also detailed about the purpose of the study, and permission was sought from the hospital administration as well as the participant to audiotape the conversation. The participant was also detailed on the confidentiality clauses and withdrawal to ensure consent to take part in the interview was voluntarily informed.

The first principle in the Nuremberg Code is very clear about the essentiality of voluntary consent in dealing with human subjects (Coup & Schneider, 2007). The participants must not only be given the legal capability to voluntarily give consent, but they must be offered the capacity to understand the information provided so as to make an informed consent.

Data Analysis

It is important to note that the study adopted the Vancouver School of doing Phenomenology as the primary methodology in order to gain a deeper insight and understanding into the lived experience of older people suffering from arthritis. According to Halldorsdottir (2000), the school “…espouses a world that is made up of meanings, which profoundly affect how people experience and live their lives” (p. 47).

As such, one of the primary objectives of data analysis using this school of phenomenology is the production of the reconstructed understandings of the phenomena under study from the point of view of the participant, who is largely referred to as a co-researcher. The research methodology, therefore, “…involves the cyclic process of silence, reflection, identification, selection, interpretation, and verification” (Halldorsdottir, 2000, p. 47). In this school of phenomenology, the process of data collection and data analysis runs concomitantly, though both processes are presented separately. The figure below demonstrates how the school is operationalized.

Although the Vancouver School of doing Phenomenology follows some 12 basic steps (Halldorsdottir, 2000), this section will only involve itself in the steps that are pertinent to the process of data analysis, and how they were applied in this study. These steps include: sharpened awareness of words (analysis); coding; constructing the fundamental structure of the phenomenon for each case; and identification of the overriding themes which comprehensively describes the phenomenon (Halldorsdottir, 2000; Maxwell, 2005).

All the conversations involving the researcher and the (participant) were audio-taped and then transcribed verbatim through processing all words on a computer (Fielding & Lee, 1993). The sharpened awareness of words step involved reading and rereading the transcribed conversation to get a sense of the participant’s lived experience as a whole. According to Halldorsdottir (2000), the researcher should first read the transcript as an exiting novel to acquire a deeper feeling for the protocols and make sense out of them, letting the data “…soak in by being as receptive as possible, listening attentively to the dialogues and reading the transcripts attentively” (p. 62). This should always be done with an open mind.

In the coding step, the researcher first identified key statements made by the participant and which had a special bearing on the phenomena under study – the lived experience of older people suffering from arthritis. Afterwards, themes of key statements were identified and coded by writing the names on the right side column of the transcribed interview (see appendix 1). According to Halldorsdottir (2000), this is a step in the Vancouver School of doing Phenomenology specifically oriented to identify the essences of the phenomena

The third step, involving constructing the fundamental structure of the phenomenon for each case, was simplified since the in-depth interview was only administered to one participant. However, the researcher used this phase to group similar themes into one category so as to get a clearer picture of the phenomena under study. Finally, the researcher undertook to identify overriding themes which described the phenomena under study so as to gain a deeper insight into the issues that were of fundamental importance to the study (Halldorsdottir, 2000). The underlying themes and associated meanings were then formulated into analytical findings that could be used objectively to explain the lived experience of older people suffering from arthritis

Brief Synopsis of Findings

Findings

The findings of this particular study are presented in the table below, stated according to the underlying themes and related clusters of meaning for ease of understanding

Experiencing pain is a central component to osteoarthritis experience

• Pain is more bearable when an individual can anticipate its end, or when one has a sense of control over the pain
• Pain caused by arthritis causes one to slow down
• Pain caused by arthritis decreases level of confidence and trust on self

Functional and mobility limitations devalues self-worth

• Having a functional or mobility challenge devalues one’s sense of self-worth since mobility is an integral component of self-identity
• Mobility transformations arising from chronic pain makes an individual to become conspicuous to others that he/she experiencing poor health
• The sensation of stiffness caused by arthritis impairs one’s capacity to move freely

Sharing the experience of living with arthritis

• Experiences of others suffering from the same condition influence perceptions, opinions and decisions, not mentioning that such experiences provides information
• Sharing experiences with others offer meaning for enduring hardship and chronic pain

Assessing own Health

• Comparisons are made at different points in time and with others suffering from the same or similar condition to assess performance, health, and wellbeing
• Trust in the doctor/nurse – patient relationship results when the provider’s evaluation of the patient’s status reflects his/her feelings

Managing Chronic Pain

• Knowledge regarding management of pain is particularly gleaned from peers and social support systems, rather than nurses and physicians
• Excessive pain decreases the quality of life
• Excessive/chronic pain is positively correlated to depression
• Physicians offer passive treatment methodologies, not active management approaches, to live with persistent pain

The Experience of Age

• Older people have strong coping mechanisms that may confuse healthcare professionals about the extent and scope of pain
• Chronic pain increases with age, and this increases feelings of worthlessness

Discussion

A meta-analysis done by Jakobsson & Hallberg (2002) on the lived experience of the elderly people suffering from chronic pain found that not only did the functional limitation continued to worsen with disease duration and age, but also anxiety and depression continued to increase with disease duration. The analysis also revealed that pain was one of the most upsetting challenges among the elderly living with rheumatoid arthritis, and it tended to increase with age and disease duration.

The findings of the present study collaborates these facts. A study conducted by Beitz et al (2005) on the lived experience of having a chronic wound revealed that dependence on others, lack of social support, and negative spouse/relative behaviour such as avoidance and critical remarks exacerbated pain, not mentioning that these factors decreased the quality of life and wellbeing of sufferers. In addition, the study demonstrated a correlation between wellbeing and quality of life on the one hand and functional limitation on the other.

The present study has demonstrated that severe pain and age progression not only reduces vitality and social functioning, but it has underlined the importance of social support and understanding of the lived experience in the management of the chronic pain occasioned by arthritis. Therefore, it is critically important to have a deeper understanding of the lived experience of older people suffering from arthritis if effective treatment and management strategies are to be achieved (Hyde et al, 1999), and if the older people are to be assisted to have more satisfying lives.

Limitations of the Methodology & Methods

The credibility of qualitative research is to large extent dependent on the methodical skill, understanding, and integrity of the researcher (Halldorsdottir, 2000), especially in analyzing the subjective meanings and developing themes that can be used to adequately answer the phenomena under study (Grbich, 1999; Moon, 2004). This implies that the validity, trustworthiness, reliability of studies using the phenomenological approach is largely dependent on the skills, rigour and competence of the researcher, and therefore may be expensive to undertake since they require specialized skills (Halldorsdottir, 2000; Moon, 2004).

According to Grbich (1999), some phenomenological approaches have received criticism because of the fact that “…it may not be possible to suspend all empirical and metaphysical presuppositions about the world through bracketing” (p. 170). Still, access to concealed subjective meanings has also been challenging, as has the inclination for the approach to generate only shallow narratives of social phenomena.

As such, the interviewer must have the capacity to continually question the interpretation of subjective meanings or risk validity. Some researchers have also questioned the rationale of inter-subjective interaction between the researcher and the participant (Sokolowski, 2000; Manen, 1990), claiming that such interaction can be used to alter findings, therefore risking the reliability and trustworthiness of the study.

In terms of the methods used, Whitehead & Annell (2007) argues that in-depth interviews are not only time-consuming and resource-intensive to establish, but also encounter ethical challenges especially in questions which may seem biased, leading, manipulative or coercive. In addition, limitations may arise in “…securing access, making sensitive records, managing power relationships, managing space, managing communication, and managing sequelae of interviews” (Whitehead & Annell, 2007, p. 129).

Grbich (1999) & Reason (1988) notes that in-depth interviews require skills, competency and integrity to undertake, thus the risk of getting invalid results in studies undertaken by researchers who lack these competencies is a matter of concern. Purposive sampling, according to Gray et al (2003), has a potential for inaccuracy in the criteria used to select the sample used for the study.

Reference List

Beitz, J.M., Goldberg, E., & Voder, L.H. (2005). The lived experience of having a chronic wound: A Phenomenological study. MEDSURG Nursing, 14(1), 51-82. Web.

Carson, M.G., & Mitchell, G.J. (1998). The experience of living with persistent pain. Journal of Advanced Nursing, 28(6), 1242-1248. Web.

Coup, A., & Schneider, Z. (2007). Ethical and legal issues in research. In Z. Schneider, D. Whitehead, D. Elliot, G. Lobiondo-Woed & J. Haber (Eds.), Nursing & midwifery research: Methods and appraisal for evidence-based practice 3^rd Ed. Marrickville, NSW: Elsevier Australia.

Family Health International. (n.d.). Qualitative research methods: A data collector’s field guide. Web.

Fielding, N., & Lee, R.M. Using computers in qualitative research. Thousand Oaks, CA: Sage Publications, Inc.

Flynn, J.A., & Johnson, T. (2006). Arthritis 2006. Arthritis, 1-90. Retrieved from Health Source – Consumer Edition Database.

Gladhill, S., Abbey, J., & Schweitzer, R. (2008). Sampling methods: Methodological issues involved in the recruitment of older people into a study of sexuality. Australian Journal of Advanced Nursing, 26(1), 84-94. Web.

Gray, P.S., Williamson, J.B., & Karp, D.E. (2003). The research imagination: An introduction to quantitative and qualitative methods. Thousand Oaks, CA: Sage Publications, Inc.

Grbich, C. (1999). Qualitative research in health: An Introduction. CrowsNest, NSW: Allen & Unwin.

Gudmannsdottir, G.D., & Halldorsdottir, S. (2009). Primacy of existential pain & suffering in residents in chronic pain in nursing homes: A phenomenological study: Scandinavian Journal of Caring Services, 23(2), 317-327. Web.

Halldorsdottir, S. (2000). The Vancouver school of doing phenomenology. In B. Fridlund & C. Haldingh (Eds.), Qualitative research methods in the service of health. Lund: Studentlitteratur.

Hopkins, A., Dealey, C., Bale, S., Defloor, T., & Worboys, F. (2006). Patient stories of living with a pressure ulcer. Journal of Advanced Nursing, 56(4), 345-353. Web.

Hyde, C., Ward, B., Hursfall, J., & Wider, G. (1999). Older women’s experience of living with chronic leg ulceration. International Journal of Nursing Practice, 5(4), 189-198. Web.

Jakobsson, U., & Hallberg, I.R. (2002). Pain and quality of life among older people with Rheumatoid Arthritis and/or Osteoarthritis: A literature review. Journal of Clinical Nursing, 11(4), 430-443. Web.

Maly, M.R., & Kropa, T. (2007). Personal experience of living with knee osteoarthritis among older adults. Disability and Rehabilitation, 29(18), 1423-1433. Web.

Manen, M. (1990). Researching lived experience: Human Science for action sensitive pedagogy. New York, NY: State University of New York Press.

Maxwell, J.A. (2005). Qualitative research design: An interactive approach. Thousand Oaks, CA: Sage Publications, Inc.

Minichiello, V., Aroni, R., & Hays, T. (2008). In-depth Interviewing, 3^rd Ed. Sydney: Pearson/Prentice Hall.

Moon, J. (2004). Handbook of reflective and experiential learning: Theory and practice. London: Routledge.

Oliver, S. (2009). Understanding the needs of older people with Rheumatoid Arthritis. The role of the community nurse. Nursing Older People, 21(9), 30-37. Web.

Reason, P. (1988). Human inquiry in action. Thousand Oaks, CA: Sage Publications, Inc.

Schroeder, J. (2010). Arthritis: So many types, so much to learn. American Fitness, 28(1). Web.

Sokolowski, R. (2000). Introduction to phenomenology. Cambridge: Cambridge University Press.

Spiegelberg, H. (1982). The phenomenological movement, 3rg Ed. Cambridge: Cambridge University Press.

Whitehead, D., & Annell, S.M. (2007). Sampling data and data collection in qualitative research. In Z. Schneider, D. Whitehead, D. Elliot, G. Lobiondo-Woed & J. Haber (Eds.), Nursing & midwifery research: Methods and appraisal for evidence-based practice 3^rd Ed. Marrickville, NSW: Elsevier Australia.

Appendix 1: Transcription of the In-Depth Interview

Introduction

Inflammation is a protective reaction associated with vascular tissues in response to different stimuli such as irritants and pathogens. In addition, other causes of inflammation may include physical injuries and immune reactions on body cells and tissues. Therefore, inflammatory reactions serve to eliminate the stimuli and start the process of healing on damaged cells, tissues, and organs (Ferrero-Miliani et al., 2007, p. 227). Conversely, these inflammatory reactions can be chronic or acute. This essay presents the etiology, pathogenesis, diagnosis, clinical manifestations, prognosis, and the treatment of Rheumatoid Arthritis (RA) and Guillain-Barre Syndrome (GBS).

Rheumatoid Arthritis (RA)

Chronic immune inflammatory reactions can occur on synovial tissues in response to the synovitis, synovial cells, and the accumulated synovial fluid in the joints. This type of autoimmunity causes Rheumatoid arthritis (Majithia & Geraci, 2007). The symptoms of RA are not only limited to the articular regions but they can also spread to other parts of the body. Therefore, RA affects the joints, skin, lungs, kidneys, blood vessels, heart, and other systemic tissues.

In addition, the disorder leads to destruction of the ankylosis and cartilage lining the joints. It also causes nodular lesions on the skin and diverse inflammatory reactions on different systemic tissues (Majithia & Geraci, 2007, p. 937). The clinical diagnosis of RA involves physical examination of symptoms, blood tests, x-ray radiographic imaging, and other differential diagnoses, which are aimed at distinguishing the symptoms of RA from other disorders.

Moreover, the pathogenesis of RA entails proliferation and fibrosis of cells; the destruction of cartilage and bones; and pannus formation. These changes are caused by the activities of proteolytic enzymes, cytokines, and prostanoids in the synovial region (Majithia & Geraci, 2007, p. 937). Here, inflammation is mediated by Tumor Necrosis Factor-alpha and Interleukin-1 (IL-1), which are the most notable pro-inflammatory cytokines in the disease process of RA. The two cytokines enhance the production of other inflammatory elements such as nitric oxide (NO) and prostaglandin E₂ (PGE₂).

However, IL-1 has shown prominence in the pathogenesis of RA. Initial IL-1 release stimulates osteoblasts, synoviocytes, and chondrocytes. The cells take part in the inflammatory reactions, bone destruction, and pannus formation. Furthermore, the inflammatory reactions elevate the secretion of IL-1 relative to the progress of the disease. In addition, IL-1 stimulates the movement of neutrophils into the synovial region; the production and differentiation of lymphocytes; and finally the activation of macrophages. Additional IL-1 production leads to severe erosion of bone and cartilage, produces pain, and impairs tissue repair (Majithia & Geraci, 2007).

Lastly, Rheumatoid arthritis can be treated using medications such as analgesics, steroids, and disease-modifying antirheumatic drugs (DMARDs). In addition, non-pharmacological therapies such as physical therapy and nutritional therapy can halt the development of the disease. Conversely, the prognosis of RA shows varied symptoms in different patients such as disabilities, poor prognostic factors, and sometimes death (Majithia & Geraci, 2007, p. 939).

Guillain-Barre Syndrome (GBS)

Acute infections of the peripheral nervous system can cause an autoimmune reaction in response to the pathogens and the host tissues. These immune responses are targeted at pathogens such as bacteria and the influenza virus but instead they attack the gangliosides of the nerve tissues (Hughes et al., 1999). This is the basis of GBS, which leads to inflammatory demyelination of the nerves and multiple neuropathies. Consequently, GBS is characterized by impaired sense of position, paralysis, absence of fever, areflexia, and symmetrical weaknesses that begin with the legs and spread to the upper limbs and finally to the face.

Conversely, analyses of the cerebrospinal fluid and electrodiagnostics provide important insights into the diagnosis of GBS. In addition, observable paralysis and areflexia can be used as the immediate indicators of GBS. However, additional differential diagnoses are important to distinguish the symptoms of GBS with other disorders such as the Motor Neuron Disease (Hughes et al., 1999, p. 74).

The pathogenesis of GBS is associated with immune responses targeted at an acute infection. However, the pathogens involved in the infection contain epitopes resembling some components of the peripheral nervous system. Therefore, the immune reaction attacks the nerve components causing acute inflammation on the myelin sheath or the axon (Hughes et al., 1999). Furthermore, the inflammatory reactions cause severe demyelination in the nodes of Ranvier and nerve roots.

These inflammatory reactions are mediated by both the cellular and humoral immune components such as activated T-lymphocytes, which invade the demyelinated regions and attract macrophages that destroy the nerve membranes. Additional demyelination is thus, mediated by the macrophages and components of the complement system.

Lastly, the treatment of GBS entails providing supportive care for patients with paralyzed diaphragms and intravenous injections of immunoglobulin for stable patients. In addition, administration of plasmapheresis is recommended. Conversely, except for isolated cases of persistent areflexia, the prognosis of GBS shows that most patients begin recovering at the forth week after the onset and they can be completely healed after a few months or one year.

Conclusion

The essay presents a detailed discussion on two inflammatory conditions, which are caused by immune responses that target cells, tissues, and organs in the body. Therefore, the essay examines the etiology, clinical manifestations, diagnosis, pathogenesis, treatment, and the prognosis of Rheumatoid arthritis and Guillain-Barre Syndrome (GBS). From the discussions above, it can be deduced that inflammation is a serious complication, which occurs in the whole body or within a specific tissue and causes acute or chronic symptoms. However, most inflammatory conditions are treatable and preventable.

Reference list

Ferrero-Miliani, L., Nielsen, O. H., Andersen, P. S., & Girardin, S. E. (2007). Chronic inflammation: Importance of NOD2 and NALP3 in interleukin-1 beta generation. Clin. Exp. Immunol., 147 (2), 227–235.

Hughes, R. A., Hadden, R. D., Gregson, N. A. & Smith, K. J. (1999). Pathogenesis of Guillain-Barre syndrome. J Neuroimmunol., 100 (1-2), 74-97.

Majithia, V. & Geraci, S. A. (2007). Rheumatoid arthritis: diagnosis and management. Am. J. Med., 120 (11), 936–939.

Introduction

The reliance on clinical evidence obtained through research can be seen as one of the most effective methods of increasing the effectiveness and efficiency of medicine. The present paper will attempt to utilize the evidence and the findings of clinical research in providing treatment recommendations to resident A.B – an 84years female who has a history of thrombocytopenia, osteoarthritis, interstitial cystitis, and slight dementia. The paper will mostly focus on the findings related to pain complaints and treating Osteoarthritis.

Problem Statement

In the present research, the problem is resident A.B. whose medical diagnosis is Thrombocytopenia. Additionally, she complains of acute osteoarthritis pain which she rates 8/10, and which is not relieved. The patient has a history of progressively worsening osteoarthritis.

Literature Review

In Tsai, Chu, Lai and Chen (2008), the authors clinically tested the importance of dealing with pain in the elderly population with osteoarthritis in Taiwan. The authors outlined the differences in the mechanisms of coping with pain in the aforementioned population, between pharmacological and non-pharmacological. Accordingly, the relationship between the way the elderly population deals with pain and scores with worst pain outlined significant differences in the scores of the satisfaction with the living situation. Furthermore, the scores of satisfaction with living situation, i.e. the intensity of average pain, pain interference with walking, pain interference with sleeping and pain control beliefs, can be used as predictors of the intensity of the worst pain (Tsai, Chu, Lai, & Chen, 2008, p. 2602).

In Merkle and McDonald (2008), on the other hand, the problems of osteoarthritis in elderly adults were approached from the perspective of investigating the types of treatment the elderly use to manage pain and the correlation of the types of treatment used with the demographics of the population. His study distinguished between three types of treatment of osteoarthritis, non-traditional, traditional, and recommended gold standard treatment (the combination of acetaminophen/paracetamol or NSAIDs, combined with physical therapy or exercise) (Merkle & McDonald, 2008, p. 830). The study revealed that there was a correlation between demographic characteristics and the type of treatment used to manage osteoarthritis pain.

Findings and Recommendations

The findings of the articles indicate the importance of managing the pain and adherence to recommended pain medication. In that regard, the practical implication of such findings in the present case can be summarized through the following points:

• Conduct assessments of pain, its frequency, and monitor coping strategies.
• Monitor adherence to the medication.
• Conducting group discussions with the patient and her relatives on the efficiency of a recommended medication.

The average pain and the worst pain experienced by the patients have a direct relation, as the findings revealed in the review. In that regard, the importance of coping with everyday pain through recommended medication might provide improvements in the degree of worst experienced pain.

Conclusion

The present paper outlined the findings of evidence-based research related to the treatment of osteoarthritis pain in the elderly population. These findings can be used for the main participant of the present research, the resident A.B. According to the findings of the research, it is recommended that that the daily coping with pain mechanisms of the patient be monitored, to reduce the frequency and the severity of the worst pain experiences. Accordingly, the type and the efficiency of the medication should be discussed with the patient. It can be concluded that the importance of evidence-based medicine cannot be overestimated, which was demonstrated through this paper.

References

Merkle, D., & McDonald, D. D. (2008). Use of recommended osteoarthritis pain treatment by older adults. Journal of Advanced Nursing, 65(4), 828–835. Web.

Tsai, Y.-F., Chu, T.-L., Lai, Y.-H., & Chen, W.-J. (2008). Pain experiences, control beliefs and coping strategies in Chinese elders with osteoarthritis. Journal of Clinical Nursing, 17, 2596–2603. Web.

The current statistics indicate that close to 6 million Americans are suffering from a particular form of Arthritis. Arthritis is a disease that usually affects old people and the risk of contracting the disease increases with age. The disease mostly affects the joints and causes swelling, weakening and pain in the joints. There are two forms of arthritis: Osteoarthritis and Rheumatoid arthritis (Cherniack 340). Like most other untreatable diseases that have been extensively researched and characterized, there has been an emergence of alternative medicine for managing arthritis. Current directions in alternative medicine are geared towards preventing the advancement of the disease and managing the symptoms.

Factors such as the cost of conventional medication and side effects have led to the proposition of a range of alternative medications (Cherniack 347). The pharmacology of alternative medications is not well documented and there is little evidence on whether they can complement or replace conventional medication in the management or even treatment of arthritis. The paper will look at some of the key considerations in choosing a form of medication and establish whether there is a possibility of replacing conventional medication with an alternative medication, or whether alternative medication can act as a good complement.

Side Effects

The drugs mostly used for the treatment of arthritis are aimed at reducing pain (analgesics) and preventing further inflammation (anti-inflammatory). According to Aronson, analgesics and anti-inflammatory drugs have been known to lead to viral and bacterial infections, and could also be transferred to the baby of a breastfeeding mother through breast milk (541). Alternative medications according to Michael, should be used with caution because they also present certain risks (58).

For instance, acupuncture is only a short term pain reliever, Ginger, which is used as an analgesic, causes heartburn and diarrhea. However, the use of magnet therapy does not have any known side effects (Michael 59). Both the conventional and alternative drugs for the treatment of arthritis have their unique side effects. However, the side effects of conventional drugs appear to be more medically serious as compared to the side effects of alternative drugs. For instance, ginger may only cause heartburn while a conventional drug-like Infliximab leads to tuberculosis.

Cost

The cost of conventional medication for the treatment of arthritis has also been a factor that has driven many people to opt for alternative therapies. According to a study conducted by Null and Seaman, the sale of drugs for the management of arthritis totalled US$ 27 million in 2005 and the figure was expected to rise even further (50). Unlike treatment, the management of an illness is a continuous undertaking because the medication only reduces the side effects for some time. Although alternative medications for arthritis such as acupuncture, magnet therapy or the use of natural drugs also cost money, Null and Seaman outline that the cost is much lower as compared to the conventional medications (52). In addition, alternative medications do not place significant pressure on the health care system because they can be produced cheaply domestically.

The general realization is that the cost of conventional arthritis medication is an important factor that can drive individuals to consider alternative medication. Conventional drugs always use natural products such as ginger, magnet and omega 3 oils most of which can be obtained easily without having to go to a hospital to get a prescription. In essence, alternative drugs for arthritis are accessible both in terms of cost and in terms of availability.

Safety

Safety is a key consideration when choosing a type of medication because it would be illogical to give a medication that might cause other problems or further complicate the current problem. Conventional drugs are usually undertaken through clinical tests and trials to ensure that they are safe for human consumption. During clinical tests and trials, scientists can establish aspects such as the effective route of administration, the long terms and short-time side effects and pharmacokinetics of the drug (Gad 33). Before a conventional drug is made available for human consumption, the relevant authorities have to ascertain that it will not cause further risks or the risks are lesser than the projected benefits.

However, when it comes to alternative medications, it is usually difficult to establish the risks associated because most of them are produced and used on small scale. In addition, a factor such as a cost usually prevents the producers from employing clinical tests and trials that are exhaustive. According to Cherniack (343), the fact that a particular medication is obtained from natural sources does not mean that it is completely harmless. Cherniack gives an example of ginger that might lead to blood coagulation even though it is a natural substance. The administration of conventional drugs is usually accompanied by prescriptions from professionals and follow ups to determine the effect of the drugs on the individual patient.

However, alternative drugs are mostly administered locally with little follow ups from the doctors. The general realization is that alternative drugs might pose additional problems especially in instances where an individual is allergic to the drug (Cherniack 348). These considerations make conventional drugs safer as compared to alternative drugs. Safety is not only an issue that affects alternative drugs used in the management of arthritis but also most other diseases, and it has been a subject of extensive debate in medicine.

Given the discussion, most alternative drugs used in the treatment of arthritis are aimed at avoiding the shortcomings evident in conventional medications. Conventional drugs for arthritis are very expensive and an individual who would rather take naturally available ginger, than aspirin is relatively costly. Concerning side effects, both conventional and alternative medications have their unique side effects. However, conventional drugs have more serious side effects as compared to alternative drugs. Normally, conventional drugs are considered safer to take because they are known to have undergone extensive clinical tests and trials as per government regulations.

However, the safety of alternative medication is usually questionable because they do not usually undergo extensive clinical tests and trials. In essence, conventional drugs are still medically safe. Concerning the current information on alternative drugs used in the treatment of arthritis, they should not be used as complete replacements for the management of arthritis. Alternative drugs can only be used in situations where doctors have ascertained beyond reasonable doubt that they can manage a certain aspect of the condition effectively. However, these drugs can still act as better complements in areas where conventional drugs are not effective. However, with further developments in research, there is hope that alternative drugs can be used more because they are less costly.

Works Cited

Aronson, Jeffrey K. Meyler’s Side Effects of Analgesics and Anti-inflammatory Drugs. San Diego, CA: Elsevier, 2010. Print.

Cherniack, Paul. Alternative Medicine for the Elderly. Berling: Springer-Verlag, 2003. Print.

Gad, Shayne Cox. Drug Safety Evaluation. New Jersey: John Wiley, 2009. Print.

Michael, Angelillo. All about Arthritis- Find Updated Causes, Symptoms, Diagnostic Tests, New Alternative Treatments, Cures and Breakthroughs. New York: iUniverse, 2009. Print.

Null, Gary. For Women Only: Your Guide to Health Empowerment. New York: Sage, 2003.

Introduction

Synovitis, swelling, and joint degeneration are all caused by immune system mediators and antibodies, both innate and adaptive. Loss of tolerance to citrulline residues in self-proteins is caused by the interaction of genes and the environment. Arginine residues are converted to citrulline by peptidyl arginine deiminase following translation. The immune system targets patients who share epitopes, creating ACPAs (Volkov et al., 2020). There is evidence that inflammation and the formation of adhesion molecules in the synovium occur before the emergence of systemic autoantibodies in RA.

When leukocytes invade the synovium, a condition known as synovitis is induced. Synovial microvessels create adhesion molecules and chemokines, which cause leukocytes to move from distant sources into the synovium. As a result of synovial cell proliferation and reduced capillary flow, the interior of the inflamed synovium is hypoxic. Hypoxia enhances synovial angiogenesis, perhaps through an increase in VEGF synthesis. The development of rheumatoid arthritis (RA) is a complex process involving adaptive and innate immunological components. Cytokine and chemokine levels in the synovium significantly impact the dynamics of these interactions (Lin et al., 2020). Proliferating inflammatory cells populate the synovial membrane in RA and act synergistically to cause joint destruction.

As dendritic cells, critical antigen-presenting cells, are found near clusters of T cells in the synovium, RA’s adaptive immune response is likely involved. Dendritic cells deliver Antigens to T cells in the synovium, which is essential in T-cell activation. T-cell activation and downstream pathways are inhibited when CD80/86 is suppressed competitively. CD80/86 inhibition’s success in treating RA shows that T cells play a role in the disease’s development.

Th1, Th2, and Th17 subpopulations form when T cells get activated, each having distinct cytokine production profiles and responsibilities. The adaptive immune system also influences RA’s etiology. B cells can play a role in autoimmune disease in various ways. B-cell tolerance checkpoints can be defective, allowing autoreactive B cells to activate T cells as antigen-presenting cells. The cytokines they generate might be pro- or anti-inflammatory (Weyand & Goronzy, 2021). As a result, B cells are now capable of producing antibodies. RA can be brought on by anyone or a combination of these mechanisms. The synovial membrane is home to macrophages, mast cells, and natural killer cells, whereas the synovial fluid is home to neutrophils. Synovitis macrophages release proinflammatory cytokines, reactive oxygen intermediates, prostanoids, and matrix-degrading enzymes. Pathogen-inducing stimuli such as a pathogen elicit an inflammatory and immunological response from TLRs on macrophages and dendritic cells in the body.

Intracellular signaling networks are involved in the pathogenesis of RA. Antibodies and antigens generate inflammation by binding to receptors on target cells. Intracellular signaling events lead to the nucleus, where gene expression is altered, influencing cell function due to receptor interaction. Variations in the production and release of inflammatory mediators are commonly associated with immune cell gene expression variations. The original signal is amplified and modified when these mediators are released extracellularly. A healthy immune response necessitates intracellular signaling networks, which might be impaired in autoimmune illness. It is now being used in the treatment of RA, the first generation of small intracellular molecules. New therapy targets might be discovered by further investigation of these pathways.

Treatment

Medications

The symptoms and RA length will influence the drugs the doctor recommends.

• NSAIDs. Inflammation and discomfort can be reduced by using NSAIDs. Aspirin (Advil, Motrin IB) and naproxen sodium (Aleve) (Aleve). Over-the-counter NSAIDs lack the potency of prescription medications (Lin et al., 2020). In addition to stomach pain and palpitations, kidney impairment might result from using this medication.
• Steroids: Prednisone and other corticosteroids like Prednisone slow down the degradation of joints. Diabetes, obesity, and bone loss are all symptoms of osteoporosis. Corticosteroids are usually administered quickly to minimize adverse effects.
• DMARDs: These drugs can help rheumatoid arthritis patients prevent joint and tissue damage that cannot be reversed with conventional treatment. Sulfasalazine and methylchloroquine (Plaquenil) are examples of DMARDs (Azulfidine). Liver and lung infections are two possible side effects.
• Biology: It is worth noting that the most recent DMARDs on the market include the previously mentioned DMARDs abatacept (Orencia), etanercept (Orencio), infliximab (Rituximab), and rituximab (Orencio) (Actemra).
• Therapy: A physical or occupational therapist can teach joint flexibility exercises under the doctor’s direction. They may also suggest less taxing daily routines for one to follow. One can elevate objects with the forearms. Assistive gadgets can help alleviate pain in the joints.

Surgery

Surgery may be required if medication-induced joint damage occurs. In some cases, joint function can be restored following surgery (Bullock et al., 2018). In terms of pain and function, this vitamin can be beneficial.

Surgery for rheumatology includes:

• Synovectomy: To alleviate discomfort and improve range of motion, it is recommended that inflammatory synovium be removed (joint lining).
• A tendon injury: The strain on a tendon can be exacerbated by joint inflammation and damage. After surgery, one may be able to grow new tissue.
• Synthesis: Joint replacement may be avoided in favor of surgical fusion to provide stability, realignment, and pain relief.
• Joint replacement: If one of the joints is damaged, a metal and plastic replacement is implanted into the body.

Summary of the Interview

A common autoimmune illness, RA manifests itself in inflammation and swelling of the joint is synovium. If left untreated, it can result in the loss of the joint is bony and cartilaginous components, resulting in incapacity. There is a wide range of comorbidities associated with systemic inflammation, all of which have a part in the increased death rates reported in those who have RA. The pathophysiology of RA is still largely unknown, although antigen presentation, T-cell activation, and autoantibody production are all thought to play a part in the inflammatory process (Weyand, & Goronzy, 2021). The medical history of the patient, as well as the physical examination, are utilized to identify whether or not the patient has rheumatoid arthritis. To aid in developing therapeutic interventions, markers of disease activity have been developed.

References

Bullock, J., Rizvi, S. A., Saleh, A. M., Ahmed, S. S., Do, D. P., Ansari, R. A., & Ahmed, J. (2018). Rheumatoid Arthritis: A Brief Overview of the Treatment. Medical Principles and Practice, 27(6), 501-507.

Lin, Y. J., Anzaghe, M., & Schülke, S. (2020). Update on the Pathomechanism, Diagnosis, and Treatment Options for Rheumatoid Arthritis. Cells, 9(4), 880.

Volkov, M., van Schie, K. A., & van der Woude, D. (2020). Autoantibodies and B Cells: The ABC of Rheumatoid Arthritis Pathophysiology. Immunological Reviews, 294(1), 148-163.

Weyand, C. M., & Goronzy, J. J. (2021). The Immunology of Rheumatoid Arthritis.Nature Immunology, 22(1), 10-18.

Patient Information

K. H., 69 years old, female, Asian American S.

CC frequent numbness in upper and lower limbs, mild neck pain, and moderate pain in the lower spine.

HPI: 69-year-old A.A. female.

Location: neck

Onset: 11 months ago.

Character: nagging, stiffness in the spine.

Associated signs and symptoms: headaches, frequent numbness in feet and arms, occasional disorientation.

Timing: in the morning, after sleeping, and following physical activities.

Exacerbating/ relieving factors: prolonged sitting exacerbates the discomfort, and replacing the mattress and pillows slightly relieves the symptoms.

Severity: 3/10 pain scale.

Current Medications: Acetaminophen – 1 dose per day.

Allergies: Medication – none; food – shellfish (urticaria, angioedema), environmental – none.

PMHx: Last tetanus – booster shot in 2014;

Past illnesses and surgeries: in 2015, the patient fractured her hip following a fall, and the recovery was successful. In 2010, the patient underwent kidney stone removal surgery. In 1973, the patient had a surgical intervention for appendicitis.

Soc Hx: The patient is retired and lives alone in a private residence, formerly worked as an accounting consultant for 21 years. K. H. tries to maintain an active, healthy lifestyle, as suggested by her physician, following the 2015 hip fracture recovery. She smoked for 31 years but quit in 2017. The patient’s main hobbies include power-walking, floral decorations, and piano practicing. Since the fall in 2015, K.H. has taken the corresponding precautions to prevent such incidents at home. The patient’s house is equipped with extra railings at the staircases and in the bathroom, as well as emergency contact buttons and smoke detectors. The patient remains in close contact with her children and younger siblings, who visit her at least once in two weeks.

Fam Hx: The patient currently does not have any known genetic life-threatening conditions. However, the family history includes cases of lethal cancer outcomes: father (age 61, lung cancer), grandfather (age 77, colon cancer), uncle (age 55, lung cancer). The patient’s mother deceased at the age of 88 due to Covid-19-associated pneumonia. The patient’s younger brother is currently treated for a non-cancerous brain tumor (glioma).

ROS

GENERAL: No weight loss, fever, chills, weakness, or fatigue. Slight height loss

HEENT: Eyes: No visual loss, double vision, or yellow sclerae. Occasional blurred vision. Ears, Nose, Throat: No hearing loss, sneezing, congestion, runny nose, or sore throat.

SKIN: No rash or itching.

CARDIOVASCULAR: No chest pain, chest pressure, or chest discomfort. No palpitations or edema.

RESPIRATORY: No shortness of breath, cough, or sputum.

GASTROINTESTINAL: No anorexia, nausea, vomiting, or diarrhea. No abdominal pain or blood.

GENITOURINARY: No discomfort during urination.

NEUROLOGICAL: Occasional headaches and dizziness, frequent numbness and tingling in the extremities. No signs of syncope, paralysis, or ataxia. No change in bowel or bladder control.

MUSCULOSKELETAL: Mild-to-moderate pain throughout the spine, particularly present in lower sections and the neck. Frequent stiffness of the neck.

HEMATOLOGIC: No anemia, bleeding, or bruising.

LYMPHATICS: Node size within the age norm No history of splenectomy.

PSYCHIATRIC: No history of depression or anxiety.

ENDOCRINOLOGIC: No reports of sweating, cold, or heat intolerance. No polyuria or polydipsia.

ALLERGIES: Shellfish causes urticaria and angioedema. No history of asthma, eczema, or rhinitis.

O.

Physical exam: General: The patient’s movements are restrained and cause visible discomfort. EENT: the vision is clear and unimpaired. Musculoskeletal system: The neck is not swollen, but the patient struggles to lean it over 45o. The right shoulder is visibly higher than the left one. The spinal curvature is observed but not alarming. Back muscles are tense. The legs are

Diagnostic results: X-Ray examination will be needed for a more detailed assessment. MRI diagnostics are required to enable precise data regarding potential spine conditions.

A.

Differential Diagnoses

Cervical spondylosis

Osteoarthritis

Facet arthropathy in L4-S1 vertebrae

Mild loss of vertebral body height of L4 and L5

P.

Following the initial assessment of the patient, a list of differential diagnoses was drafted. Based on the constant presence of such symptoms as extremity numbness, the patient is likely to have a mild form of cervical spondylosis. Lv et al. (2018) state that the prevalence of this condition is rather significant in older adults of Asian origins. Furthermore, the likelihood of the condition positively correlates with the patient’s age. Considering her ethnic background and age of K.H., she is likely to have cervical spondylosis. However, the location of the back pains suggests the development of facet arthropathy in L4-S1 vertebrae as an underlying condition. In addition, the patient reports a visible decrease in height, which indicates a mild loss of vertebral body height of L4 and L5.

The patient encountered the first symptoms about 11 months ago. The first examination at a different facility resulted in a similar conclusion. The previous medical specialists noted that the condition of K.H. was normal for her age and proposed paracetamol-based medication to relieve the symptoms upon need. Even though the condition did not progress significantly, the symptoms persisted throughout the year. The patient demonstrated a good level of personal health awareness and decided to address a different medical unit in order to prevent further complications. Alizada et al. (2018) refer to cervical instability as the primary cause of cervical instability and impaired mobility, especially in older patients. Therefore, K.H. made the correct decision to seek more profound treatment. The contemporary practice recognizes cervical disc arthroplasty as an effective method of addressing the issue and preserving the patient’s mobility (Chang et al., 2018). However, such an intervention is rather serious, and K.H. may not need such strong measures so far. Accordingly, the consecutive treatment plans will be based on the preservation of the patient’s mobility through pharmacology and physiotherapy. Overall, this case highlights the importance of evidence-based practice, as the details of it become clearer in the context of the patient’s ethnic and age-related variables.

References

Alizada, M., Li, M. R., & Hayatullah, G. (2018). Cervical instability in cervical spondylosis patients.Der Orthopäde, 47, 977-985. Web.

Chang, C. C., Huang, W. C., Wu, J. C., & Mummaneni, P. V. (2018). The option of motion preservation in cervical spondylosis: Cervical disc arthroplasty update.Neurospine, 15(4), 296-305. Web.

Lv, Y., Tian, W., Chen, D., Liu, Y., Wang, L., & Duan, F. (2018). The prevalence and associated factors of symptomatic cervical spondylosis in Chinese adults: A community-based cross-sectional study.BMC Musculoskeletal Disorders, 19. Web.

Pneumonia is one of the common infections that affect the lungs. Bacteria, fungi, or viruses are the significant aspects that cause the infection. The condition is also life-threatening and has led to the deaths of many individuals. Typically, pneumonia causes the air sacs to become inflamed and fill up with fluid, causing breathing difficulties to the patient. In many cases, health practitioners use antibiotics to treat the condition. Moreover, people are encouraged to seek medical care when experiencing some symptoms such as fever, cough, sweating, and rapid breathing. Thus, an individual can analyze various aspects concerning pneumonia and other respiratory complications.

Pathophysiology of Pneumonia and how it May Relate to the Presented Scenario

The scenario presented reveals that TM has Rheumatoid Arthritis (RA), one of the risk factors of pneumonia. Doctors have argued that people with RA have twice the average risk of being infected with pneumonia (Cao et al., 2019). Persistence cough is another common symptom of pneumonia since the infection impacts the respiratory system. The sign should, therefore, be considered when diagnosing TM since it might be influenced by pneumonia. The patient’s working environment may also be another aspect that can lead to the development of pneumonia. TM operates a bakery, which increases her risk of being exposed to fungi and bacteria from the yeast. Hysterectomy has also been performed on TM, which is a factor that can lead to pneumonia. Physicians have argued that postoperative pneumonia is one of the issues that can be experienced by people who undergo a hysterectomy (Galvis et al., 2019). Thus, these different aspects reveal that TM has a high chance of having pneumonia.

How an Environmental Exposure/Factor or Medication Affects the Pulmonary System

Exposure to different environmental factors can lead to pulmonary complications. One of the organs that are sensitive to environmental agents is the lungs. For instance, increased air pollution has led to many people experiencing respiratory infections (De Giacomi et al., 2018). The surroundings of individual influence conditions such as pneumonia and acute bronchitis. Many people working in companies that emit massive carbon stunts are at high risk of developing pulmonary infections (Suzuki & Suda, 2019). Although safety precautions have been emphasized in different organizations, many workers develop various respiratory complications since they gradually consume toxic particles that impact their health.

Medications can also be an aspect that can lead to various infections. Many people undergoing treatment develop other conditions due to body changes. Some drugs can lead to a weak immune system, increasing the risks of being infected with other diseases. For instance, the scenario presented shows that TM receives an etanercept injection weekly, leading to a fragile body system (Chen et al., 2019). Thus, the patient is at high risk of developing pulmonary infections. Some of the medications used can also interrupt hormones, leading to increased chances of lung infections (Chen et al., 2019). Therefore, health care practitioners have been encouraged to focus on any available medical records when diagnosing patients with respiratory infections.

Etiology of Cough

Several inflammatory changes in the airways can trigger a cough. Increased environmental pollution has led to many cases of people with respiratory infections. Many companies are using harmful chemicals that lead to pulmonary complications. Mechanical irritants have also increased in the modern world due to globalization leading to an increased number of firms. Therefore, various issues have led to a high number of pulmonary diseases.

Cough is a common condition and has various causes that can be examined in different individuals. Asthma is one of the significant conditions that is associated with cough. Typically, asthmatic people experience breathing challenges, leading to persistent cough (Yuan et al., 2019). Patients with asthma are advised to use inhalers to unblock the respiratory system and limit coughing. Some of the infections block the air sacs making breathing difficult for the patients. Health care providers have also encouraged people with respiratory diseases to ensure that they seek treatment to unblock their lungs and limit coughing. Another major cause is Gastroesophageal reflux disease (GERD), which involves stomach acid flowing back into the tube that connects the esophagus and the digestive system. Thus, individuals experience constant irritation, which leads to chronic coughing in some cases. Failure to treat the condition worsens the GERD, and persistent cough is experienced.

Conclusion

Many people experience pulmonary complications due to various factors. For instance, air pollution has led to increased cases of lung infections in different areas. Factors such as medications have also been termed as aspects that lead to the development of respiratory complications. Pneumonia and acute bronchitis are some of the common pulmonary conditions that affect many people. Additionally, pneumonia has been ranked as one of the respiratory infections that cause death among many patients. Cough is also another common condition in various regions. Doctors have revealed that individuals experience coughs due to various causes. For instance, asthma is one of the conditions that is associated with the complication. GERD is also an issue that leads to coughs in humans since it affects the lungs. Therefore, health practitioners encourage people to seek medical care and determine the cause of their cough. In essence, respiratory complications are a significant issue that impacts many people’s health, and people with different symptoms should seek health care services.

References

Cao, J., Zhang, N., Wang, Z., Su, J., Yang, J., Han, J., & Zhao, Y. (2019). Microneedle-assisted transdermal delivery of etanercept for rheumatoid arthritis treatment.Pharmaceutics, 11(5), 235. Web.

Chen, X. F., Du, M., Wang, X. H., & Yan, H. (2019). Effect of etanercept on post-traumatic proliferative vitreoretinopathy. International Journal of Ophthalmology, 12(5), 731. Web.

De Giacomi, F., Vassallo, R., Yi, E. S., & Ryu, J. H. (2018). Acute eosinophilic pneumonia. Causes, diagnosis, and management.American Journal of Respiratory and Critical Care Medicine, 197(6), 728-736. Web.

Galvis, J. N., Vargas, M. V., Robinson, H. N., Tyan, P., Gu, A., Wei, C, & Moawad, G. (2019). Impact of Chronic Obstructive Pulmonary Disease on Laparoscopic Hysterectomy Outcome. JSLS: Journal of the Society of Laparoendoscopic Surgeons, 23(1). Web.

Suzuki, Y., & Suda, T. (2019). Eosinophilic pneumonia: A review of the previous literature, causes, diagnosis, and management.Allergology International, 68(4), 413-419. Web.

Yuan, H., Liu, X., Li, L., Wang, G., Liu, C., Zeng, Y., & Chen, Z. (2019). Clinical and pulmonary function changes in cough variant asthma with small airway disease.Allergy, Asthma & Clinical Immunology, 15(1), 1-10. Web.

Summary

The musculoskeletal system has crucial functions such as body support, internal organs protection, facilitation of movement, and blood cell formation. However, various orthopedic conditions can negatively impact the way the system works. As a result, an individual with any orthopedic disorder may have trouble executing their daily activities. Osteoarthritis is one of the diseases that affect the musculoskeletal system.

Causes and Risk Factors

Osteoarthritis is a type of arthritis, which causes inflammation and pain in joints. The condition is common among middle-aged and older adults and worsens over time, breaking down joint cartilages (Mobasheri & Batt, 2016). Any joint in the body is vulnerable to the disease; however, knees, hands, spine, and hips are the most affected. The disorder is classifiable as primary or secondary osteoarthritis. While there is no known cause of primary osteoarthritis, the other group of illnesses is associated with deformity, injury, other diseases, and infection. Osteoarthritis starts with the joint’s cartilage breakdown, leading to the thickening of the bone ends and the formation of bony growths (bone spurs) and fluid-filled cysts. The former and the latter can significantly limit the movement of the affected joint. The disease’s risk factors include heredity, extra weight, being old and a female, and injuries (Mobasheri & Batt, 2016). Such genetic problems as too loose joints or those with defects can lead to osteoarthritis. Being obese or overweight exerts more pressure on joints such as knees over time, leading to orthopedic disorder. Severe injury to the knees due to misuse or overuse can lead to osteoarthritis.

Signs and Symptoms

Osteoarthritis may present signs and symptoms similar to those of other health conditions. However, typical physical assessment findings include joint pain and stiffness (Mobasheri & Batt, 2016). Notably, pain, especially after inactivity or overuse of a joint, is the most common disease symptom. An individual with osteoarthritis experiences stiffness when they remain inactive for some time or after sleep. Reduced joints and grinding feeling when they are moved and swelling are other indicators that a person has osteoarthritis. The signs are associated with the breaking down and wearing of cartilages.

Treatment Plan

The treatment plan for osteoarthritis focuses on relieving the symptoms, improving patients’ ability to move, and allowing them to remain active. Jönsson et al. (2019) indicate that chronic orthopedic condition has variable outcomes over time. Its signs can improve, stay the same, or worsen gradually as time goes by depending on the modification of contributing factors (Deveza, 2019). The treatment plan is tailored based on the joint’s pain severity and stiffness, the affected joint, and the number of difficulties one has with their daily activities.

Interventions

Osteoarthritis is manageable using both pharmacological and non-pharmacological interventions, and in worst cases, surgical procedures. The disease’s common pharmacotherapies include nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, and glucocorticoid injections (Jönsson et al., 2019). NSAIDs such as topical capsaicin are applied on the skin over the affected joint with insignificant side effects, while others such as ibuprofen and naproxen are orally administered. Acetaminophen is not effective in relieving osteoarthritis pain and is associated with side effects, particularly liver damage (Deveza, 2019). Doctors recommend glucocorticoid injections for people who are unresponsive to other medications. Non-pharmacological therapies for osteoarthritis include physical therapy and exercises, weight loss, and the use of assistive devices and orthoses.

Patient Education

Healthcare providers should educate patients about osteoarthritis, focusing on causes, risk factors, symptoms, and possible interventions to manage the condition. Knowing the origin and aspects that increase the possibility of contracting the illness can help people lead healthy life (Deveza, 2019). Additionally, when they are aware of the disease’s signs, they can seek treatment before it worsens. Learning about treatments can help patients actively participate in their care and know the way they can manage the illness when doctors and nurses are not around.

References

Deveza, L. A. (2019). Overview of the management of osteoarthritis. UpToDate. Web.

Jönsson, T., Eek, F., Dell’Isola, A., Dahlberg, L., & Ekvall Hansson, E. (2019). The better management of patients with osteoarthritis program: Outcomes after evidence-based education and exercise delivered nationwide in Sweden. PLOS ONE, 14(9), e0222657. Web.

Mobasheri, A., & Batt, M. (2016). An update on the pathophysiology of osteoarthritis. Annals of Physical and Rehabilitation Medicine, 59(5-6), 333–339. Web.