Category: Arthritis

The Purpose and Population for the Investigation

Study hypothesis

The research aims at evaluating the efficacy of purified honey bee (Apis mellifera) venom (HBV) biotherapy for the treatment of osteoarthritis (OA) knee pain and physical function.

Study population

The study population under research comprises of patients with osteoarthritis (OA). The inclusion criteria for the subjects of investigation consist of the prevalence of at least one knee, which has been determined to be Kallgren-Lawrence radiograph grade of between one to three. For inclusion, the patient is also necessitated to possess moderate to severe knee pain. This pain is categorized by a score of greater or equal to two on question Number one of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Moreover, the subjects were required to be under chronic pain medication for not less than four days/week in 28 days before screening. The exclusion criteria for topics for the study include hypersensitivity to bee venom or the prevalence of a positive skin test to honey bee venom (HBV).

Patients with IS injection of hyaluronic acid, corticosteroids, or IA viscosupplementation were excluded from the study. Patients with the general usage of chronic oral antihistamines, Beta-blockers, simultaneous injury, or inflammation of the target knee were excluded from the study. Furthermore, subjects under inhibitors of cytochrome P450 enzyme isoforms were also excluded from the study.

Sample Size and Statistical Power

932 patients were screened; however, only 538 patients were enrolled for the study. A total of 361 patients were randomized for the Honey Bee Venom, while 177 subjects were selected as a control group for the study. Statistical power refers to the likelihood that a certain test will correctly reject a false null hypothesis. Therefore, the higher the statistical power for a given experiment, the lower the probability of committing a type two error. The statistical power for the study is 90% which means when a series of trials is run on the drug and placebo; the chances are 90% to get a statistically significant result (Conrad et al., 2019). The power also means there is a 10% probability for the results not to be statistically significant.

Selection of Participants for the Study and Control Groups

Process

The study utilized a randomized approach to identify and assign subjects to experimental or control groups.

Confounding variables

The confounding variables refer to a set of variables that affect other variables within a study to produce distortion between the variables. The confounding variables tend to influence both the independent and the dependent variables, leading to a spurious association. The confounding variables within the study include the prevalence of exercise and weight loss. The variables also entail use of prohibited medications, systemic reaction to the HBV hypersensitivity skin test, or recent use of an investigational product.

Masking or blinding

Masking or blinding was evident in the research as the double-blind study was used for the clinical trials.

Measurement of outcomes or endpoints in the study and control groups

Appropriate

The study undertook different assessments to determine whether purified honey bee (Apis mellifera) venom (HBV) biotherapy can offer alternative treatment of osteoarthritis (OA) knee pain and physical function. Some of the assessments employed by the study include global physician assessment (PGA) and physical functioning subscales to assess the physical functioning of the subjects after being treated to the medication or the placebo. Other assessments used to determine subjects’ pain include the WOMAC pain and the global patient assessment (PGA). To ensure that the outcomes or endpoints of both the control and study groups are adequately assessed, rescue medication usage was also evaluated. The routine safety parameters were also closely monitored to determine the study’s outcome.

Comparison of outcomes in the study and control groups

Estimation

The HBV biotherapy showed an increasingly significant improvement compared to the control within the WOMAC pain score after 12 weeks that was also upheld in the four weeks post-treatment. In addition, the WOMAC physical function was high among the control compared to the HBV for 12 weeks and four weeks post-treatment. The VAS scores were relatively high within the HBV subjects compared to the control group and PGA and PGA assessments. An estimated 77%-78% of the subjects from the two groups used rescue acetaminophen (Conrad et al., 2019). Additionally, HBV was highly associated with cases of injection site reaction. Nonetheless, the safety profiles between the two groups were comparable.

Inference/Adjustment

The analysis of variance (ANOVA) technique is one of the statistical methods used in the study to investigate whether the differences between the HBV and controlled groups bear any statistical significance. Another method used in the research includes ANCOVA, which entails a blend of ANOVA and regression. The study also employs the one-sample median test, which investigates whether or not a significant difference exists between the hypothesized media and the real median of a sample.

Statistical technique(s) used to take into account or control for potential

Confounding variables

Some of the available statistical techniques essential in taking into account or controlling the likelihood of confounding variables include the logistic regression technique that yields results that can be interpreted as an odds ratio. Other methods include multivariable regression analysis, restriction, and matching, which are essential to control confounding variables during the analysis phase. The research utilized the randomization technique to control confounding variables that should not or cannot be held constant.

Meaning of the results for those included in the investigation

Contributory Cause or Efficacy

According to the phase 3 trial findings, the usage of HBV on the subjects was found to enhance improvement in the physical function and OA pain significantly and alleviate undesirable outcomes.

Harms and interactions

The study identifies different adverse effects and interactions that can influence the meaning of the results. Some of the adverse events (SAEs) placed on patients subject to the study include pneumonia aspiration, anaphylactic reaction, sinus Bradycardia, diverticulitis, and sinus bradycardia. The anaphylactic reaction was common among Subjects who regularly received an injection at shorter intervals than recommended by the protocols.

Subgroups

There is a similarity in the outcomes observed within subgroups under investigation and the overall results for the study. For instance, regarding safety, the percentage of subjects reporting at least one treatment-emergent AEs (TEAEs) for HBV and control groups was 49.0% and 46.3%, respectively (Conrad et al., 2019). These outcomes are similarly observed in the overall investigation sites that the overall safety profile was comparable to control-treated patients. Likewise, effects observed by Conrad et al. (2019) the baseline reveal that the HBV sub-group responded to the treatment positively as “very good” and “good” compared to the control sub-group (20.9%, 61.1% and 23.3%, 39.1%, respectively). These outcomes conform to the overall effects of the study where VAS pain assessments ascertained the efficacy of HBV treatment over control. The efficacy results of HBV have further been categorized as comparable to those of the Synvisc-One (hyaluronan viscosupplement). The Synvisc-One is an intra-articular injection used to treat pain in the osteoarthritic knee.

Meaning for those not included in the investigation

To similar individuals, groups or populations

The researchers finally extrapolate the conclusions of the study to groups and individuals. They recommend the usage of HBV injections as a potential treatment alternative to patients who fail to respond to nonpharmacologic therapy and traditional analgesics like acetaminophen positively.

Beyond the data

The investigators revealed that HBV had been found effective in improving knee OA pain and physical function for a period extending to four weeks post-treatment.

To other populations

The investigators revealed that the HBV and Control groups patients were African Americans and Whites. This data shows that the study’s findings can only be generalized to these races. In addition, Conrad et al. (2019) reveals that the populations of African Americans in the control group were higher than those within the HBV group (32.3% and 24.4%, respectively).

Brief Summary of the Article

Clinical decisions entail analyzing different information, assessing the available evidence, and administering significant knowledge to pick interventions that ensure quality care and minimum risk to the patient. As patients respond differently to certain treatment plans, it becomes essential for clinicians to review available evidence. The review helps develop evidence-based practices that explore alternative interventions to certain conditions. Different patients have shown poor responses to simple analgesics and nonpharmacologic therapy interventions to knee OA pain and physical functioning. The research provides evidence by analyzing the results of clinical trials carried on a control group and an HBV group. The study recommends the usage of HBV intervention to address knee OA pain and physical functioning. However, it is essential to note that clinical trials have only been done on whites and African Americans. Nonetheless, the available evidence reveals that the majority of patients who have been subjected to the treatment have defined it as “very good” and “good.”

The study has a commendable statistical power of 90%; high statistical power is significant to develop accurate conclusions regarding a certain effect if development is found. In addition, the study sample size and response rate are relatively good. However, the research lacks more depth as there is insufficient representation of different races or a review of various studies done on the same topic across different cultures. This information would improve the generalization of the study results across diverse populations. This study has been crucial to improving personal understanding of available evidence of alternative treatment interventions for osteoarthritis (OA) knee pain and physical function.

Work Cited

Conrad V, Hazan L, Latorre A, Jakubowska A, Kim C. Efficacy and Safety of Honey Bee Venom (Apis mellifera) Dermal Injections to Treat Osteoarthritis Knee Pain and Physical Disability: A Randomized Controlled Trial. The Journal of Alternative and Complementary Medicine. 2019;25(8):845-855.

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

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

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

Reference

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

Introduction

Humans are susceptible to various ailments as they age, including cancer, heart failure, Alzheimer’s, and arthritis. All of these diseases have been detrimental to people’s life. In the United States, arthritis is the second most prevalent chronic illness (Roy et al., 2018). It develops when the body mistakenly views its tissue as alien and begins to fight it. Over eighty autoimmune diseases are included in the category of arthritis. As a result of this illness’ impact on connective tissues and joints, the joints become stiff and painful, inflamed, and swollen. While some forms of arthritis can result in disabling, they are rarely fatal.

Rheumatoid arthritis and osteoarthritis are the two most prevalent kinds of arthritis. Cartilage, the tough, slick membrane that cushions the endings of bones as they come together to create a joint, deteriorates due to osteoarthritis. The immune system targets the joints in rheumatoid arthritis, starting with the covering of the joints. According to Roy et al. (2018), up to 40% of arthritis can be inherited from family members making it one of the risk factors for the disease. While gout prevalence in men is 6% and in women 2.3%, osteoarthritis is relatively widespread in women (Roy et al., 2018). Being overweight places stress on joints,therefore, obese people are more likely to develop arthritis.

Osteoarthritis is the most prevalent type of arthritis in Florida and the United States. According to Roy et al. (2018), 23% of non-Hispanic Whites with arthritis experience less extreme joint discomfort and work constraints than African Americans, Hispanics, and multiracial populations. Their ability to work may be restricted by arthritis, or they may be unable to work at all. The prevalence of arthritis in Florida is at 22% with women taking two-thirds of the percentage (Hootman et al., 2018). Even though arthritis is not lethal in and of itself, the consequences that can develop in relatively severe cases can cause a reduction in a lifetime.

Review of Descriptive Epidemiology of Arthritis

In several societies, the occurrence of arthritis is mainly stable. Individuals with average health are most likely to have arthritis than adults in perfect health, and its prevalence rises with age from 23.6% in adults aged 40 to 48% in those above 60 (Roy et al., 2018). In addition, compared to adults who satisfy physical activity guidelines, individuals having no leisure-time physical exercise are likely to develop arthritis. In the upcoming decades, an upsurge in the rate of arthritis with a medical diagnosis is anticipated. It is predicted that 78 million adults aged 18 and over will have the disease by 2040 (Hootman et al., 2018). Moreover, females are projected to make up two-thirds of the population with arthritis.

People are more prone to later suffer arthritis in a joint that has been injured, possibly while participating in sports. Compared to people with a lesser body mass index, about 8% of persons 18 years of age and over who are obese more frequently report having arthritis by a doctor (Roy et al., 2018). Women are susceptible to developing arthritis for a variety of reasons. Weight gain is common among menopausal women, and this added strain on the joints account for 12% arthritis cases (Roy et al., 2018). The traits of the at-risk category include joint stiffness and discomfort, which often get worse as people age. Numerous risk factors, including genetics, weight, lifestyle choices like smoking, and past joint injuries, may influence the onset of different types of arthritis.

Overview of HP2020 for Arthritis

The Healthy People initiative lays forth 10-year national goals for promoting the wellness of all Americans. Healthy People has set benchmarks and tracked development to encourage collaborations between communities and sectors, gauge the effectiveness of prevention efforts, and enable people to make knowledgeable health decisions. By fostering more excellent public knowledge on the factors that influence health, as well as the prospects for advancement, HP2020 aims to identify national health enhancement priorities. Arthritis breaches HP2020 goals since it significantly impacts health and 40% of individual’s productivity (“Arthritis, osteoporosis, and chronic,” 2022). Therefore, the goal of the program is to prevent osteoporosis, persistent back disorders, arthritis, various rheumatic diseases.

Doctors examine patients’ joints physically to diagnose arthritis and look for swelling, redness, and warmth. Additionally, the doctor would want to assess the patient’s joint mobility. Various types of bodily secretions can be analyzed in lab testing to determine the type of arthritis. Blood, urine, and joint fluid are among the fluids that are frequently studied and it is applied to about 66% of obese females in their late 40s (“Arthritis, osteoporosis, and chronic,” 2022). Doctors also use low doses of radiation through x-rays which indicate bone degeneration and cartilage loss and are used to monitor the course of the disease, even though they may not detect early arthritic impairment.

Population Level Prevention and Health Promotion Review

Some factors, such as becoming older, being a woman, or having a history of arthritis in the family, are beyond an individual’s control. However, people can take precautions to lower their risk of developing arthritis or postpone it. In the U.S., the Centers of Disease Control and Prevention (CDC) acknowledges several interventions for easing arthritic symptoms. In Florida, citizens are encouraged to get involved in a self-management training program like the Chronic Disease Self-Management Program, which imparts knowledge and self-assurance necessary for daily living with arthritis (“Arthritis awareness month,” 2022). To lower their risk of developing knee osteoarthritis, the at-risk group can keep a healthy weight. Approximately 70% of guidelines from medical professionals inspire people to engage in physical activity (Roy et al, 2018). In addition, those who are diagnosed earlier, undergo treatment and learn ways to handle their situation have a higher quality of life.

Florida makes advantage of CDC money to broaden and track the audience for programs that promote information about arthritis self-management and keep them going over time. Additionally, states employ CDC funds to encourage walking, urge individuals with arthritis to be sent to successful intervention programs, and enhance health care professional counseling about the advantages of physical exercise for managing arthritis. CDC collaborates with federal agencies to increase and monitor the application of research-based therapies for arthritis in adults (“Arthritis awareness month,” 2022). Adults with arthritis and various chronic illnesses can live better lives by monitoring these tactics across numerous industries.

Conclusion

Only a few forms of arthritis can be healed, affecting millions of adults. Therefore, symptom management and decreasing the disease’s recurrence must be the main goals of arthritis treatment. The emergence of various kinds of arthritis may be influenced by risk factors such past joint injury and lifestyle decisions like smoking. Although arthritis’ mortality rate is low, the serious impact can be deadly. There are some interventions such as self-management training program that offer the at-risk population with information about arthritis. These interventions are tracked by the help of CDC funding to different states to make them effective. Home cures and lifestyle changes are other ways to manage the sickness. People who do this maintain joint functionality and lessen the impact of the illness.

References

Arthritis awareness month: Expanding interventions for arthritis. (2022). Centers for Disease Control and Prevention. Web.

Arthritis, osteoporosis, and chronic back conditions. (2022). Healthy People. Web.

Hootman, J. M., Murphy, L. B., Omura, J. D., Brady, T. J., Boring, M., Barbour, K. E., & Helmick, C. G. (2018). Health care provider counseling for physical activity or exercise among adults with arthritis – United States, 2002 and 2014.Morbidity and Mortality Weekly Report, 66(52), 1398-1401. Web.

Roy, N., Tanner, K. M., Merrill, R. M., Wright, C., Pierce, J. L., & Miller, K. L. (2018). Epidemiology of swallowing disorders in rheumatoid arthritis: Prevalence, risk factors, and quality of life burden.Annals of Otology, Rhinology & Laryngology, 127(9), 577-587. Web.

Introduction

Fish oil is a popular supplement derived from fatty fish oil or cod liver oil. In addition to being high in omega-3 fatty acids, fish oil is rich in vitamins. There is a theory that fish oil containing omega-3 fatty acids may be useful for patients suffering from arthritis (Saidane et al., 2019). For example, theoretically, it can reduce joint pain associated with this disease (Saidane et al., 2019). Fatty acids high in omega-3 include eicosatetraenoic acid, docosahexaenoic acid, and alpha-linolenic acid (Cordingley & Cornish, 2022). Fish oil can be only recommended to patients as a supplement when changing their diet to a healthier one.

Rationale for the Choice

Fish oil is a fairly popular treatment for many ailments and a well-known supplement that many patients take in order to switch to a healthier diet (Raad et al., 2021). The main danger is that some patients consume this supplement on their own without consulting a doctor (Kostoglou-Athanassiou et al., 2020). Since arthritis is a disease that usually develops with age, older patients are at a separate risk group. For example, fish oil increases blood sugar levels, which is categorically contraindicated in patients with diabetes mellitus (Cordingley & Cornish, 2022). In addition, fish oil may be incompatible with medications taken by patients as ongoing therapy (Cordingley & Cornish, 2022). The main research question is whether Omega 3-FA is useful in treating arthritis. The study will address gaps in existing research and draw a clear conclusion as to whether omega-3 fish oil can be recommended for patients with arthritis.

Search History

Synopsis

Some studies were excluded because they dealt with the benefits and drawbacks of omega-3 acid treatment for other conditions. There are no complete and comprehensive studies of the effect of fish oil and reviews of the course of arthritis over the past 5 years. Therefore, the study focused on qualitative research and reviews of the existing literature. The search criteria were the English language, the openness of the source, and the date of publication. For the search, the Google Scholar database was used because of the ease of setting up filters and a large amount of open information.

During the search in Google Scholar Database searched with the terms Omega 3-FA and treating arthritis, it turned out that there is not enough scientific data on the topic of the use of fish oil in the treatment of arthritis. Most of the articles focus on the impact of dietary changes on the management of patients with arthritis. That is why the search and analysis of articles has been extended to studies containing data on the use of omega-3 acids, not necessarily in the form of fish oil. Search keywords included: fish oil, omega-3s, arthritis, osteoarthritis and rheumatoid arthritis. More than twenty articles were studied during the research. As a result of selection, seven studies were included in the review that are most relevant to the chosen topic.

Summary and Critical Analysis of Results

Cordingley and Cornish conducted the study aimed at identifying if fatty acids are a possible option for treating osteoarthritis (2022). The sample size was 13.6% of adults over 20 years, RCT was Canada and the United States of America, and meta-analysis was pre-clinical and clinical evidence. Researchers are highlighting the anti-inflammatory properties of polyunsaturated fatty acids, which may be helpful in curbing inflammatory markers in osteoarthritis (Cordingley & Cornish, 2022). Cordingley and Cornish provide preclinical and clinical data on the use of omega-3s in the treatment of osteoarthritis (2022). Preclinical data provides strong evidence for human trials of the use of omega-3s as a possible treatment option for osteoarthritis, while evidence requires further research to determine optimal treatment protocols (Cordingley & Cornish, 2022). It has been suggested that anti-inflammatory properties may alleviate a mild inflammatory environment and slow cartilage catabolism and the disease progression (Cordingley & Cornish, 2022). The reduction in cartilage inflammation and catabolism may be consistent with increased function and improvement in symptoms associated with osteoarthritis, such as joint pain and stiffness.

If future research concludes that omega-3 treatment regimens, along with additional potentially beneficial therapeutic diets, can improve patient-reported outcomes, this could be a cost-effective treatment option, resulting in lower health care costs (Raad et al., 2021). The study is limited to a descriptive approach, despite the use of clinical and preclinical data. Subsequent research should include direct experimentation with an established focus group to fill in the existing knowledge gaps (Elfagi, 2021).

Dietary Interventions with or without Omega-3 Supplementation

Raad, T., Griffin, A., George, E. S., Larkin, L., Fraser, A., Kennedy, N., & Tierney, A. C. (2021). Dietary interventions with or without omega-3 supplementation for the management of rheumatoid arthritis: A systematic review.Nutrients, 13(10), 1-20. Web.

Raad et al. are concentrating on research into dietary intervention in the treatment of rheumatoid arthritis (2021). The aim of the systematic review is to investigate the effect of dietary interventions with or without omega-3 supplementation on the treatment of rheumatoid arthritis (Raad et al., 2021). 15 studies were reviewed, the findings were that dietary interventions can help relieve symptoms significantly, others worsen symptoms. The gaps of the studies were the lack of reliance on experimental data to a descriptive approach. Electronic databases were systematically searched for clinical trials of dietary interventions with or without omega-3 supplements to find documents from their inception to April 2021 (Raad et al., 2021). Summary of the findings is the following: dietary interventions with an anti-inflammatory base may be an effective option for adults with rheumatoid arthritis seeking additional therapies that could potentially improve certain parameters (Raad et al., 2021). The type of study was systematic review; sample sizes are 15 cross-country studies.

However, long-term studies are needed that are well designed and have sufficient power to investigate the effect of a diet rich in omega-3 fatty acids on the course of the disease. Some dietary interventions can help relieve symptoms significantly, others worsen symptoms (Raad et al., 2021). The main focus of future research should be to study the effect of dietary changes on pain in arthritis (Raad et al., 2021).

The Effect of Omega-3 Fatty Acids on Rheumatoid Arthritis

A study by Kostoglou-Athanassiou et al. focuses on the overall health benefits of omega- 3 fatty acids, which are thought to play an important role in health conditions. The aim of the research is to identify if the effect of omega-3 on patients, suffering from rheumatoid arthritis condition. Omega-3 fatty acids are believed to have immunomodulatory properties as they act as precursors to lipid inflammatory mediators that can limit or modulate the inflammatory response (Kostoglou-Athanassiou et al., 2020). Researchers conclude that omega-3 fatty acids prevent or alleviate experimental arthritis. The type of study is clinical studies; the sample size is 32 patients with RA.

Omega-3 fatty acids have been shown to improve or prevent experimental arthritis and may reduce disease activity in rheumatoid arthritis (Kostoglou-Athanassiou et al., 2020). Clinical studies have shown that omega-3 fatty acids may have a modulating effect on disease activity, namely the number of swollen and painful joints (Kostoglou-Athanassiou et al., 2020). The study is unequivocal in its judgment and recommends treatment with omega-3 fatty acids. However, the study is descriptive and has little evidence base (Kostoglou-Athanassiou et al., 2020). The findings are mostly based on theoretical assumptions about the overall benefits of polyunsaturated fatty acids.

The Mediterranean Diet, Fish Oil Supplements and Rheumatoid Arthritis Outcomes

Peterson et al. pay attention to the types of diets and nutritional supplements used in the treatment of rheumatoid arthritis (2018). The study aims to understand the effect the diet has on patients’ conditions. The researchers recognize an unmet need for a better understanding of the impact of specific dietary interventions on disease outcomes, along with growing patient interest in lifestyle interventions beyond pharmacotherapy, which is what prompted this descriptive literature review (Petersson et al., 2018). There is growing evidence that polyunsaturated fat supplementation can reduce inflammation and provide clinical benefits, possibly «slowing the transition to pharmacotherapy» (Petersson et al., 2018). However, many of these studies to date are limited in their methodology: for example, they only used limited evidence; this is partly a reflection of the complexity of the research questions being addressed. Therefore, the conclusions that can reasonably be drawn from their results are limited (Petersson et al., 2018).

With a focus on clinical fish oil, this review critically analyses the evidence, discusses research findings in the broader context of impact on the patient outcomes, methodological issues, and practical considerations (Petersson et al., 2018). Dietary interventions such as fish oil supplements are important in the treatment, but research advocates their use in combination with other non- dietary interventions, including appropriate pharmacotherapy where indicated (Petersson et al., 2018). Further research should focus on specifically examining the impact of each diet, with an experimental part. At the moment, the study is limited by the lack of emphasis on data obtained in the course of practical research (Petersson et al., 2018).

Relationship between Omega-3 Dietary Intake and Rheumatoid Arthritis

Elfagi notes the problem of low awareness of doctors and patients about the role of nutrition in the treatment of rheumatoid arthritis and this paper is dedicated to the problem of arthritis. This low awareness is thought to be related to the low prevalence of the disease. The aim of the study is to summarize the relationship between consumption of omega-3 fatty acids in the form of fish oil and positive outcomes in the treatment of rheumatoid arthritis (Elfagi, 2021). The study was cross-sectional and included a sample of one hundred patients diagnosed with rheumatoid arthritis; the P value is higher than the value of the alpha-level z-indicator. (Elfagi, 2021). An attempt was made to prove the role of the anti-inflammatory properties of omega-3 in the activity of RA disease, as well as to study patients’ knowledge of omega-3 and their attitudes towards nutrition (Elfagi, 2021). Both a significant statistical difference and the level of awareness support the need to use omega-3 fatty acids in the diet. (Elfagi, 2021). The overall conclusion of the study was that a diet rich in omega-3s, regardless of its source, may be associated with a reduction in rheumatoid arthritis activity.

In the summary of the findings the article concludes that based on the data obtained, patients should be educated, especially the elderly, to increase their knowledge and awareness of the benefits of omega-3 (Elfagi, 2021). It is important to reduce the symptoms of the disease in addition to therapy to increase the daily dose, and the dose of omega-3 should also be encouraged, whether from dietary sources or supplements (Elfagi, 2021). However, further research is needed to determine if more frequent consumption of omega-3 rich foods is associated with lower disease activity in rheumatoid arthritis. The study is limited by focusing on low awareness, not on the evidences of omega-3 treatment outcomes.

Could Omega-3 Fatty Acids Prevent Rheumatoid Arthritis?

The systematic research conducted by Saidane et al. in 2019 focuses on the role of omega-3s in preventing the risk of rheumatoid arthritis. The aim of the research is to review literature on the omega-3 treatment. The review indicates conflicting results that do not provide clear conclusions (Saidane et al., 2019). The authors concludes that overall, fatty acid intake may influence the risk of developing rheumatoid arthritis (Saidane et al., 2019). Research values were calculated based on the content of erythrocyte membranes, which may be relevant methods for drawing conclusions (Saidane et al., 2019). The next step of the research can be considered an assessment of individuals at risk of developing of rheumatoid arthritis, assessing their protective properties during the transition from preclinical autoimmunity to established disease.

Omega-3 fatty acids can be clearly identified as a dietary factor capable of modulating the course of rheumatoid arthritis with preclinical phases of the established disease by the evidence-level practice. Omega-3s show a negative relationship with the formation of autoantibodies in genetically predisposed individuals, and with the development of RA in individuals who have already developed biological autoimmunity (Saidane et al., 2019). Although the study uses a significant amount of literature, it is limited by the lack of clear conclusions due to low level of evidence because of the type of studies and sample sizes. A lack of practical evidence is again a knowledge gap. Further research is needed to determine the impact of a high-fatty acid diet for people who have a genetic predisposition to develop rheumatoid arthritis.

Rheumatoid Arthritis and Dietary Interventions: Systematic Review of Clinical Trials

Philippou et al. aimed at studying the effect of dietary interventions on rheumatoid arthritis, which is characterized by an immune-inflammatory response. To draw the conclusion, a systematic literature review method based on the latest available data which is a higher level of evidence was used (Philippou et al., 2021). The researchers focused on 70 studies that conducted experiments with a group of subjects (Philippou et al., 2021). The introduction of omega-3 polyunsaturated fatty acids in high doses led to a decrease in of rheumatoid arthritis disease activity and a lower rate of failure of RCts pharmacotherapy (Philippou et al., 2021). The findings of the review are that several dietary interventions, including the addition of omega-3s as fish oil to the diet, may have a positive effect on the course of rheumatoid arthritis. However, the study is limited by the fact that the results are very individual and cannot be considered completely reliable. Further research should concern the study of individual reactions in order to close this knowledge gap.

Discussion of Findings

At the moment, there is little evidence that fish oil is guaranteed to relieve arthritis. Despite a large body of literature on the effect of omega-3 fatty acids on the course of arthritis, no single study offers clear conclusions. Over the past five years, no quantitative studies have been conducted that would indicate a clear dynamic of the disease in reduction in symptoms with the use of fish oil supplements and without this intervention. Most researchers note a positive trend with the use of large amounts of omega-3, for example, Saidane and Elgafi. However, it is impossible to say with accuracy what caused such a dynamic omega-3 effect: individual characteristics, a change in nutrition, or the characteristics of the course of arthritis.

All researchers are unanimous in their opinion about the existing research gap: there is no relevant evidence base for real improvements in the conditions of patients with arthritis when taking fish oil. Several of the large systematic reviews showed a reduction of symptoms when O3FAs were added to the diet; however, findings could not be applied to the general population (Cordingley & Cornish, 2022). Based on these findings, it is impossible to decide whether to recommend the use of fish oil supplements for a particular patient (Kostoglou-Athanassiou et al., 2020). Omega-3, if used, should be combined with the main treatment, and not be a substitute for it Kostoglou-Athanassiou et al., 2020). However, the research question – whether Omega 3-FA is useful in treating arthritis – remains unanswered. In the absence of contraindications, increased Omega-3 intake may be recommended to patients, but only as part of a transition to a healthier diet.

Conclusion

The evidence base has not been sufficient to draw a firm conclusion about how fish oil supplementation can be a treatment for arthritis. Research is limited by the descriptive approach, as well as the lack of clear benefit indicators. There was a lack of RCTs and clinical trials of some sort in some of the studies, for example, in Philippou et al. (2021). It is not known what specific fact influenced the improvement in the condition of patients using fish oil. At this stage, fish oil cannot be recommended as a treatment for patients with arthritis. Further extensive quantitative studies are required to exclude the possibility of mutual influence. Currently, only a dietary change to more omega-3s consumption can be recommended for patients, suffering from arthritis, unless there are contraindications for doing so in most of the studies.

References

Cordingley, D. M., & Cornish, S. M. (2022). Omega-3 Fatty Acids for the Management of Osteoarthritis: A Narrative Review.Nutrients, 14(16), 33-62. Web.

Elfagi, S. (2021). Study the Relationship between Omega-3 Dietary Intake and Rheumatoid Arthritis.Sch Acad J Pharm, 8(1), 128-138. Web.

Kostoglou-Athanassiou, I., Athanassiou, L., & Athanassiou, P. (2020). The effect of omega-3 fatty acids on rheumatoid arthritis.Mediterranean journal of rheumatology, 31(2), 190- 205. Web.

Petersson, S., Philippou, E., Rodomar, C., & Nikiphorou, E. (2018). The Mediterranean diet, fish oil supplements and Rheumatoid arthritis outcomes: Evidence from clinical trials.Autoimmunity reviews, 17(11), 1105-1114. Web.

Philippou, E., Petersson, S. D., Rodomar, C., & Nikiphorou, E. (2021). Rheumatoid arthritis and dietary interventions: systematic review of clinical trials.Nutrition reviews, 79(4), 410-428. Web.

Raad, T., Griffin, A., George, E. S., Larkin, L., Fraser, A., Kennedy, N., & Tierney, A. C. (2021). Dietary interventions with or without omega-3 supplementation for the management of rheumatoid arthritis: A systematic review.Nutrients, 13(10), 1-20. Web.

Saidane, O., Semerano, L., & Sellam, J. (2019). Could omega-3 fatty acids prevent rheumatoid arthritis?Joint Bone Spine, 86(1), 9-12. Web.

Introduction and Patient’s History

• 73-year-old female patient.
• Had knee pain.
• Could not walk without a walker.
• No fracture.
• An outpatient with severe tricompartmental osteoarthritis in the left knee:
  • medial compartment;
  • osseous remodeling;
  • eburnation with subchondral sclerosis and cystic changes;
  • small suprapatellar joint effusion.

In this case, a patient was a 73-year-old female with knee pain as her chief complaint. She could not walk without a walker and had to be transformed to the table with the help of a wheelchair. Although no recent fractures were reported, the radiologist’s reading presented enough information about the patient’s condition, including severe tricompartmental osteoarthritis in her left knee (medial compartment is more pronounced compared to other parts). Additional health problems were osseous remodeling, eburnation with subchondral sclerosis, some cystic changes, suprapatellar joint effusion, and dystrophic calcification.

Pathology

• Osteoarthritis is inflammation that challenges knees, hands, and hips.
• Articular cartilage changes or loss provoke the disorder.
• Elderly people are at risk.
• Tricompartmental osteoarthritis touches upon three areas: medial, patellofemoral, and lateral.
• Equilibrium of collagen, chondrocytes, proteoglycans, and water is broken.

Osteoarthritis is a common form of arthritis that may affect many people from different parts of the work. This type of inflammation damages joints and is frequently observed in knees, hands, or hips. Knee osteoarthritis happens because of wear and tear of articular cartilage or even its progressive loss (Hsu & Siwiec, 2019). Elderly women and men are usually the populations at risk. Tricompartmental osteoarthritis is characterized by changes in three compartments at once: medial (inside the knee), patellofemoral (across the kneecap), and lateral (outside the knee). There are several important components in articular cartilage, including collagen, chondrocytes, proteoglycans, and water, and when its equilibrium cannot be maintained, inflammation is developed, causing pain and bone changes (Hsu & Siwiec, 2019). Traumas, aging, weight, and genetics are the major causes of this disorder.

Imaging Techniques and Treatment

• Images:
  • Radiography (20o flexion);
  • CT (2 sec, 140 kVp, 70 mA);
  • MRI (600 msec – repetition time).
• Treatment:
  • Pharmacology (NSAIDs or acetaminophen to control pain);
  • Physical and occupational therapies to strengthen muscles;
  • Surgery or injections (cortisone or hyaluronic acid to relieve pain or joint replacement).

The identification of the disorder is possible with the help of radiographs, computed tomography, or magnetic resonance imaging. MRI is the most comprehensive assessment tool to identify and classify a disorder, as well as promote tissue contrast (Li, Amano, Link, & Ma, 2016). As soon as the diagnosis is given, a treatment plan should be developed. In this case, the patient has to consider pharmacological treatment, including NSAIDs or acetaminophens like Tylenol to control pain, or physical and occupational therapies to strengthen muscles, modify activities, and consider weight changes. Finally, surgery to replace joints or injections with cortisone or hyaluronic acid to relieve pain is recommended.

References

Hsu, H., & Siwiec, R. M. (2019). Knee osteoarthritis. Web.

Li, Q., Amano, K., Link, T. M., Ma, C. B. (2016). Advanced imaging in osteoarthritis. Sports Health, 8(5), 418-428.

Introduction

Falvo (2005) writes on the medical and psychosocial aspect of chronic disease including fibromyalgia. Fibromyalgia is defined as a rheumatologic disease in which the patient experience widespread pain, coupled with aching and stiffness of muscles and/or joints, plus fatigue, sleep disturbances, and broadly distributed sites of tenderness (tender joints) (Millea & Hollaway, 2000, cited in Flavio, 2005, p. 421).

The pain and uneasiness linked to fibromyalgia are spread, occurring in the hips, lower back, shoulders, and neck and other sites. The author refutes fibromyalgia as a degenerative disease because it does not cause damage to joints or bones; therefore, there is no definitive diagnostic test or objective findings that can validate the condition.

Because of the lack of exceptional laboratory tests applied for diagnosis of the condition, diagnosis is centered on individuals’ testimony of history and symptoms, regarding the identifiable tender points as the major diagnostic indicator. Falvo (2005) notes that fibromyalgia can manifest other symptoms besides musculoskeletal pain, such as irritable bowel syndrome or headaches.

Falvo (2005) argues that this condition can occur parallel with other sevre rheumatic disorders including rheumatoid arthritis and lupus. Moreover, psychological signs of depression and anxiety often accompany fibromyalgia.

This chronic illness can impact an individual’s quality of life and can lead to interpersonal challenges due to its symptoms. The author underscores the significance of validating the individual’s symptomatic complaint in that it helps restores self-esteem and self-control, assisting them to adjust to their symptoms.

Cause of Fibromyalgia

According to the findings of Liu, Mantyh, & Basbaum, (1997), enduring physical or emotional abuse subjected to a person may produce some physiological alterations in that individual. It has been proven that a substantial group of people diagnosed with this illness that were subject to chronic stress from physical and emotional abuse, shared a common physiological outcomes.

These outcomes include increased levels of N-methyl-D-aspertatesubstance P (NMDA-SP) and a rise in the expression of c-fos, which is a protein released under stress and found in neurons corresponding with pain. These outcomes considerably point to chronic stress as an impetus for hyperalgesia in FMS.

The resultant hyperalgesic state is a product of chronic muscular hypersensitivity to fatigue and pain, denoted as a stress-induced, diathetic, neuromuscular hyperalgesic condition (Ellis, n.d).

Benett (1999) concluded that an ultimate understanding of pathogenesis of non-nociceptive pain is prerequisite for disqualifying FMS as a somatoform disturbance. Moreover he proposes that there may be needed a review of the concept of somatoform abnormalities, to classify them under clinical conditions by virtue of the knowledge physiology.

The author defined the neurological pain course as gush of nerve impulses that emanates from nociceptors in visceral or somatic tissues (p. 386). In the course, nerve “impulses travel in peripheral nerves, with a first synapse in the dorsal horn and a second synapse in the thalamus, and end up in the cerebral cortex and other supraspinal structures.

This results in a pain experience and the activation of reflex and later reflective behaviors” (p. 386).

Normally, nociceptor-driven pain is effectively eliminated. Nevertheless with chronic pain, the association between nociception and resuscitation from pain is out of place or even absent and, thus pain endures.

Usually the pain threshold escalates with palpation, though it decreases in FMS (Kosek, Ekholm, & Hansson, 1996). Ellis, (n.d) presumes that this may be as a result of the absent or insufficient resuscitation of nociceptor signals.

It is increasingly becoming evident that fibromyalgia has a genetic predisposition (Medscape, 2006). Progressively, the author argue that first-degree relatives of people indicating fibromyalgia are eight times at risk of developing the illness compared to the general population.

This condition has been often associated with polymorphism in serotonergic 5-hydroxytryptamine (HT) 2A receptor, the catecholamine o-methyl transferase enzyme, the serotonin transporter and the dopamine 4 receptor. These polymorphisms reportedly have influence on the transportation or metabolism of monoamines, compounds that are responsible for sensory processing and stress response (Medscape, 2006).

Diagnosis

Ellis (n.d) asserts that the key observations useful in the diagnosis of FMS are; i) a history of extensive pain, lasting for three months minimum and; ii) the recognition of pain in eleven out of eighteen tended sites on palpation.

However, there are specific psychological and neuroendocrine factors that have been perceived to be virtually exhibited in FMS sufferers. Other diagnostic elements hat can give a comprehensive and accurate results are:

1. Assessment of continuing stress as indicated on a score of state-trait anxiety.
2. Assessment of the different physiological outcomes common in fibromyalgia patients that include though not necessarily limited to:

• Assessment for weak thyroid stimulating hormone (TSH) response and the decreased free serum calcitonin and calcium.
• Assessment for changed hypothalamic-pituitary-adrenal axis (H-P-A) because of exaggerated adrenocortricotropic hormone feedback to coticotropin-releasing hormone (CRH) and subsequent decreased secretion of cortisol.
• Assessment for increased levels of substance P.

Medical management/Treatment of fibromyalgia

By virtue of being a chronic condition, only relative enhancement can be provided. Fibromyalgia patients may find neck support in sleep or abdominal exercise to alleviate stress on the lower back useful.

Aerobic exercise including swimming or walking are valuable in relieving pain and tenderness and helping regarding sleep disturbances. Current studies have proven that hyperbaric oxygen therapy can be effective in treatment of the disease (Falvo, 2005).

Hyperbaric oxygen therapy

Hyperbaric oxygen therapy refers to administration of 100% oxygen at two or three folds the atmospheric pressure. It specifically used for treatment of specific musculoskeletal conditions including chronic osteomyelitis (Sugihara et al., 2004, cited in Falvo, 2005, p. 425).

This strategy works by renovating the body’s immune system against infection and increasing frequency at which the system can destroy pathogens.

Patients inhale hyperbaric oxygen in an atmosphere of a specially deviced cylindrical single-occupant chamber through mask hoods, or designed tubes that are introduced into the trachea. The duration and intensity of therapy depends on the rationale for treatment. For musculoskeletal conditions, therapy may average 90 minutes (Falvo, 2005).

Physical therapy

According to Falvo (2005), this strategy encompasses various approaches that are usually conducted by a physical therapist or his/her assistant. The form of physical therapy is based on the specific musculoskeletal condition. It is usually aimed at increasing or sustaining a joint’s variety of motion, increasing muscle tenacity, alleviating pain or teaching skill for ambulation.

Some procedures include therapeutic exercise, either active or passive. Passive exercise involves the therapist or a mechanical instrument performs the exercise on the body part. While active exercise involves the patients performing a special exercise program under the supervision of the physiotherapist or his assistant.

Other techniques may concern applying heat or cold massage to relax muscles or for pain relieve. Heat may be exerted using hot packs, whirlpool births, infrared radiation, or hot soaks.

Medication of fibromyalgia (MedicineNet, 2011 April)

Antidepressants: The most useful medication in the treatment of this chronic illness customarily has been trycyclic antidepressants. Although, popular in management of depression it is administered during bedtime at fractions of the doses used in the treatment of depression.

Trycyclic antidepressants help alleviate fatigue, resuscitate muscle spasm and pain, and facilitate deep, restorative sleep in fibromyalgia patients. Scientists posit that tricyclic function by interfering with serotonin, a neurotransmitter. Examples of tricyclic antidepressants popularly used in this regard are; doxepin (sinequan) and amitrypatyline (Elavil) (MedicineNet, 2011).

Fluxetine: there is substantial evidence that adding fluxetine (Prozac), or analogous medication, with low-dosage amitryptyline increases muscle pain relief, alleviate depression and anxiety in fibromyalgia patients. This combination is additionally more useful in enhancing restorative sleep and a general perception of well-being.

The two combinations tend to neutralize the adverse effects each may cause. Tricyclic antidepressants can induce tiredness and fatigue, whereas fluxetine can cheer up and make patients more alert. In addition research has proven that Lorazepam (Ativan) was effective in relieving symptoms.

Prozac has additionally been proven to be appropriate as a monotherapy with certain fibromyalgia patients. Trazodone can be administered at bedtime to enhance sleep if patients express hypersensitivity to trycyclic antidepressant

Pregabalin (Lyrica): this medication was approved in 2007 to be used distinctively for treatment of fibromyalgia. Probably, this medication act through blockade of pain impulses in fibromyalgia patients. Its advantages lie in the flexibility of its dosing which can be shifted to meet the demands of the persisting symptoms. A related drug, gabapentin may also be employed in the treatment of the chronic illness.

Duloxetine and milnacipran: the brand names are cymbalta and savella respectively. This drug combination has been conceived recently to be useful in the treatment of this disorder. These drugs have been proven to be useful in alleviating pain and improving function in fibromyalgia sufferers. Duloxetine has been useful in the treatment of depression and in alleviating pain in psychotic, including depression and anxiety.

Pain relievers: Many other medications can be employed for the alleviation of fibromyalgia pain. Such pain relievers are; cortisone, tramadol, cyclobenaprine (muscle relaxant), nonsteroidal anti-inflammatory drugs (NSAIDs), and guaifenesin.

Other strategies include; use of cast, assistive devices, orthoses, traction, and surgery.

Implications of Fibromyalgia illness

Illness is defined as the ultimate feeling of out-of-control (McDaniel, Hepworth, & Doherty, 1997, p. 7). Normally, ill individuals experience the despair to exercise some control over their lives such that they distress upon loosing their capacity to control significant outcomes in their lives.

Thus, when people have a sense of individual control regarding their illness, they have a high tendency to have an optimistic physical and psychological adjustment to chronic condition [including Fibromyalgia] than their inverse (Shapiro, Shwartz, & Astin, 1996).

A hermeneutic-phenomenological evaluation of 12 women’s live experience with fibromyalgia outlined the themes of coping, ambivalence, and powerlessness (Ranhein & Holand, 2006). The testimonies of these women depicted their efforts to control and manage the serious symptoms of their illness and their struggles to alleviate their sense of powerlessness that emanate from fatigue, pain and immobility.

Victims of chronic diseases such as this have, who develop efficient methods for controlling their utmost serious symptom tend to posses a more optimistic attitude and reduced sense of powerlessness (Larsen, 2009).

Seaman and Lewis (1995) found that powerlessness was linked with activity limitations and psychosocial indications, and mounting powerlessness was connected with failing health status. The theme of powerlessness in chronic illness is a fluctuating and complex matter. This phenomenon, can be caused by individual characteristics and outlook or induced by the changing nature of the disease; Fibromyalgia.

It is inherent at same time imminent in the chronic illness. Nevertheless, the sense of powerlessness retreats and advances throughout the course of the disease as the patient negotiate between loss and control and steer through the varying landscape of their enduring realities.

Also, factors such as the ability to manage symptoms and the degree of physical limitations can influence people’s experience with sense of powerlessness (Larsen, 2009).

Clearly, fibromyalgia can have serious implications on the sufferer’s different aspects of live. These aspects may include education, training, and employment.

Implication on employment

Resells (2003) argues that fatigue, chronic pain and faults in processing and arranging cognitive experiences impact negatively on the patient’s capacity to compete in the labor force. They impact on his/her ability to focus. S/he may find annoying the extensions of tasks which normally are done over a short period.

Often, patients exhibit intolerance for repetitive tasks or prolonged standing or sitting. Stress and unpleasant climatic conditions can prominently worsen the FMS symptoms. Clearly, such employees cannot meet the expectations of the employer and as such jeopardize their job. They often get dismissed from work due to their low productivity.

Further, the author asserts that the patient may exhibit lack of endurance because of physical or mental fatigue. S/he may express intense deterioration of symptoms with initially tolerated amounts of mental and physical functions leading to reactive symptoms.

Other sources of work disability in FMS include; the lack of endurance, the randomness of symptom dynamics on a daily and even hourly basis, as well as the incidence of delayed reactive fatigue, pain and cognitive abnormalities.

This requires prolonged time in the morning for patient to get going and many require frequent rest during the day. It in turn hinders patients from embarking on regularly planned tasks that are typically necessary for work-related functions and prerequisite in the competitive labor force.

Implication on education

Loss of mental acuity by patient can manifest in various ways including; poor concentration; problem in making and consolidating memories; incapacity to plan tasks and increased time required to complete a task; and emotional imbalances resulting from the impairment.

This means that the student who suffers this illness often perform unsatisfactorily. This serves to worsen the condition due to frustration, leading to stress. This problem usually aggravates the effects of physical fatigue.

In addition, short-memory failure exhibited by the patient undermines the efficiency of a task because intentions are initiated and forgotten and much energy and time is wasted locating lost items and they constantly need to reorganize disrupted tasks. This means that students experience challenges in recalling facts, and procedures. The patients often will fail their exams and fail to progress in academics.

Vocational rehabilitation in fibromyalgia patients

The following factors have a significant bearing in the vocational rehabilitation of patients with fibromyalgia. They are:

Disability

Resells (2003), suggest that the ability of the patient to engage and function sufficiently in rehabilitation programs must be reviewed through a long period with focus on long term range collective effects subsequent to a period spent in the program and the recurrence of symptoms.

Disability can emerge in the emotional, cognitive and physical realms in different proportion of activity and impairment. In this regard various factors have a bearing in FMS patient’s rehabilitation. They include; effects of the symptoms, lack of patient endurance, impaired neurocognitive ability, unpredictability of symptom instability, and cumulative outcome.

Assessment

Examination by an by accredited occupational therapist (OT) or occupational specialist who is educated on fibromyalgia syndrome, and experienced in assessing disability may be useful though the treating physician should supervise and coordinate any rehabilitation interventions (Resells, 2003). Patient’s assessment can be carried out at home or workplace.

In home assessment, an OT can avail significant background information on the routine function at home, including self care, endurance, maintenance of home and so forth. The degree of function at home has direct implication for the degree of function at workplace. In this regard the OT can assist the sufferer with energy conservation values and in pacing their performance (Resells, 2003).

Workplace assessment, on the other hand, affords specific information on mental, physical, social, environmental and emotional job requirements. The author suggests that the assessment ought to be done on the job place as much as possible.

All jobs must be assessed for aggravators to improve ergonomics, vary job responsibilities and positions, and enable flexibility in planning if employer based on the employers cooperation.

Rehabilitation potential

Resells (2003) argues that the fibromyalgia patient’s medical treatment must be optimized before any rehabilitation program is considered. Importantly, the treating doctor must direct and coordinate the management and rehabilitation interventions.

Rehabilitation staff must be knowledgeable about fibromyalgia syndrome. Also, the Pathophysiology of the disease must be considered and reflected in the rehabilitation program. Noteworthy, the rehabilitation program must be set based on the patient’s general demands and routine shifts in the patient’s symptoms and functional limits.

The patient should be given the space to exercise autonomy in regard of the pace, complexity and duration of the program. In addition the attending physician must guarantee that the patient’s symptoms are checked consistently to detect cumulative outcomes.

Importantly, a work hardening programs which undermines the Pathophysiology of fibromyalgia and/or the patient’s autonomy are improper for the patient and will aggravate the patient’s symptoms and clinical condition.

Conclusion

Suffers of fibromyalgia syndrome (FMS), argues Levy (1999), should know how its effects can impact adversely on the patients ability to sustain steady employment. The American with Disability Act (ADA) was enacted in 1990 to address the civil rights of the disable. This act aims to level the grounds for disabilities to sustain equal participation in the society.

The law prohibits discrimination of the FMS patient through job application and recruitment protocols, hiring, firing, promotion, reimbursements, training, leaves among others. Also, it concerns privileges and conditions of employment including insurance, company parking lots, and so forth.

Reference list

Falvo, D. R. (2005). Medical and psychological aspects of chronic illness and disability. London: Jones and Bartlett Publishers.

Ellis, L. E. (n.d). Etiology, Diagnosis and Treatment of Fibromyalgia: A Practical and Effective Approach. Compelling Counseling Interventions Article 16. Web.

Kosek, E., Ekholm, J., & Hansson, P. (1996). Sensory dysfunction in fibromyalgia patients with implications for pathogenic mechanisms. Pain, 68(2-3), 375-383.

Larsen, P. D. (2009) Illness behavior. In P. D. Larsen & I. M. Lubkin (Eds). Chronic illness: Impact and intervention. Ontario & London: Jones & Bartlett Publishers.

Levy, A. S. (1999). The Americans With Disabilities Act: What Persons With Fibromyalgia Need to Know. National Fibromyalgia Partnership, Inc.

McDaniel, S. H., Hepworth, J. & Doherty, W. J. (1997). The shared emotional themes of illness. In S.H. McDaniel, J. Hepworth, & W. J. Doherty (Eds). The shared experience of illness: stories of patients, families, and their therapist. New York: Basic Books.

MedicineNet. (2011). Fibromyalgia: what is the treatment for fibromyalgia? MedicineNet.

Ranhein, M. & Holand, W. (2006). Lived experience of chronic pain and fibromyalgia: Women’s stories from dailiy life. Qualitative Health Research, 16(6), 741-761.

Resells, J. I. (2003). The fibromyalgia syndrome: a clinical case definition for practitioners. Binghamton: Haworth Medical Press.

Seaman, M., & Lewis, S. (1995). Powerlessness, health and mortality: AS longitudinal study of older men and mature women. Social Science in Medicine, 41(4), 517-525.

Shapiro, D. H., Schwarz, C. E. & Astin, J. A. (1996). Controlling ourselves, controlling our world: psychology’s role in understanding positive and negative consequences of seeking and gaining control. American psychologist, 51, 1213-1230.