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Friday, April 22, 2016

Most Common Disease of50plus: The Clinical trials and Studies of Musculo-Skeletal disorders(MSDs) - Rheumatoid Arthritis: The Comorbidities

Kyle J. Norton (Scholar)
Health article writer and researcher; Over 10.000 articles and research papers have been written and published on line, including world wide health, ezine articles, article base, healthblogs, selfgrowth, best before it's news, the karate GB daily, etc.,.
Named TOP 50 MEDICAL ESSAYS FOR ARTISTS & AUTHORS TO READ by Disilgold.com Named 50 of the best health Tweeters Canada - Huffington Post
Nominated for shorty award over last 4 years
Some articles have been used as references in medical research, such as international journal Pharma and Bio science, ISSN 0975-6299.

Musculoskeletal disorders (MSDs) are medical condition mostly caused by work related occupations and working environment, affecting patients’ muscles, joints, tendons, ligaments and nerves and developing over time. A community sample of 73 females and 32 males aged 85 and over underwent a standardised examination at home. Musculoskeletal pain was reported by 57% of those interviewed. A major restriction of joint movement range was frequent in the shoulder but uncommon in other joints(1).

Types of Musculo-Skeletal disorders in elder(2)

1. Osteoarthritis
2. Gout
3. Rheumatoid Arthritis
4. Polymalagia Arthritis
5. Cervical myleopathy and spinal canal stenosis
6. Osteoporosis
7. Low back pain
8. Fibromyalgia



                                                      Rheumatoid Arthritis

Rheumatoid Arthritis is defined a chronic disorder as a result of inflammation, affecting mostly the flexible (synovial) joints and tissues and organs in the body. The disease affects more women than men and generally occurs after the ages of 40, causing diminished quality of life of many elders(1). According to CDC, Musculoskeletal disorders (MSDs) affects over 52 millions of adults in the US alone, including 294,000 children under age 18 with some form of arthritis or rheumatic conditions(2). Rheumatoid Arthritis can induced bone loss through elevating bone resorption without increasing bone formation(4). A cross-sectional population-based study of 1042 patients with rheumatoid arthritis showed that RA patients had an increased risk of death from various causes(4a).

The Diseases associated to Rheumatoid Arthritis(Comorbidities)


The simultaneous presence of chronic Rheumatoid Arthritis with other diseases or conditions, include cardiovascular diseases (CVD), cancer, osteoporosis, and depression with often underrecognized in patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), or psoriasis (PsO)(94).according to the joint study lead by Notre-Dame Hospital.

1. Cardiovascular disease (CVD)
Cardiovascular disease (CVD), one the most leading cause of death in US, in particular Coronary artery disease, is found to associate to patient with RA(95). Dr.Goodson N said" Cardiovascular death is........ responsible for approximately half the deaths observed in RA(95). The study of 54 patients with RA :87% were women, with a mean age of 51 and 92% with rheumatoid factor positive showed that high homocysteine concentration is correlate to highest risk of CVD in RA patient(96).
Recent study by Dr. Kumar N and Armstrong DJ. insisted that traditional risk factors such as homocysteine, oxidised low-density lipoprotein, high-sensitivity C-reactive protein and leptin may contribute to the growing rates CVD death in RA patient(97).

2. Infections
The chronic, debilitating, autoimmune nature of RA affected directly or indirectly in almost all organ systems of RA patient, have shown to induced risk of infection(98) which is found to be responsible for death of 25% of RA patients(99). According to the joint study lead by Tampere University, in total of 10,994 patient-years, 341 serious infections were found in patient with RA(100).
3. Mental health issues
According to the study by National Institute for Science and Technology high prevalence of anxiety and depression and even suicide ideation has been found to associated to patient with RA(101) probably due to inflict of medicine(101). Dr. Rouse PC and the research team at the joint study lead by the University of Birmingham, Birmingham, suggested that depression is one most concern and positive psychological well-being in RA patients(102).
Dr. Ryan and Dr. McGuire B insisted that chronic pain associated to PA may constitute to psychological symptoms of depression and anxiety in patients with RA(103).

4. Cancers
Use of TNF-alpha antagonists for treatment of inflammatory diseases may associate to risk of cancer, particular lung cancer(104). According Dr. Buchbinder R and the research team lead by the Monash University, "Malignancy incidence was low in this RA cohort and biologic exposure did not increase the risk of malignancy. Melanoma risk was increased in both TNFi-treated and biologic-naïve RA patients compared with the general population suggesting that RA status, and possibly methotrexate exposure, may be responsible"(105).

5. Gastrointestinal ulcer
Use of Non-steroidal anti-inflammatory drugs (NSAIDs) for treatment of RA is frequently associated to gastrointestinal (GI) ulcers and complications of ulcers(106). The Tokyo Women's Medical University study suggests the prevalence of upper gastrointestinal (UGI) ulcer in patient with RA is also related to Helicobacter pylori and the association of H. pylori infectionas well as the intake of nonsteroidal anti-inflammatory drug (NSAID), according to a cohort of Japanese patients with rheumatoid arthritis (RA)(107).

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By addressing the Underlying Causes through Clinical Trials and Studies

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References
(1) 8 Areas of Age-Related Change(NIH)
(2) Arthritis-Related Statistics(CDC)
(3) Valgus deformities of the feet and characteristics of gait in patients who have rheumatoid arthritis by Keenan MA1, Peabody TD, Gronley JK, Perry J.(PubMed)
(4) Serum Sclerostin Level Among Egyptian Rheumatoid Arthritis Patients: Relation to Disease Activity ,Bone Mineral Density and Radiological Grading by Mehaney DA, Eissa M, Anwar S, El-Din SF(PubMed)
(4a) Death rates and causes of death in patients with rheumatoid arthritis: a population-based study by Sihvonen S1, Korpela M, Laippala P, Mustonen J, Pasternack A(PubMed)

(95) Coronary artery disease and rheumatoid arthritis by Goodson N1.(PubMed)
(96) Cardiovascular risk factors in Chilean patients with rheumatoid arthritis by Cisternas M1, Gutiérrez MA, Klaassen J, Acosta AM, Jacobelli S.(PubMed)
(97) Cardiovascular disease--the silent killer in rheumatoid arthritis by Kumar N1, Armstrong DJ.(PubMed)
(98) Comorbidities in rheumatoid arthritis by Michaud K1, Wolfe F.(PubMed)
(99) Rheumatoid Arthritis (RA)(CDC)
(100) Rates of serious infections and malignancies among patients with rheumatoid arthritis receiving either tumor necrosis factor inhibitor or rituximab therapy by Aaltonen KJ1, Joensuu JT2, Virkki L2, Sokka T2, Aronen P2, Relas H2, Valleala H2, Rantalaiho V2, Pirilä L2, Puolakka K2, Uusitalo T2, Blom M2, Konttinen YT2,Nordström D2(PubMed)
(101) Anxiety, depression and suicidal ideation in patients with rheumatoid arthritis in use of methotrexate, hydroxychloroquine, leflunomide and biological drugs by Pinho de Oliveira Ribeiro N1, Rafael de Mello Schier A, Ornelas AC, Pinho de Oliveira CM, Nardi AE, Silva AC.(PubMed)
(102) Measuring the positive psychological well-being of people with rheumatoid arthritis: a cross-sectional validation of the subjective vitality scale by Rouse PC1, Veldhuijzen Van Zanten JJ2,3, Ntoumanis N4, Metsios GS5,6, Yu CA7, Kitas GD8,9, Duda JL10.(PubMed)
(103) Psychological predictors of pain severity, pain interference, depression, and anxiety in rheumatoid arthritispatients with chronic pain by Ryan S1, McGuire B2.(PubMed)
(104) Risk of solid cancer in patients exposed to anti-tumour necrosis factor therapy: results from the British Society for Rheumatology Biologics Register for Rheumatoid Arthritis by Mercer LK1, Lunt M1, Low AL1, Dixon WG1, Watson KD1, Symmons DP1, Hyrich KL1; BSRBR Control Centre Consortium(PubMed)
(105) Malignancy risk in Australian rheumatoid arthritis patients treated with anti-tumour necrosis factor therapy: analysis of the Australian Rheumatology Association Database (ARAD) prospective cohort study by Buchbinder R1,2, Van Doornum S3, Staples M4,5, Lassere M6, March L7.(PubMed)
(106) Decreasing incidence of symptomatic gastrointestinal ulcers and ulcer complications in patients with rheumatoid arthritis by Steen KS1, Nurmohamed MT, Visman I, Heijerman M, Boers M, Dijkmans BA, Lems WF.(PubMed)
(107) Prevalence of Helicobacter pylori infection and risk of upper gastrointestinal ulcer in patients with rheumatoid arthritis in Japan by Tanaka E1, Singh G, Saito A, Syouji A, Yamada T, Urano W, Nakajima A, Taniguchi A, Tomatsu T, Hara M, Saito T, Kamatani N, Yamanaka H.(PubMed)

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