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Musculo-Skeletal Disorders - Rheumatoid Arthritis

By Kyle J. Norton

Musculoskeletal disorders (MSDs) is medical condition mostly caused by work relatedoccupations and working environment, affecting patients' muscles, joints, tendons,ligaments and nerves and developing over time. A community sample of 73 females and32 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. Ashoulder disorder was found in 27% of subjects, rheumatoid arthritis in 1% andosteoarthritis (OA) of the hand, hip, and knee in five, seven, and 18% of subjects,respectively. Disability was frequent: a walking distance of < 500 m was found in 60%and ADL dependency in 40% of the group. Factors related to one or both of thesedisability measures included female gender, hip and knee OA, impaired vision,cognitive impairment and neurological disease (1).

III. Rheumatoid ArthritisRheumatoid Arthritis is defined a chronic disorder as a result of inflammation, affectingmostly the flexible (synovial) joints and tissues and organs in the body. The diseaseaffects more women than in men and generally occurs after the ages of 40 and diminishesthe quality of life of many elders.A. Signs and Symptoms1. The feetIn the study to investigate the rheumatoid arthritis (RA) patients with foot complaints toaddress the associations between clinical signs and symptoms, radiographic changes, andfunction in connection with disease duration, showed that pain and swelling of the anklewere correlated weakly but statistically significantly with limitation and disability (0.273 to 0.293) as measured on the 5-Foot Function Index (FFI). The clinical signs of the forefoot joints did not influence any of the functional outcome measures.Radiographic scores for both forefeet (SvdH) and hindfeet (Larsen) were correlatedwith the total Health Assessment Questionnaire Disability Index (HAQ DI) and the5-FFI limitation subscale. Pain and disease duration, more than radiographicdamage, influence the total HAQ DI significantly. With the progression of time,structural damage and function of the rheumatic foot worsen in RA patients . Painand swelling of the ankle contribute more to disability than radiographic damage of the foot and ankle (2).

2. The JointsIn patients with rheumatoid arthritis, pain and range of movements of joints have thegreatest impact on individual subdimensions of the HAQ. Extent of radiographic damage in peripheral joints and the number of swollen and tender joints are of lesser importance for function(3).

3. The Muscle strengthDr. Hkkinen A and the research team at Jyvskyl Central Hospital, in the assessment to

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study the extent to which muscle strength and performance, pain, and disease activity areassociated with the total Health Assessment Questionnaire (HAQ) disability index and itssubdimensions in male and female patients with rheumatoid arthritis, indicated thatwomen reported greater disability than men both in the total HAQ and in the majority of its eight subdimensions. In addition to disease activity and pain, muscle strength has a

major impact on disability especially in female rheumatoid patients(4).

4. Rheumatoid nodulesRheumatoid nodules affect the joints of patients with rheumatoid nodules and are alesion commonly found under the skin as a result of microchimerism(5).

5. Conjunctival noduleAlthough is rare in patients with rheumatoid arthritis. There is a 49-year-old woman withseropositive rheumatoid arthritis, who was being treated only with oral steroids andhydroxychloroquine, developed diffuse anterior scleritis in the right eye. In addition,examination showed a focal raised yellow/tan conjunctival nodule. The nodule was

within the bulbar conjunctiva with no attachments to the underlying tissue, which isdifferent from nodular scleritis(6).

6. Morning stiffnessMorning stiffness is a very common symptoms of patients in early rheumatoid arthritis.Some researchers suggested that the degree of morning stiffness appears to reflectfunctional disability and pain more than traditional markers of inflammation such as jointcounts and ESR in patients with early RA. Inclusion of morning stiffness as a marker of inflammatory activity in classification criteria for RA, inclusion criteria for most clinicaltrials in RA, and RA remission criteria, may be open to reassessment(7).

7. Quality of life7.1. Physical disabilityIn the study to 1) investigate the degrees of correlations between different disease activityscores (DASs) and health-related quality of life (HRQoL), and 2) determine if DASscorrelate with either physical or mental HRQoL, showed that SF-36 total score showed asignificant inverse correlation with the DAS4-ESR, DAS-3 ESR, DAS4-CRP, DAS3-CRP, DAS4-28 ESR, DAS3-28 ESR, DAS4-28 CRP, and DAS3-28 CRP, withcorrelation coefficients of -0.320, -0.314, -0.330, -0.323, -0.327, -0.318, -0.360 and-0.348, respectively (P < 0.01 for all). The correlation coefficients between different DASindices and the HRQoL score were not significantly different. In addition, all DASsshowed significant correlations with physical HRQoL, but not with mental HRQoL(8).

7.2. Concurrent psychiatric disordersDr. Mok C, and the scientists at the Tuen Mun Hospital in the study to investigate theeffect of concurrent psychiatric disorders on health-related quality of life (HRQOL) in

patients with rheumatoid arthritis (RA), indicated that in forty-seven (23.5%) patientsdiagnosed with a psychiatric disorder, depressive disorders in 29 patients and anxietydisorders in 26 patients. Patients with either condition had significantly higher fatiguescores (26 8.8 vs. 16 6.9, p < 0.001) and were more likely to be unemployed (p =

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0.02) and dependent on government subsidy for living (p < 0.001) than those without.The scores of the eight domains and the physical and mental components of the SF-36were significantly lower in RA patients with psychiatric disorders (p < 0.001 in all). Ina linear regression model, the presence of either depressive or anxiety disorders ( =-0.23, p < 0.001), older age ( = -0.16, p = 0.006), self-perceived pain ( = -0.25, p