MUSCULOSKELETAL
DISORDERS
PREPARED BY MR. ABHIJIT DAS
RHEUMATOID ARTHRITIS
DEFINITION
Rheumatoid arthritis is a chronic autoimmune disease
that primarily affects the joints, but can also affect other parts of the body.
In rheumatoid arthritis, the body's immune system mistakenly attacks the lining
of the joints, causing inflammation, swelling, pain, and eventually joint
damage.
ETIOPATHOGENESIS
1.
Genetic factors: Certain genetic factors
have been identified as increasing the risk of developing RA. Individuals with
specific genetic markers, such as the HLA-DRB1 gene, are more likely to develop
the disease.
2.
Environmental factors: Environmental
factors, such as smoking, can trigger the onset of RA or worsen its symptoms.
Infections, such as bacterial or viral infections, have also been linked to the
development of RA.
3.
Immunologic factors: In RA, the immune
system mistakenly attacks the synovial lining of the joints, leading to
inflammation and joint damage. It is believed that certain triggers, such as
infections or environmental factors, can cause the immune system to malfunction
and attack the body's own tissues.
4.
Synovial membrane changes: Changes in
the synovial membrane (the lining of the joint) can also contribute to the
development of RA. Inflammation within the synovial membrane can cause it to
thicken and produce excess synovial fluid, which can lead to joint swelling and
damage.
CLINICAL MANIFESTATIONS
1.
Joint pain and stiffness: Pain and
stiffness in the joints, especially in the morning or after periods of
inactivity, are common symptoms of RA.
2.
Joint swelling and warmth: Inflammation
in the joints can cause swelling, redness, and warmth.
3.
Joint deformity: Over time, RA can cause
joint damage and deformity, particularly in the hands and feet.
4.
Fatigue and weakness: Many people with RA
experience fatigue, weakness, and a general feeling of malaise.
5.
Fever and weight loss: Some people with
RA may experience a low-grade fever and unintended weight loss.
6.
Rheumatoid nodules: Small, firm bumps
under the skin, called rheumatoid nodules, may develop in some people with RA.
NON-PHARMCOLOGICAL MANAGEMENT
1.
Physical therapy: Physical therapy can
help improve range of motion, strength, and flexibility in the affected joints.
2.
Occupational therapy: Occupational
therapy can help individuals with RA develop strategies for managing daily
tasks and activities while minimizing joint pain and stiffness.
3.
Exercise: Regular exercise, such as
walking, swimming, or cycling, can help improve joint function and reduce pain
and stiffness.
4.
Weight management: Maintaining a healthy
weight can help reduce the load on affected joints, which can reduce pain and
improve function.
5.
Heat and cold therapy: Applying heat or
cold to affected joints can help reduce pain and inflammation.
6.
Rest and relaxation: Resting and
practicing relaxation techniques, such as deep breathing and meditation, can
help reduce stress and improve sleep quality.
7.
Assistive devices: Assistive devices,
such as braces, splints, and canes, can help support and protect affected
joints.
PHARMCOLOGICAL MANAGEMENT
1.
Nonsteroidal anti-inflammatory drugs
(NSAIDs): These medications, such as ibuprofen and naproxen, can help reduce
pain and inflammation in affected joints.
2.
Disease-modifying antirheumatic drugs
(DMARDs): DMARDs, such as methotrexate and sulfasalazine, work by suppressing
the immune system and reducing inflammation, and are often used to slow or halt
the progression of joint damage.
3.
Janus kinase inhibitors (JAK
inhibitors): JAK inhibitors, such as tofacitinib, work by blocking the action
of enzymes that contribute to inflammation in the joints.
4.
Corticosteroids: Corticosteroids, such
as prednisone, can help reduce inflammation and relieve pain in the short term,
but are generally used at the lowest effective dose due to their potential for
side effects.
OSTEOARTHRITIS
DEFINITION
Osteoarthritis is a common joint disorder that is
characterized by degeneration of the cartilage that lines the joint surfaces,
along with changes in the underlying bone, joint lining, and surrounding
tissues. It is also referred to as degenerative arthritis or degenerative joint
disease. Osteoarthritis typically affects the weight-bearing joints such as the
knees, hips, and spine, as well as the hands and feet.
ETIOPATHOGENESIS
1.
Age: OA is more common in older adults,
as the natural wear and tear on the joints over time can lead to cartilage
damage and joint degeneration.
2.
Joint injury or trauma: Joint injuries,
such as fractures, ligament tears, and dislocations, can cause direct damage to
the joint and increase the risk of developing OA later in life.
3.
Joint overuse or repetitive stress:
Repetitive use of joints in certain occupations or sports can increase the risk
of developing OA over time.
4.
Obesity: Being overweight or obese puts
added stress on the joints, particularly in the knees and hips, which can
contribute to cartilage breakdown and joint degeneration.
5.
Genetics: Certain genetic factors may
increase the risk of developing OA, including abnormalities in genes that
affect cartilage and bone metabolism.
6.
Metabolic factors: Metabolic factors,
such as high levels of uric acid or calcium crystals in the joint fluid, can
contribute to joint inflammation and damage over time.
CLINICAL MANIFESTATIONS
1.
Joint pain: Pain is one of the hallmark
symptoms of OA and is typically described as a dull ache or stiffness in the
affected joint. Pain may be worse with activity and can improve with rest.
2.
Joint stiffness: Stiffness is another
common symptom of OA and may be most noticeable in the morning or after periods
of inactivity. Stiffness can make it difficult to move the affected joint and
can improve with gentle movement.
3.
Reduced range of motion: As OA
progresses, the joint may become increasingly stiff, limiting the range of
motion in the affected joint.
4.
Joint swelling: Inflammation in the
joint can cause swelling, which may be visible or palpable around the joint.
5.
Joint instability: As the joint surfaces
become more damaged, the joint may become unstable, leading to a feeling of giving
way or buckling.
6.
Joint deformity: In advanced cases of
OA, joint deformity may occur, which can cause the affected joint to look
misshapen or crooked.
NON-PHARMACOLOGICAL MANAGEMENT
1.
Exercise: Regular low-impact exercise,
such as walking, swimming, or cycling, can help to reduce pain and improve
joint function in people with OA. Exercise can also help to improve muscle
strength and flexibility, which can support the affected joint.
2.
Weight management: Being overweight or
obese can increase the stress on the joints, particularly in the knees and
hips, which can exacerbate symptoms of OA. Maintaining a healthy weight through
diet and exercise can help to reduce pain and improve joint function.
3.
Physical therapy: Physical therapy can
help to improve joint function and reduce pain in people with OA. A physical
therapist can work with a person to develop a personalized exercise and
stretching program that can help to improve joint mobility and reduce pain.
4.
Assistive devices: Assistive devices,
such as braces, splints, or orthotics, can help to support the affected joint
and reduce pain during movement.
5.
Heat and cold therapy: Applying heat or
cold to the affected joint can help to reduce pain and stiffness. Heat therapy
can help to improve circulation and relax muscles, while cold therapy can help
to reduce inflammation and numb pain.
6.
Acupuncture: Acupuncture involves the
insertion of thin needles into specific points on the body to help relieve pain
and promote healing. Some studies have suggested that acupuncture may be
effective in reducing pain and improving function in people with OA.
PHARMACOLOGICAL MANAGEMENT
1.
Non-steroidal anti-inflammatory drugs
(NSAIDs): NSAIDs, such as ibuprofen, naproxen, and celecoxib, are commonly used
to reduce pain and inflammation in OA. They work by blocking the production of
prostaglandins, which are chemicals in the body that cause pain and
inflammation.
2.
Acetaminophen: Acetaminophen is an
over-the-counter pain reliever that is commonly used to manage mild to moderate
pain in OA. It is less effective than NSAIDs in reducing inflammation but may
be a safer option for people who cannot take NSAIDs.
3.
Corticosteroids: Corticosteroids, such
as prednisone, can be injected directly into the affected joint to help reduce
inflammation and pain. They are generally reserved for severe cases of OA or
when other treatments have not been effective.
4.
Hyaluronic acid injections: Hyaluronic
acid is a substance that is naturally found in the joint fluid. Injections of
hyaluronic acid, such as Synvisc and Hyalgan, can help to lubricate the joint
and reduce pain and inflammation.
5.
Disease-modifying anti-rheumatic drugs
(DMARDs): DMARDs, such as methotrexate and sulfasalazine, are commonly used to
treat rheumatoid arthritis, but they may also be effective in reducing pain and
inflammation in OA.