Rheumatoid Arthritis

OA is a musculoskeletal disease that causes chronic joint pain and reduced physical functioning (Laba, brien, Fransen, & jan, 2013). Osteoarthritis (OA) is a non-inflammatory disorder of synovial joints that results in loss of hyaline cartilage and remodeling of surrounding bone. OA is the single most common joint disease, with an estimated prevalence of 60% in men and 70% in women later in life after the age of 65 years, affecting an estimated 40 million people in the United States (Goodman & Fuller, 2009). Women are more commonly affected after the age of 55, almost everyone has some symptoms by the age of 70 (Tan, Zahara, Colburn & Hawkins, 2013, p.78). Osteoarthritis can be described radiological, clinical, or subjective.

Progression of osteoarthritis involves of three stages. Stage 1 start from cartilage matrix breakdown follow by cartilage fibrillation and erosion. Disease continues to progress to stage three where synovial inflammation started. With inflamed synovial, synovial membrane produced cytokines, particularly inflammatory cytokines and growth factors which both able to diffuse through synovial fluid and enter the cartilage. This will activates pro-inflammatory cytokines (Pelletier et al, 1999).In short, cartilage breakdown or degrade will lead erosion and release pro-inflammatory cytokine which in turn contribute to joint destruction. In an osteoarthritis knee, Examples of pro-inflammatory cytokines are interleukin-1, IL-1 and tumour necrosis factor alpha, TNF-α.

Osteoarthritis (OA) is the most common joint disorder. It occurs when cartilage begins to break down or be worn away and the bone rubs together. As a result bony spurs and inflammation of the joint(s) occurs. Surrounding ligaments and muscles may also weaken or stiffen. Major risk factors are: genetics, excess weight, joint injuries, jobs that involve more than an hour of joint stressing activities like kneeling, and sports that involve direct impact on the joints, twisting, or throwing. Bleeding disorders, disorders that blood supply near joints, and other types of arthritis can cause osteoarthritis. Symptoms typically begin while one is middle aged and almost everyone shows some symptoms of OA by age 70. This is important to note because OA is seemingly inevitable for everybody. OA is not curable and typically gets worse with time, but the symptoms can be managed. Strength in weight bearing joints, the hip, the knee, and the ankle, is particularly important for prevention. Also important are not overusing joints and maintaining a normal body weight.

Osteoarthritis (OA) is a very common joint deterioration disease that touches millions of people around the world every day. With an estimated occurrence of 60 % in men and 70 % in women (). Osteoarthritis is a condition sometimes called “wear and tear” arthritis because the joints are affected by degeneration( Mega). With OA it affects the cartilage of the joint which is the tissue that covers the ends of the bones in a joint. With healthy cartilage, bones can slide over each other, and it also helps with the absorbing shock of movement. Unforntantly in patients who have OA, there is a breakdown of cartilage, and it wears away, which allows bones to rub together. As bones rub together this will cause pain, swelling, and possible loss os motion in the joint. After a while the joint loses its normal shape, there may also be bone spurs of the joint. Bone and cartilage may break off inside joint space and float around which will lead to even

Rheumatoid arthritis (RA) is a systemic autoimmune disease that occurs when the body’s immune system attacks the tissue that lines the inside of the joints (synovium). Over time cartilage and bone within the joint is destroyed and the joint spacing between bones become smaller. According to the text Understanding Pathophysiology by Huether and McCance cartilage damage in RA is the result of three processes: (1) neutrophils and other cells in the synovial fluid become activated, degrading the surface layer of articular cartilage; (2) cytokines, particularly tumor necrosis factor alpha (TNF-α), stimulate syntheses of preinflammatory compounds, including interleukin-1 (IL-1), interleukin-6 (IL-6), and interleukin-8 (IL-8), and cause the chondrocytes

In addition to the discussion I would like to briefly explain the pathophysiology of RA. The interaction of genetic risk factors, environment and the immune systems are the main pathogens in RA. Regardless of the initial factors, RA progresses, when an amino acid required for protein synthesis is converted from arginine to citrulline (called citrullination), which alters the structure and function of the proteins. The body's immune system does not recognise these citrullinated proteins as self, and so begins to attack the immune system and occurs persistent inflammation of the synovium and bone destruction. Ongoing damage in the joint causes persistent inflammation and generates large amounts of inflammatory cytokines and growth factors. Circulation of high levels of these pro-inflammatory mediators causes the synovial joint inflammation (Casey 2015).

Rheumatoid Arthritis or (RA) is an autoimmune disease that attacks the joints and connective tissue. The result is inflammation that produces permanent damage in the joints. Rheumatoid arthritis is a chronic syndrome that tends to be progressive and destructive as compared to Osteoarthritis or (OA), which is more of an age related disease caused by “wear and tear” of the joints. In contrast to (OA), rheumatoid arthritis is characterized by inflammation mostly of the joints, but is a general body disease.

Rheumatoid arthritis is a chronic syndrome that is characterized by inflammation of the peripheral joints, but it may also involve the lungs, heart, blood vessels, and eyes. The prevalence of this autoimmune disease is between 0.3% to 1.5% of the population in the United States (Feinberg, pp 815). It affects women two to three times more often than men, and the onset of RA is usually between 25 and 50 years of age, but it can occur at any age (Reed, pp 584). RA can be diagnosed by establishing the presence of persistent joint pain, swelling in a symmetric distribution, and prolonged morning stiffness. RA usually affects multiple joints, such as the hands, wrists, knees, elbows, feet, shoulders, hips, and small hand joints. RA is

“Rheumatoid arthritis, RA, causes premature mortality, disability and compromised quality of life in the developed and emerging world (cdc.gov).” RA is the most common of chronic inflammatory arthritis. Rheumatoid arthritis is an autoimmune condition; it is a chronic inflammatory polyarthritis, in which more than five joints are affected. Rheumatoid arthritis is a systemic inflammatory disease which it manifests itself in numerous joints of the body. The inflammatory process mainly affects the lining of the joints, usually small joints then leading to many other organs. “Rheumatoid arthritis is a type of chronic arthritis that occurs in joints on both sides of the body. This symmetry helps distinguish rheumatoid arthritis from other types of arthritis. Rheumatoid arthritis may also affect the skin, eyes, lungs, heart, blood, or nerves (webmd.com).”

Rheumatic or musculoskeletal conditions comprise over 150 diseases and syndromes. One condition called Osteoarthritis (OA) is the most common degenerative joint disease that affects the cartilage. In developed countries it ranks among the top ten for disabling diseases. It is associated with aging and affects the joints that have been continuously stressed throughout the years. This includes the knees, hips, fingers, and lower spine region. The condition presents itself as a loss in flexibility, stiffness, and a deep, achy pain. Treatment of this condition requires a variety of components to fit a person's needs, lifestyle, and health.

Rheumatoid arthritis (RA) is a chronic inflammatory disorder that typically affects the small joints in the hands and feet. Unlike the wear-and-tear damage of osteoarthritis, RA affects the lining of the joints, causing a painful swelling that can eventually result in bone erosion and joint deformity. In America, RA is the most common form of autoimmune arthritis, affecting more than 1.3 million Americans. Of these, about 75% are women. The disease most often begins between the fourth and sixth decades of life. However, the RA also can start at any age. In Malaysia, RA affects about 5 in 1000 people. According to Malaysian Statistic on Medicine in 2005, the total drug expenditure in 2005 for the treatment of inflammatory and rheumatic diseases was RM 50.7 million, and form 7.8% of the top 40 prescribed drugs in Malaysia. It was ranked 5th as the highest prescribed group of drugs (MOH, 2004).

In general Arthritis describes that inflammation that occurs in the joints which can be warmth, redness, pain and/or selling. RA is an ongoing type of arthritis, the symmetric involvements of joints differentiates RA from other arthritis types. normally when one side is effected the other side most likely is also effected such as both knees, hand or/and wrists. Patients with rheumatoid arthritis suffer from Joint pain, stiffness, fatigue etc which can effect their quality of life. In addition to medications clinicians must educate patients on Non-pharmacologic approaches to aid in relief such as the following

Shankman and Manske include in their text that a bacterial or viral infection is said to activate this disease, which prompts the autoimmune reaction. This type of reaction helps the body attack at its own tissues, which eventually leads to the failure of the joints. The intricate details of RA are that it destroys the synovium lining, which triggers expansion, causing the bone cartilage and extracellular matrix to damage. The autoimmune response, associated with RA, also leads to the initiation of T cells. T cells are known to produce cytokines. A little information of cytokines is that it enlarges the foundation of macrophages and fibroblast-like cells which leads to the interruption of bone and cartilage (Shankman & Manske, 2011).

Range of movement may also decrease, and redness of the skin around the joint may occur. Osteoarthritis starts as occasional joint pain know as Acute Osteoarthritis. Subacute Osteoarthritis is more frequent and severe pain. Arthritis can be treated and still be reversed at this stage. The next stage is Chronic Osteoarthritis where a patient is experiencing severe pain and limited movement. The final stage is Degenerative Osteoarthritis where cartilage is gone and bone on bone pain is constant. People in this stage are typically immobile. Rheumatoid arthritis begins with Early Stage, when there is pain and swelling when the joint is used. Next is Moderate Stage, when the joint narrows and pain worsens. Severe Stage causes limited movement and constant, severe pain. The final stage of RA is End Stage when all movement of the joint is gone. Severe Rheumatoid arthritis can cause joint disfigurement if left untreated. Arthritis is most common in people over the age of 55 and women are more likely to be diagnosed than men. 60% of Osteoarthritis patients and 70% or Rheumatoid Arthritis patients are

The University of Maryland Medical Center (UMMC, 2015) declares Osteoarthritis (OA) as the most common form of arthritis that affects approximately 27 million people in the U.S. alone. According to the medical center, OA is a joint disease, which can occur as a result