Arthritis or Osteoarthritis (OA)

ARTHRITIS TIME AGE_Matthew Henry-hour-glass-sands-of-time.jpg
 
 

Osteoarthritis (OA) is a degenerative joint disease that creates painful joints’ and bones’ deformities, stiffness, synovial inflammation and swelling. Rheumatoid Arthritis (RA) is a progressive autoimmune disease with unpredictable pain and produces inflammation around joints and organs.

Arthritis is expected to become the world’s fourth cause of disability by the year 2020 (Woolf & Pfleger, 2003) and is already the first cause of disability in adults in U.S.A (Centers for Disease Control and Prevention [CDC], 2015) and in UK (Arthritis Research UK, 2013). Prevalence of OA is 9.6% for male and 18% for female and prevalence of RA is 0.3% to 1% (Saloni, 2004).  Prevalence of OA and RA increases by age and is consistently greater among women (Saloni, 2004). High health care direct costs – 80.8 billion dollars in US for the year 2003 (Yelin, 2007) and 8 billion pounds in UK, yearly (National Rheumatoid Arthritis Society [NRAS], 2010) – reflect the high prevalence rates.

There has been a substantial amount of research that relates stress with arthritis in both cause and effect layers – related to neuroendocrine and immune procedures (Irwin, 2008; Walker et al., 1999). In parallel, depression is more prevalent among older people and people who have lost valuable activities (Keefe & France, 1999; Kool &Geenen, R.2012), reaching 20% among patients of RA, who are diagnosed with Major Depression (Irwin, 2008).

 

It is important for practitioners to conceptualize the dynamic interaction between stress and feelings of inadequacy, pain and dysfunction (Strating, Schuur, & Suurmeijer, 2006). Chronic pain changes the psychological and social presence of patients (Roy, 2004; Sperry, 2014).  Patients with arthritis are at risk of early retirement, of being downsized at work and being bullied at work (Kivimäki, Vahtera, Ferrie, Hemingway, & Pentti, 2001; Schofield et al., 2013; Fattori et al., 2015). Losing societal/familial roles, sense of control, self-efficacy and social support, as opposed to maladaptive beliefs, guiltiness, catastrophizing and depression – they all have been related to pain experience (Keefe & France, 1999; Cross, March, Lapsley, Byrne, & Brooks, 2006; Roy, 2008; Okifuji & Turk, 2015).

 

Suffering in chronic illness is not only about pain and disability but also grief for what is lost by pain (Roy 2008). A study on 3,844 individuals measuring health related quality of life (HRQOL) among patients with arthritis as opposed to individuals with no arthritis has  concluded that patients with arthritis had consistently lower HRQOL scores in all 6 indexes and in all gender/age groups (Khanna et al., 2011).  Furthermore, a large study with 18.531 participants, has reported that individuals with higher scores of pain were comparable in functionality to individuals which were 2 or 3 decades older but with lower scores of pain (Covinsky,Lindquist, Dunlop, & Yelin, 2009).

 

Health Behaviours: the role of physical activity and appropriate nutrition:

Over-protective coping strategies and activities’ avoidance in response to pain causes muscle atrophy, arthritis’ deterioration and further pain (Fordyce as cited in Okifuji, 2015; Plasqui, 2008).  Muscles mass protection and retention of joints’ flexibility are of vital importance. The sensitivity of muscle mass to limited physical activity in response to pain is probable (Plasqui, 2008). The sensitivity of muscles’ atrophy to physical inactivity is well depicted (Plasqui, 2008).

 

Exercise and in specific intensive exercise has been proved better in illness deterioration and is strongly recommended in OA (Booth, Roberts, & Laye, 2012; NICE, 2014; NICE,  2009). However, it is very important for patients to know that exercise by itself is not enough. In fact, in one study the proportion of sedentary time and the occurrence of metabolic syndrome have been found significant – independently of the rest physical activity (Bankoski et al, 2011).

 

Adipose tissue (body fat) has been consistently related to increased production of the pro-inflammatory cytokines (interleukin) in OA (Nelson, 2012) and balanced diet has been associated with reduced inflammation in RA (Kjeldsen-Kragh & Haugen, 1991).  A diet – longitudinal intervention with 34 participants with RA, followed for a year and being in fasting and vegetarian diet, found significantly related improvements in a wide range of measures compared to control group.  Participants in fasting and vegetarian diet condition improved in biological measurements such as erythrocyte sedimentation rate, c-reactive protein (measures of level of inflammation) and white blood cell, in pain level, swelling and stiffness (Kjeldsen-Kragh & Haugen, 1991). When patients are overweight then weight loss in OA is highly advised, (NICE, 2014), however, these findings suggest that interventions must be rich in nutritional information – not focused solely to weight control (Nelson, 2012).

 

On the top of that, arthritis has been strongly related to metabolic syndrome (Nelson, 2012), while the disease most commonly comorbid with cardiovascular diseases (Lima-Martinez et al., 2014; CDC, 2015). The relationship of sedentary lifestyles and the metabolic syndrome is widely proposed (Bankoski et al, 2011). However, in any case, exercise and weight control are of vital importance in arthritis course, as depicted by studies on body fat and arthritis disease activity.

 

References

Bankoski, A., Harris, T. B., McClain, J. J., Brychta, R. J., Caserotti, D., Chen, K. Y., … Koster A. (2011). Metabolic syndrome independent of physical activity. Diabetes care, 34, 497-503. doi: 2337/dc10-0987Booth, F. W., Roberts, C. K., & Laye, M. J. (2012). Lack of exercise is a major cause of chronic diseases. Comprehensive physiology, 2(2), 1143-1211. doi: 10.1002/cphy.c110025

Centers for Disease Control and Prevention. (2015). Arthritis. Retrieved from http://www.cdc.gov/arthritis/index.htm

Covinsky, K. E., Lindquist, K., Dunlop, D. D., & Yelin, E. (2009). Pain, functional limitations, and aging. Journal of American geriatrics Society, 57(9), 1556-1561. doi.org/10.1111/j.1532-5415.2009.02388.x.Pain

Cross, M. J., March, L. M., Lapsley, H. M., Byrne, E., & Brooks, P. M. (2006). Patient self-efficacy and health locus of control: relationships with health status and arthritis-related expenditure. Rheumatology, 45(1), 92-96. doi.org/10.1093/rheumatology/kei114

Fattori, A., Neri, L., Aguglia, E., Bellomo, A., Bisogno, A., Camerino, D., … Favaretto, G. (2015). Estimating the Impact of Workplace Bullying : Humanistic and Economic Burden among Workers with Chronic Medical Conditions. Biomed research international,15(1), 1-12. doi.org/10.1155/2015/708908

Irwin, M. R., Davis, M., & Zautra, A. (2008). Behavioral Comorbidities in Rheumatoid Arthritis: A Psychoneuroimmunological Perspective. Psychiatric Times, 25(9).  PMCID: PMC2707019

Keefe, F. J. & France, C. R. (1999). Pain : Biopsychosocial Mechanisms and Management.Current directions in psychological science, 8(5), 137-141. Retrieved from https://www.researchgate.net/

Kivimaki, M, Vahtera, J., Ferrie, J.., Hemingway, H., & Pentti, J., (2001). Organizational downsizing and musculoskeletal problems in employees: a prospective study. Occupational and environmental medicine, 58, 811-817.  10.1136/oem.58.12.811

Khanna, D., Maranian, P., Palta, M., Kaplan, R. M., Hays, R. D., Cherepanov, D., & Fryback, D. G. (2011). Health-related quality of life in adults reporting arthritis: analysis from the National health measurement study. Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation, 20(7), 1131-40. doi: org/10.1007/s11136-011-9849-z

Kjeldsen-Kragh, J., & Haugen, M. (1991). Controlled trial of fasting and one-year vegetarian diet in rheumatoid arthritis. Lancet, 118(8772).   doi: 10.1016/0140-6736(91)91770-U

Kool, M. B. & Geenen, R. (2012). Loneliness in patients with rheumatic diseases: the significance of invalidation and lack of social support. The journal of psychology, 146(1-2), 229-241. 10.1080/00223980.2011.606434

Lima-Martínez, M. M., Campo, E., Salazar, J., Paoli, M., Maldonado, I., Acosta, … Iacobellis, C. (2014). Epicardial fat thickness as cardiovascular risk factor and therapeutic target in patients with rheumatoid arthritis treated with biological and non-biological therapies. Arthritis. doi: 10.1155/2014/782850

National Rheumatoid Arthritis Society [NRAS], 2010). Employment and Rheumatoid Arthritis in Scotland. A national picture.  Retrieved from https://www.nras.org.uk

Nelson, F. R. T. (2012). Osteoarthritis and metabolic syndrome. Journal of American orthopaedic surgeons, 20(4), 259-260. doi: 10.5435/JAAOS-20-04-259

Okifuji, A. & Turk, D. C. (2015). Behavioral and cognitive – behavioral approaches to treating patients with chronic pain : thinking outside the pill box. Journal of rational-emotive & cognitive-behavior therapy,33(3) 218 -238. doi.org/10.1007/s10942-015-0215-x

NICE (2009). Rheumatoid arthritis in adults: management. NICE Clinical Guideline 79. Available at https://www.nice.org.uk/guidance/cg79 [NICE guideline]

NICE (2014). Osteoarthritis: care and management. NICE Clinical Guideline 177. Available at https://www.nice.org.uk/guidance/cg/79[NICE guideline]

Plasqui, G. (2008). The role of physical activity in rheumatoid arthritis. Physiology & Behavior, 94, 270-275. doi:10.1016/j.physbeh.2007.12.012

Roy, R. (2004). Chronic pain, loss and suffering. CA: University of Toronto press.

Roy, R. (2008). Psychosocial interventions for chronic pain: in research of evidence. NY: Springer science & business media.  doi: 10.4236/psych.2015.610124

Saloni, T. (2004). Osteoarthritis: opportunities to address pharmaceutical gaps. Archives of the World Health Organization. Retrieved from http://archives.who.int/prioritymeds/report/background/osteoarthritis.doc

Sperry, L. (2014). Treating patients with arthritis: the impact of individual, couple, and family dynamics. The family journal: counseling and therapy for couples and families, 17(3), 236-266. doi: 10.1177/1066480709338288

Strating, M. M. H., Schuur, W. H., & Suurmeijer, T. P. B. M. (2006). Contribution of Partner Support in Self-Management of Rheumatoid Arthritis Patients. An Application of the Theory of Planned Behavior. Journal of behavioral medicine, 29(1). doi.org/10.1007/s10865-005-9032-5

Walker, J. G., Littlejohn, G. O., McMurray, N. E., & Cutolo, M. (1999). Stress system response and rheumatoid arthritis: a multilevel approach. Rheumatology, 38(11), 1050-1057. doi.org/10.1093/rheumatology/38.11.1050

Woolf, A. D. & Pfleger, B. (2003). Burden Of Major Musculoskeletal Conditions. Bulletin Of The World Health Organization, 8, 646-569. Retrieved from http://www.who.int/bulletin/volumes/81/9/Woolf.pdf

Yelin, E. (2007). National and State Medical Expenditures and Lost Earnings Attributable to Arthritis and Other Rheumatic Conditions. Morbidity and mortality weekly report, 56(01), 4-7. Retrieved from http://www.cdc.gov/mmwr/

 
 

IS ARTHRITIS AN ELDERLY DISEASE?

No, arthitis may develop in young age.

 

There has been a substantial amount of research that relates stress with arthritis in both cause and effect layers – related to neuroendocrine and immune procedures (Irwin, 2008; Walker et al., 1999).

Exercise and in specific intensive exercise has been proved better in illness deterioration and is strongly recommended in OA (Booth, Roberts, & Laye, 2012; NICE, 2014; NICE,  2009). However, it is very important for patients to know that exercise by itself is not enough. In fact, in one study the proportion of sedentary time and the occurrence of metabolic syndrome have been found significant – independently of the rest physical activity (Bankoski et al, 2011).