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| Chronic Rheumatic Conditions |
| Background: |
World population has ever been increasing and as of November 2008, the world's population is estimated to be just over 6.72 billion and is expected to reach 8 billion in 2025 and nearly 9 billion by the year 2042. |
| (Source: http://en.wikipedia.org/wiki/World_population#Population_figures). |
The life expectancy has increased over the time period and it is expected that there would be more than 1000 million elderly people (60 years and more) by 2020. With the increased number and increased life span, the world population would be more prone to various chronic diseases. |
Joints and muscles are first part of the body to change, as people grow older. Bones lose calcium, cartilage shrinks, fibrotic changes are seen in synovial joints (also called diarthrosis joints, as they are most common and most moveable type of joints in human body, e. g. Shoulder, Hip, Elbow, Knee etc.), synovial fluids decreases, mechanical weakness occurs in tendons, muscle mass and strength is reduced and the disk degenerates. |
Studies indicate that prevalence of musculo-skeletal diseases among adults is around 15% in any population. In 2005, this estimation projected that there are around 900 million patients in world and around 15 million in India. These diseases account for more impairment and functional limitations among middle age and older adults than any other disease category. |
Rheumatic or musculoskeletal conditions comprise over 150 diseases and syndromes, which are usually progressive and associated with pain. They can broadly be categorized as joint diseases, physical disability, spinal disorders, and conditions resulting from trauma. Musculoskeletal conditions are leading causes of morbidity and disability, giving rise to enormous healthcare expenditures and loss of work. |
| FACTS: |
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Arthritis is more common cause of immobility than heart disease, cancer or diabetes. |
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By 2010 India will have 66 million people above the age of 65 years at high risk of osteoarthritis. |
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An estimated one in nine Indians – nearly 10 crore people - have some or the other form of arthritis. |
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One in six people and one in three families are affected by arthritis. |
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Nearly 50% of persons in 65 years of age have Arthritis. |
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Millions of people are at higher risk and don’t even know they have arthritis. |
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Approximately 60 Lakh people are ‘self-diagnosed’ and improperly ‘self treated’. |
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200,00,000 people have been diagnosed with arthritis in India, still there are many left undiagnosed. |
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India has the second largest osteoarthritis patient base with 15 million sufferers. (Source- Times of India- Jan 2008) |
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An estimated 294,000 children under age 18 have some form of arthritis or rheumatic condition; this represents approximately 1 in every 250 children. |
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Nearly three of every five people with arthritis are younger than 65 years. |
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| 1. What are Chronic Rheumatic Conditions/Arthritis? |
Chronic Rheumatic Condition/ Arthritis is a complex disorder involving damage to the joints of the body connective tissues, muscle, tendons, and fibrous tissue. It tends to strike during the most productive years of adulthood, between the ages of 20 and 40, and is a chronic disabling condition often causing pain and deformity. There are more than 100 distinct conditions of arthritis out of which two of the most common forms are osteoarthritis and rheumatoid arthritis. |
| 2. What are the different types of Arthritis? |
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Osteoarthritis (OA) (also known as degenerative arthritis, degenerative joint disease) is a clinical syndrome in which low-grade inflammation results in pain in the joints, caused by abnormal wearing of the cartilage that covers and acts as a cushion inside joints and destruction or decrease of synovial fluid that lubricates those joints. As the bone surfaces become less well protected by cartilage, the patient experiences pain upon weight bearing, including walking and standing. |
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Rheumatoid arthritis (RA) is a chronic, systemic autoimmune disorder that causes the immune system to attack the joints, where Inflammation of the joint lining, called the synovium, can cause pain, stiffness, swelling, warmth, and redness. The affected joint may also lose its shape, resulting in loss of normal movement. RA can be a disabling and painful condition, which can lead to substantial loss of functioning and mobility. |
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Juvenile idiopathic arthritis (JIA), formerly known as juvenile rheumatoid arthritis (JRA) is the most common form of persistent arthritis in children. JIA is a subset of arthritis seen in childhood, which may be transient and self-limited or chronic. |
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Still's disease is a form of juvenile idiopathic arthritis, characterized by high spiking fevers and transient rashes. |
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Psoriatic arthritis (also called arthropathic psoriasis or psoriatic arthropathy) is a type of inflammatory arthritis that affects around 5-7% of people suffering from the chronic skin condition called psoriasis. |
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Septic arthritis is the invasion of a joint by an infectious agent which produces arthritis. The usual etiology is bacterial, but viral, mycobacterial, and fungal arthritis occur occasionally. Bacteria are carried by the bloodstream from an infectious focus elsewhere, introduced by a skin lesion that penetrates the joint, or by extension from adjacent tissue |
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Gout arthritis (also called metabolic arthritis) is a disease created by a buildup of uric acid. In this condition uric acid crystals are deposited on the articular cartilage of joints, tendons and surrounding tissues due to elevated concentrations of uric acid in the blood stream. This provokes an inflammatory reaction of these tissues. |
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| 3. What are the most common symptoms of Arthritis? |
As there are more than 100 different types of arthritis, symptoms of the disease can be many, but there are certain signs which indicate to the disease: |
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Persistent joint pain |
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Joint pain in rainy weather |
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Pain or tenderness in a joint aggravated by movement or activity, such as walking, getting up from a chair, writing, typing, holding an object, throwing a ball, turning a key. |
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Inflammation indicated by joint swelling, stiffness, redness, and/or warmth. |
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Joint deformity |
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Morning stiffness and Limited movement |
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Loss of range of motion or flexibility in a joint. |
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Extreme fatigue, lack of energy, weakness, or a feeling of malaise. |
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Non-specific fever. |
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Skin rash along with severe joint pain, if the joint is so painful that one cannot use it. |
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Sudden back pain that occurs with weakness in the leg or loss of bowel or bladder control. |
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Joint pain continues for more than 6 weeks and home treatment is not helping. |
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Side effects (stomach pain, nausea, persistent heartburn, or dark, tarry stools) from aspirin or other arthritis medications. |
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Some people might not have symptoms. |
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| 4. What are the risk factors associated with Arthritis? |
Certain factors have been shown to be associated with a greater risk of arthritis. Some of these risk factors are modifiable while others are not. |
| Non-modifiable risk factors |
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Age: The risk of developing most types of arthritis increases with age. |
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Gender: Most types of arthritis are more common in women; 60% of all people with arthritis are women. Gout is more common in men. |
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Genetic: Specific genes are associated with a higher risk of certain types of arthritis, such as rheumatoid arthritis (RA), systemic lupus erythematous (SLE), and ankylosing spondylitis. |
Modifiable risk factors |
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Overweight and Obesity: Obesity causes arthritis by increasing the mechanical stress on the cartilage. In fact, next to aging, obesity is the most powerful risk factor for osteoarthritis of the knees. |
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Joint Injuries: Damage to a joint can contribute to the development of osteoarthritis in that joint. |
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Infection: Many microbial agents can infect joints and potentially cause the development of various forms of arthritis. |
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Occupation: Certain occupations involving repetitive knee bending and squatting are associated with osteoarthritis of the knee. |
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| 5. Who are at high risk of developing Arthritis? |
Arthritis affects different people differently. Although in some people it progresses quickly, in most individuals joint damage develops gradually over years. In some people, arthritis is relatively mild and interferes little with day-to-day-life; in others, it causes significant pain and disability. However, arthritis is most common in the following groups: |
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Women |
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Older adults |
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Whites (compared with blacks and Hispanics) |
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People who are overweight or obese |
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People with sedentary lifestyles |
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6. What are the ways to control / prevent Arthritis? |
| The following measures may help relieve or prevent symptoms: |
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Maintain a healthy weight: Gradual weight loss will lessen the load on affected weight-bearing joints. Losing weight may also decrease uric acid levels. Avoid fasting or rapid weight loss because doing so may temporarily raise uric acid levels. |
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Avoid excessive amounts of animal protein: These foods contain purines. Rich sources include organ meat (liver, brains, kidney and sweetbreads) and anchovies, herring, and mackerel. Smaller amounts occur in all meats, fish and poultry. |
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Limit or avoid alcohol: Consuming too much alcohol can inhibit the excretion of uric acid, lead to its build up and cause an attack of gout. Limit alcohol to not more than two drinks a day if you’re a man. Limit alcohol to one drink a day if you’re a woman. If you have gout, it is best to avoid alcohol completely. |
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Drink plenty of liquids: Fluids help dilute uric acid in your blood and urine. |
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Rest is just as important as exercise. Sleeping 8 to 10 hours per night and taking naps during the day can help you recover from a flare-up more quickly and may even help prevent exacerbations. |
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Massage on joints with neem oil has reported improvement in chronic and acute cases. |
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Eat a diet rich in vitamins and minerals, especially antioxidants like vitamin E. These are found in fruits and vegetables. Diets high in marine oils from cold-water fish such as salmon, mackerel, and tuna have been shown to reduce the inflammation of joint conditions such as arthritis. |
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| 7. What is the treatment available for Arthritis? |
Treatment options vary depending on the type of arthritis and include
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physical and occupational therapy, |
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lifestyle changes (including exercise and weight control), |
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Medications (symptomatic or targeted at the disease process causing the arthritis) |
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Dietary supplements |
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Arthroplasty (joint replacement surgery) |
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| KEY POINTS TO REMEMBER |
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Rheumatoid arthritis is 2 to 3 times more common in women than in men, and generally affects people between the ages of 20 and 50. |
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Obesity is a major risk factor for osteoarthritis of the knee. |
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Within 10 years on onset, at least 50% of patients in developed countries are unable to hold down a full-time job due to arthritis. (WHO) |
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Exercising of the arthritic joint is encouraged to maintain the health of the particular joint and the overall body of the person. |
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© 2007 All rights reserved.
Chronic Care Foundation, E-520, IInd Floor, Palam Extn., Near Ramphal Chowk, Sec-7, Dwarka, New Delhi 110 075 (India)
Phone: + 91 11 25087853,
Email: ceo@chroniccareindia.org |
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All donations are exempt under section 80G of the Income Tax Act, 1961 vide order no. DIT (E) 2008 – 2009/C-985/3424 dated 31/03/09
for the period from A.Y. 2010-11 to A.Y. 2012-13
Public Charitable Trust Registered in New Delhi vide No.10692/4 Dtd. 21.12.2006
FCRA Registration Number- 231661163 (Nature: Educational Social)
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