Rheumatoid Arthritis - Essay Example

? Rheumatoid Arthritis There have been many studies concerning the occurrence of Rheumatoid arthritis (RA). However, most studies have not been able to establish the real causative factor of the condition as well as its effects on occupational performance. This paper wills discuss the occurrence of RA, the causes and risk factors, symptoms, diagnosis and treatment options. In addition, the paper will analyze the effects of the condition on occupational performance of the affected person. Introduction Rheumatoid arthritis (RA) is a persistent, chronic inciting disease that may cause noteworthy disability and joint pain. Although researchers have constantly claimed that the major cause of the condition is a mystery, several other studies indicate that the cytokine tumor necrosis factor (TNF) is significant in its pathogenesis. In addition to this, people suffering from this condition are susceptible to other infections. In this regard, a research conducted in Mayo Clinic indicated that occurrence of contagions requiring hospitalization were more in RA patients compared to non-RA patients (Dixon, 2006). RA affects mostly diarthrodial joints. The most widespread, form of onset entails regular pain and swelling in small joints of feet and hands, and its beginning might and does differ extensively among different persons (Stanich, et al., 2009). It is also evident that rheumatoid arthritis might hinder the execution of social roles and partaking in recreational activities (Wikstrom, et al., 2001). A major aspect of this condition is that it has an irregular course, with no common pattern and an indecisive rate of worsening. This means that the condition is very unpredictable, hence can produce adverse effects to the patient. In this regard, the condition causes an early onset of disability to the patient. This continues in the course of the disease and it becomes very complex to determine the particular time that the disability might occur. This offers several difficulties to the managers of the disease and makes it difficult for the patient to cope with the dynamic aspects of the disease. In addition, mutilation of the body of the affected person might occur due to disturbance of the body metabolisms. In some cases, the disability is very severe as to render the patient incapable of performing any task independently (Doeglas, et al., 1995). Another major aspect and effect of Rheumatoid arthritis is the reduction in life expectancy. In this regard, several studies indicate that this condition lessens life expectancy by four years in men and by 10 years in women. However, not all cases of the condition accounts for this life expectancy reduction. It is only a few cases, which are severe that accounts for such a reduction (Akil & Amos, 1995). Another important aspect of the disease is that it affects both sexes. Although it is prevalent in both sexes, studies have revealed that this condition is more common in females, characterized by pain and swelling in the joints. In addition, the occurrence of the condition is not uniform, there are various stages ranging from less severe to most severe. In some most severe cases, people suffering from this condition are incapable of even performing very simple tasks such as walking rising from a seated position (Higuera, 2011). Prevalence of Rheumatoid Arthritis The occurrence of this condition leads to a higher susceptibility of death to the people affected. It is evident that people suffering from the condition have increased death vulnerability compared to people without the condition of their same sex and age. This aspect of the occurrence of the disease is prevalent in Europe and across other many other regions. However, some studies in Japan and China reveals that the occurrence of the condition is relatively low. These studies indicate that the prevalence of this condition in these two countries actually occurs at a rate of 0.2%–0.3percent. Other studies addressing the prevalence of this condition indicate that some genetic factors depict its occurrence in some regions. For instance, RA is more common, at a rate of more than 5%, in American Indian and Alaska natives, depicting some genetic partiality. Although this condition displays reduced geographical and climatic or seasonal disparities in its occurrence, some studies in Tokyo indicated a distinct seasonal disparity in this region, with disease prevalence higher in the spring and lower in the fall (Stanich, et al., 2009). Rheumatoid arthritis occurs globally with changeable occurrence and severity. It affects up to 1-3% of the population In Western nations, even though there is no severe effect on most people and some might not look for medical help or consultancy. In general, there is a ratio of 3:1 female predominance, however this overload is bigger in youth and the age related occurrence is roughly equal in elderly people (Akil & Amos, 1995). In the U.K, a study indicated that RA was uncommon in both women and men below the age of 35. Conversely, peak occurrence of the condition occurs between ages 55 and 64 years. However, the general occurrence in the adult population in the UK according to the same study was approximately 1% (Symmons, 2005). Causes and Risk Factors of Rheumatoid Arthritis The real cause of RA remains rather uncertain, which also adds to the relative obfuscation of causation fundamental to the onset of the condition. Despite this uncertainty, most studies have indicated that the causative factor of the disease is inflammation. In addition, other studies point to the input of autoantibodies and immune difficulties in causing the onset of this condition. Pathogenesis starts with soreness of the synovium in tiny diarthrodial joints in the hands and feet, as well as in some bigger weight bearing joints. The original inflammation causes constant cartilage and bone injury, which eventually destroys joint function. In a vigorous joint, a thin synovial film having two fundamental cell forms lines the joint. One of these cell forms is the synoviomacrophage, which contains antigen-presenting capability; the second cell form, fibroblast-like synoviocytes, generates a concentrated matrix and synovial fluid. In RA, augmented cellular explosion and reduced apoptosis often occurs in this layer, and this eventually causes inflammation and hyperplasia (Stanich, et al., 2009). Although the main cause of this condition remains unclear, various risk factors or triggers accelerate the occurrence of the condition. The most common triggers of this condition include genetic factors, lifestyle factors, trauma (both physical and psychological), age and gender, hormonal factors reproductive factors and medical factors. Several studies also indicate that there is a considerable link between pregnancy and the acceleration of this condition. These studies indicate that during pregnancy, there is an increased risk of acceleration of the disease. In this regard, it is evident that the constant use of oral contraceptive pill (OCP) might cause the onset of RA (Symmons, 2005). Other studies indicate that there is a considerable link between infectious agents and the commencement of RA. Means by which infectious agents might cause or trigger RA comprise molecular impressions or mimicry and epitope scattering. The issue of molecular have been subject to considerable concern in contemporary research. In addition, recent studies indicate that this mechanism is probably the most common trigger of the condition in the society. This mechanism of molecular mimicry occurs when remaining auto-reactive T cells become triggered by peptides from infecting organisms, which have parallel organization and/or amino acid progression to that of some host peptide (Stanich, et al., 2009). Symptoms and Diagnosis of Rheumatoid Arthritis The sings and symptoms of rheumatoid arthritis differ according to the severity of the condition and most people or doctors might confuse them with signs of other autoimmune conditions. However, the most common symptoms include swelling, unexplained weight loss, morning rigidity, fever, joint pain or inflammation, unrelenting fatigue as well as nodules under the skin. Although these symptoms might be severe, there are always some phases of diminution wherein symptoms vanish temporarily (Higuera, 2011). Irritation of other synovial structures is ordinary, and a comparable process might transpire in tendon coverings, advancing to severe dysfunction and breaking. Because of damage or dislocation of sinews, there are characteristic rheumatoid malformations for instance z irregularity of the thumb, boutonniere deformities, swan neck and ulnar deviation of the fingers. Blatant coagulation or nodularity of sinews is also common in this condition (Akil & Amos, 1995). A palindromic model of commencement, usually referred to as palindromic rheumatism, also can happen. Nonetheless, this form of pattern is infrequent; it entails persistent episodes mainly of mono-arthritis, with sudden joint pain and alternative swelling of joints occurring rapidly, and then decreasing within one or two days. Another proportion of people suffering from RA portray extra-articular signs such as rheumatoid lumps, which are subcutaneous granulomatis grazes with inner fibrinoid necrosis bounded by a layer of histiocytes. Some ordinary extra-articular appearances of RA are cutaneous vasculitis, parenchymal lung disorder, pericarditis and secondary Sjogren’s syndrome (Stanich, et al., 2009). In 1987, the American College of Rheumatology initiated and generated the criterion for the categorization and diagnosis of RA. Although the means developed are seem very old, they remain the most widely used standards for diagnosis of the condition. These diagnostic standards assert that for doctors to diagnose a patient with this condition, the patient must fulfil al least four of the seven laid-down clinical symptoms of the disease. In addition, these symptoms must have been in occurrence for at least 6 weeks. The purpose of this standard is to ensure that the examiner dos not confuse the condition with other forms of virally induced arthritis that can mimic RA. The principal therapeutic approach is to identify the pertinent synovial and other pathogenic processes untimely in their development, and to intervene rapidly and insistently to avoid long-term joint damage (Stanich, et al., 2009). In diagnosis, blood tests are essential to confirm particular antibodies that might denote rheumatoid arthritis. Conversely, these antibodies are not available in all cases, so doctors might utilize other diagnostic examinations to produce a precise diagnosis (Higuera, 2011). In addition to the several blood tests, tests for liver performance might offer irregular results in patients with rheumatoid arthritis. Other forms of diagnosis f RA include Radiographs of the hands. In most cases, such tests might indicate loss of joint space, periarticular osteoporosis or swelling of soft tissue. Corrosions characteristic of rheumatoid arthritis grow within three years of the onset of the disease in more than 90% of patients who eventually develop the corrosions (Akil & Amos, 1995). Management and Treatment of Rheumatoid Arthritis The most appropriate forms of treating RA are various therapies rather than medication. In most patients, doctors are using control of systemic and articular inflammation, together with noteworthy retardation of articular injury. However, they use these therapies in most of the resistant patients. These interventions are very important since they offer the patient with an early intervention before the condition is more severe. In this regard, these strategies are useful in preventing the disability caused by severe cases of RA. However, the patients suffering from severe RA cannot rely on these therapies alone for complete healing; rather there should be the input of medication to accelerate the healing process. Certainly, there is a roughly conventional, frequently severe, setback linked with the withdrawal of most of the disease-modifying antirheumatic medication used in clinical practice (El-Gabalawy & Lipsky, 2002). Higuera (2011) indicates that people suffering from RA can lead normal lives with proper and appropriate medication. This means that with proper medication, these patients can carry out some activities that they could not perform without constant medication. Placid cases of rheumatoid arthritis might respond positively to over-the-counter (OTC) anti-inflammatory drugs for instance ibuprofen and naproxen sodium. Physicians might commend prescription drugs such as corticosteroids, anti-rheumatic drugs according to the severity of the condition. In addition to these, Immunosuppressant is useful in managing inflammation and stopping joint damage. Together with OTC and prescription drugs, home interventions can reduce the development of rheumatoid arthritis and decrease pain. For instance, regular low-impact exercise might enhance muscle and joint vigour. These exercises comprise walking, biking light aerobics as well as swimming. In addition to the various exercises, sufficient rest is also useful in eliminating tiredness. Moreover, maintaining healthy eating habits as well as maintaining a healthy weight can decrease inflammation and joint pain. Effects of Rheumatoid Arthritis on occupational performance Various studies indicate that even in its early phases, RA has a substantial effect on work status and occupational performance. For instance, in a certain study, following mean disease interval of approximately two years, 57% of the female patients and 67% of the males indicated that they were unable to carry out their former usual occupational activities. In addition, approximately 42% of the patients had renounced their jobs totally due to RA. Forty five patients (19 men and 26 women; 38%) pointed out that they were able to carry out their occupational activities entirely, even though 75% of this group did indicate that they had experienced minor or major alterations within their work due to RA. These statistics clearly indicate that both mils and severe forms of RA cause reduction on occupational performance. This is because the patients become either fully or partially disabled (Doeglas, et al., 1995). Other occupational difficulties faced by people suffering from his condition include lack of participating in leisure activities. Various studies indicate that due to severe pain associated with this condition, people suffering from RA are unable to participate in most leisure activities. This is because, these people spends little time in leisure activities because of the severe pain that they experience. This pain is due to inflammation, which is common in rheumatoid arthritis, and it causes reduced muscle strength and fine handiness. In addition, the pain might also lead to increased tiredness complexity in concentrating on an activity. In addition to pain, morning stiffness, frequently leading to functional restraints, causes loss of leisure activities (Wikstrom, et al., 2001). Conclusion Rheumatoid Arthritis is a condition that is very prevalent all over the world. It affects both sexes but it is more prevalent in females compared to males. The cause of this condition remains uncertain although several researchers indicate various risk factors. These risk factors accelerate and trigger the development of the condition to severe levels. These risk factors include genetic factors, lifestyle factors, age and gender, hormonal factors reproductive factors medical factors as well as pregnancy. Symptoms of this condition vary according to the severity of the disease although inflammation is the most common symptom. This condition has a detrimental effect on occupational performance. In addition, the person suffering from this disease does not participate in leisure activities. Treatment and management of this condition requires a combination of both therapies as well as medications. Although therapies are the most appropriate, medications reduce pain and accelerate healing process. These medications include over the counter drugs as well as prescription medications. In addition, home remedies can also help to ease the pain and accelerate healing References Akil, M. & Amos, R.S. (1995). Rheumatoid Arthritis-I: Clinical Features and Diagnosis. BMJ, 310, 587-590. Dixon, W. G. (2006). Rates of Serious Infection, Including Site-Specific and Bacterial Intracellular Infection, in Rheumatoid Arthritis Patients Receiving Anti–Tumor Necrosis Factor Therapy. Arthritis & Rheumatism, 54, 8, 2368-2376. Doeglas, D. et al. (1995). Work disability in early rheumatoid arthritis. Annals of the Rheumatic Diseases, 54, 455-460. El-Gabalawy, H.S & Lipsky, P.E. (2002). Why do we not have a cure for rheumatoid arthritis? Arthritis Research, 4, 3, 297-301. Higuera, V. (2011). Facts about Rheumatoid Arthritis. Retrieved from Stanich, J.A. et al. (2009). Rheumatoid arthritis: Disease or syndrome? Open Access Rheumatology Research and Reviews, 1, 179-192. Symmons, D. P. M. (2005). Looking back: rheumatoid arthritis: Aetiology, occurrence and mortality. Rheumatology, 44, 4, 14-17. Wikstrom, I. et al. (2001). Leisure Activities in Rheumatoid Arthritis: Change after Disease Onset and Associated Factors. British Journal of Occupational Therapy, 64, 2, 87-92. Read More