Epidemiology of Locomotor Disorders

Epidemiology of Locomotor Disorders

Rheumatoid Arthritis (RA)

• Chronic symmetrical polyarthritis of unexplained cause
• Systemic disorder characterized by chronic inflammatory synovitis of mainly peripheral joints
• Results in painful deformity and immobility, especially in the fingers, wrists, feet, and ankles
• Systemic autoimmune disease
• Risk factors: geographical, age (most common between 30 and 50 years), gender (women before menopause are affected three times more often than men)
• Familial, but sporadic, with a strong association between susceptibility and certain HLA haplotypes (e.g., HLA-DR4)

Complications of RA

• Ruptured tendons
• Ruptured joints (Baker's cysts)
• Joint infection
• Spinal cord compression (atlantoaxial or upper cervical)
• Spine amyloidosis (rare)
• Side-effects of therapy

Osteoarthritis (OA)

Definition and Epidemiology

• Disease of synovial joints characterized by cartilage loss with an accompanying periarticular bone response
• Most common type of arthritis
• Prevalence increases with age, and most people over 60 years will have some radiological evidence of it
• Women over 55 years are affected more commonly than men of a similar age
• Familial pattern of inheritance with distal interphalangeal joint involvement as the hallmark (nodal OA) and with primary generalized OA

Clinical Features

• Affects many joints, with diverse clinical patterns
• Hip and knee OA is the major cause of disability
• Early OA is rarely symptomatic unless accompanied by a joint effusion
• Advanced radiological and pathological OA is not always symptomatic
• Knee osteoarthritis is a degenerative disease, the most prevalent form of arthritis, and the major cause of disability in people aged 65 and older

Risk Factors

• Obesity
• Heredity
• Gender
• Hypermobility
• Trauma
• Congenital joint dysplasia
• Occupation (e.g., miners, cotton workers, farmers)
• Sport (repetitive use and injury in some sports)
• Age (> 65)
• Joint immobilization
• Genetic factors (major)
• Nutritional factors (↓ intake of vitamins C & D)

Osteoporosis

Definition and Incidence

• Disease characterized by low bone mass and micro-architectural deterioration of bone tissue, leading to enhanced bone fragility and an increase in fracture risk
• Remaining lifetime risk of hip fracture for a white woman at age 50 is around 15%, and 5% for men
• 30% of women and 15% of men will suffer a hip fracture if they survive to 80 years

Clinical Features

• Fracture is the only cause of symptoms in osteoporosis
• Sudden onset of severe pain in the spine, localized at the affected level and often radiating around to the front, suggests vertebral crush fracture
• Only about one in three vertebral fractures is symptomatic
• Pain from mechanical derangement, increasing kyphosis, height loss, and abdominal protuberance follow crushed vertebrae

Risk Factors

• Female sex
• Caucasian/Asian
• Hypogonadism
• Immobilization
• Alcohol abuse
• Low dietary calcium intake
• Vitamin D insufficiency
• Increasing age
• Previous fragility fracture
• Low body mass index
• Smoking
• Glucocorticoid therapy
• High bone turnover
• Increased risk of falling

Epidemiology of Fractures related to Osteoporosis

• Almost all fractures are osteoporotic
• The risk of fracture increases as bone density decreases
• The most common osteoporosis fracture is the hip fracture
• Age > 65
• Women have a higher risk of fractures than men
• A history of prior fractures

Prevention of Hip Fractures

• Prevention should begin in childhood with a healthy lifestyle
• Awareness (health education)
• Attitude modification
• Environmental modification

Epidemiology of Low Backache Pain (LBP)

• Common musculoskeletal disorder affecting 80% of people at some point in their lives
• Most common cause of job-related disability
• Second most common neurological ailment (only headache is more common)
• The majority of lower back pain stems from benign musculoskeletal problems
• 60-90% of adults experience LBP at some point in their life
• Incidence age 35-55 years
• 7% become chronic
• Males and females are equally affected

Differential Diagnosis of Low Back Pain

• Herniated disk with radiculopathy
• Consider analgesics, including NSAIDs and/or muscle relaxants, and recommend physical activity as tolerated
• Most patients will improve over 4-6 weeks
• Patients with severe or intractable pain or progressive neurologic deficits should be re-evaluated earlier and may need referral or imaging

Prevention

• Primary level of prevention: health awareness, exercise, cessation of smoking, weight control, ergonomics (adjustment of man and machine)
• Secondary level of prevention: early diagnosis and treatment
• Tertiary level of prevention: rehabilitation (medical, occupational, psychosocial)

This quiz covers the main loco motor disorders including rheumatoid arthritis, osteoarthritis, osteoporosis, and low backache. It explores the characteristics and symptoms of each disorder.