Locomotor Disorders Epidemiology PDF

Epidemiology of Locomotor Disorders Dr. Abubakr.Y. Ibrahim Associate Professor - Community Medicine International University of Africa  Main Locomotor Disorders  Rheumatoid arthritis (RA)  Osteoarthritis of the knee,  Osteoporosis  Low Backache (LBP or...

Epidemiology of Locomotor Disorders Dr. Abubakr.Y. Ibrahim Associate Professor - Community Medicine International University of Africa  Main Locomotor Disorders  Rheumatoid arthritis (RA)  Osteoarthritis of the knee,  Osteoporosis  Low Backache (LBP or LBA)  Rheumatoid arthritis  Rheumatoid arthritis is a chronic symmetrical polyarthritis of unexplained cause.  It is a systemic disorder characterized by chronic inflammatory synovitis of mainly peripheral joints.  Its course is extremely variable and it is associated with nonarticular features  It results in painful deformity and immobility, especially in the fingers, wrists, feet, and ankles.  Rheumatoid arthritis (RA) is a systemic auto- immune disease. X-ray of early RA, showing typical erosions at the thumb and middle MCP joints and at the ulnar styloid.  Risk factors  Geographical. RA has a world-wide distribution and affects 0.5-3% (depending on the definition) of the population.  It is a significant cause of disability & mortality & carries a high socio-economic cost.  Age. RA presents from early childhood (when it is rare) to late old age.  The most common age of onset is between 30 and 50 years.  Risk factors  Gender. Women before the menopause are affected three times more often than men.  After the menopause the frequency of onset is similar between the sexes, suggesting an aetiological role for sex hormones.  The use of oral contraceptives may delay the onset of RA but does not reduce the risk of developing it.  Risk factors  Familial. The disease is familial but sporadic.  In occasional families it affects several generations.  It is estimated to account for 50% of disease susceptibility.  HLA types. There is a strong association between susceptibility to RA and certain HLA haplotypes.HLA-DR4  The Problem of RA  The incidence and prevalence of RA rises with increasing age until 70, then declines.  Around twice as many women as men are affected.  The prevalence of classical RA is 40 % of patients are no longer able to work.  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  Osteoarthritis  It is a disease of synovial joints characterized by cartilage loss with an accompanying periarticular bone response.  There is no simple definition of OA as it require three overlapping areas :  Pathological changes,  Radiological features and  Clinical consequences.  Osteoarthritis  Pathologically, there is an alteration in the cartilage structure  Radiologically there are osteophytes and joint space narrowing.  Clinically some patients complain of pain and disability.  Epidemiology  Osteoarthritis is the most common type of arthritis.  The prevalence increases with age, and most people over 60 years will have some radiological evidence of it.  It occurs world-wide, although OA of the hip is less common in black Africans and Chinese populations than in Caucasians.  Most epidemiological studies have been based on radiological evidence, which is much more frequent than symptomatic OA.  Epidemiology  Women over 55 years are affected more commonly than are men of a similar age.  There is a familial pattern of inheritance with distal interphalangeal joint involvement as the hallmark (nodal OA) and with primary generalized OA.  OA has a variable distribution  The resulting disabilities have major socio- economic resource implications, particularly in the developed world. a) primary generalized OA and (b) pyrophosphate arthropathy.  Clinical features  Osteoarthritis 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.  The advanced radiological and pathological OA is not always symptomatic.  Some flare-ups are due to inflammation but are not associated with an increased ESR or CRP.  Clinical features  The most common is the knee osteoarthritis  Knee osteoarthritis is a degenerative disease  It is the most prevalent form of arthritis  It is the major cause of disability in people aged 65 and older.  Clinical features Symptoms  Main - Joint pain Joint gelling (stiffening and pain after immobility) Joint instability Loss of function.  Clinical features Signs  Main - Joint tenderness Crepitus on movement Limitation of range of movement Joint instability Joint effusion and variable levels of inflammation Bony swelling Wasting of muscles X-ray of a knee, showing early osteoarthritis. There is a medial compartment narrowing owing to cartilage thinning with sub articular sclerosis and marginal osteophyte formation (arrows).  Risk Factors  Obesity - Predicts later risk of radiological and symptomatic OA in population studies.  Heredity - Familial tendency to develop nodal and generalized OA.  Gender - Polyarticular OA is more common in women; a higher prevalence after menopause suggests a role for sex hormones.  Hypermobility - Increased range of joint motion and reduced stability lead to OA.  Osteoporosis - There is reduced risk of OA.  Risk Factors  Trauma - A fracture through any joint. Meniscal and cruciate ligament tears cause OA of the knee.  Congenital joint dysplasia - Alters joint biomechanics and leads to OA.  Mild acetabular dysplasia is common and leads to earlier onset of hip OA.  Congenital dislocation of the hip or a slipped femoral epiphysis or Perthes' disease;  Osteonecrosis of the femoral head in children and adolescents causes early-onset OA.  Risk Factors  Occupation  Miners develop OA of hip, knee and shoulder,  Cotton workers OA of the hand.  Farmers OA of the hip.  Sport - Repetitive use & injury in some sports causes a high incidence of lower-limb OA.  Age: > 65  Joint immobilization  Genetic Factors (major )  Nutritional Factors: (↓ intake of vitamins C & D)  Osteoporosis Definition and incidence  It is defined as 'a disease characterized by low bone mass and micro- architectural deterioration of bone tissue, leading to enhanced bone fragility and an increase in fracture risk'.  Bone is normally mineralized but is deficient in quantity, quality and structural integrity  Osteoporosis Definition and incidence As the risk of fracture increases exponentially with age, changing population demographics will increase the burden of disease (currently costing almost £1.75 billion annually in the UK).  The remaining lifetime risk of hip fracture for a white woman at age 50 is around 15%, 5%  for men, with equal risks around 11-13% for Colles' or vertebral fractures.  Who survives to 80 years, 30% of women and 15% of men will suffer a hip fracture.  Osteoporosis 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.  Osteoporosis Clinical features  Pain from mechanical derangement, increasing kyphosis, height loss and abdominal protuberance follow crushed vertebrae.  Colles' fractures typically follow a fall on an outstretched arm.  Fractures of neck the femur usually occur in older individuals falling on their side or back.  Other causes of low-trauma fractures must not be overlooked, including metastatic disease and myeloma. Risk factors for osteoporosis Bone mineral density (BMD) -dependent  Female sex  Caucasian/Asian  Hypogonadism  Immobilization  Alcohol abuse  Low dietary calcium intake  Vitamin D insufficiency  Risk factors for osteoporosis Bone mineral density (BMD)-independent  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.  Hip fracture risk rises dramatically from the decade of the 70th and thereafter  Epidemiology of fractures related to osteoporosis  Age > 65  Women have a higher risk of fractures than men.  A history of prior fractures  Patients presenting with hip fractures are several times more likely to have had 1 or more vertebral fractures  Prevention of Hip Fractures  Prevention should begin in childhood with healthy life style  Awareness (health education)  Attitude modification  Environmental modification  Epidemiology of Low Backache Pain (LBP)  Epidemiology of LBP  Low back pain (lumbago) is a common musculoskeletal disorder affecting 80% of people at some point in their lives  it is the most common cause of job-related (occupational) disability,  It is a leading contributor to missed work, and the second most common neurological ailment (only headache is more common).  Epidemiology of Low Backache Pain (LBP)  The majority of lower back pain stems from benign musculoskeletal problems  It is commonly due to muscle or soft tissues sprain or strain, particularly in instances where pain arose suddenly during physical loading of the back, with the pain lateral to the spine  Epidemiology of Low Backache Pain (LBP)  60 – 90% of adults experience LBP at some point in their life.   incidence age 35- 55 years  7% become chronic  M/ F equally affected  With surgery, no earlier return to work – symptomatic and functional outcome is better  Herniation of a disc is one of the complications of LBP Differential Diagnosis of Low Back Pain*  HERNIATED DISK WITH RADICULOPATHY  Acute radiculopathy from a herniated disk (sciatica) is initially treated similarly to acute lumbar strain.  Some of these cases may have mild neurological deficits (decreased reflexes or strength), but are still initially treated conservatively.  Consider analgesics, including NSAIDs and/or muscle relaxants, and recommend physical activity as tolerated.  HERNIATED DISK WITH RADICULOPATHY Most patients will improve over 4 to 6 weeks.  Patients with severe or intractable pain or progressive neurologic deficits should be re-evaluated earlier & may need referral or imaging. Patients with radicular symptoms (such as lower extremity radiation of pain, numbness or absent reflexes) that are not improved at 6 weeks should probably have an MRI to determine whether there is a lesion that correlates with the symptoms.  Herniated Discs - only about 10% considered for surgery after 6 weeks  Prevention Primary Level of Prevention: 1. Health awareness (Exercise, Cessation of smoking, Weight control …) 2. Ergonomics: Adjustment of Man & Machine Secondary level of Prevention: Early Diagnosis and Treatment Tertiary Level of Prevention: Rehabilitation (medical, occupational, psychosocial …) Samples of Health Education Posters The seminar  Traffic ,work and home accidents( trauma )