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Inflammatory Musculoskeletal Diseases

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Inflammatory Musculoskeletal Diseases
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Musculoskeletal disorders are common and they can affect different age groups, frequently causing disability and immobility. They cause discomfort or pain in the joints, bones and muscles. The disorders can range from being acute to chronic, diffuse or focal.
The chances of a person developing musculoskeletal disorders increase with age, but they are more common among the elderly. The disorders can range from back pain and gout, as well as rheumatoid arthritis, musculoskeletal pain and tendinitis. Treatments vary depending on the age of the patient, and there is a need for physicians to intervene early before the disease progresses to ensure better chances of recovery. The physiology of aging is an important aspect of treatment for musculoskeletal problems. “Immunosenescence” is a term that refers to changes in the immune system which is characterized by declined cellular immunity resulting to increase in auto antibodies. T-cell and cytokine production also decrease. Aging results in musculoskeletal changes. The tendons, ligaments and where they attach to bonesfray and weaken; muscle mass, quality, and strength also lessen. The gait of a person with musculoskeletal problems changes with age; gait speed, stride length and step length are reduced ((Phyllis & Samuel, 2009). Treatment in older patients is risky because of polypharmacy where patients attend different specialty clinics, getting prescriptions for different medications. This raises the risk of drug-drug interaction. Adverse drug reactions are common among elderly patients because of comorbid chronic or acute diseases where multiple drugs are prescribed, and changes in organs which interfere with drug metabolism (Nakasato & Yung, 2011) In the meantime, water-soluble drugs often are reduced in volume when taken by the elderly. This is because of the decreased body water in elderly. Lipid-soluble drugs, on the other hand, tend to be distributed in higher volumes because of the high fat content also found in the bodies of elderly people. There is a notable change in their liver size; this consequently alters the hepatic blood flow that leads to the altered liver clearance of drugs. This may result to reduced tubular and glomerular functions (Kavanaugh, 2008) Management of pain is important in the elderly patients. If pain is left unchecked, it may lead to depression, impaired ambulation, cognitive dysfunction, insomnia, isolation, malnutrition, functional decline and mood swing. All persons involved directly in the management and care of the elderly should establish clear communication among themselves when administering narcotics and NSAIDS because of their side effects (Barry & Doherty, 2008). Opioids have high efficacy and can be administered with care. They are less irritating effects than NSAIDs , but cause somnolence that could lead to falls. Corticosteroids, narcotic analgesics and NSAIDs can lead to depression, as well as cognitive impairments in the elderly. Physicians prefer to prescribe opioids in limited amounts and they recommend the frequent reassessment of pain. (Andersen, 2013)
As the elderly population continues to increase, the challenges to the health care providers also increase. Inflammatory musculoskeletal diseases continue to prove to be difficult to diagnose because of the effect of comorbid diseases, and unusual signs and symptoms. Therapeutic choices should be considered for elderly patients, as well as other non-chemical changes to avoid unnecessary side effects.

References
Phyllis, E., & Samuel, M. S. (2009). Overcoming the Pain of Inflammatory Arthritis. California: Avery .
Andersen, L. (2013). Your Life with Rheumatoid Arthritis: Tools for Managing Treatment, Side Effects and Pain . New Jersey: Lene Andersen.
Barry, M., & Doherty, M. (2008). Clinical Practice in Rheumatology b. New York : Springer.
Kavanaugh, A. F. (2008). Rheumatic Diseases in the Elderly, An Issue of Clinics in Geriatric Medicine. Pennsylvania: Saunders.
Nakasato, Y., & Yung, R. L. (2011). Geriatric Rheumatology: A Comprehensive Approach . New York: Springer.

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