Topical ache is a feeling that emerges in a specific location depending on a lot of cases (e.g. wounding, trauma, operation, strain, contusion, rheumatic diseases). The location, level and duration of the pain matter in terms of treatment approaches. In general, the pains that last less than 3 months and begin suddenly are named sharp pain. Chronic pain is a sort of pain the start time of which cannot be stated clearly but which is known to continue for a long time. Furthermore, it causes tribulations in social and psychological aspects taking form with the past experiences of the person.

The most common cases among rheumatic diseases are osteoarthritis, rheumatoid arthritis, and soft tissue diseases.

OSTEOARTHRITIS

What Is Osteoarthritis (Calcification)?

 It is the most frequent rheumatismal joint disease, whose cardinal symptom is pain, and, which affects bones together with cartilages. Osteoarthritis (OA) is one of the most important reasons of physical disability. It may attack neck, spine, thigh, hands, knees, and wrists.

 Averagely, OA is seen in the frequency of 1% in individuals under 30 years old, 10% in those over 40, and 50% in individuals over 60. According to the estimation of World Health Organization, roughly 25% of the adults over 65 have OA-driven pain and loss of function. By the reason of the gradual rise in the number of elderly individuals in the society, OA has turned into a remarkable public health problem especially including major joint OA¹.

How Does Osteoarthritis Begin?

Osteoarthritis arises out of the over time spoilage of the cartilages present in epiphyses. Cartilage is a solid and greasy tissue which prevents joint movements from friction. In osteoarthritis, this greasy tissue begins being rigid. Eventually, bones begin to rub against each other if cartilage is completely worn².

  What Are The Risk Factors of Osteoarthritis?

-        Age: In addition to affecting almost any age group, OA increases dramatically in men over the age of 50 and in women over the age of 40.

-        Gender: Osteoarthritis, which especially attack hand and knee joints, is seen more frequently and fatally in women. Although its reason is not yet known, hormones, genetic structure, or other reasons might be influential.

-        Obesity: Whether obesity is a risk factor for osteoarthritis changes depending upon joints. It is the most critical reason of the osteoarthritis that develops especially in many people’s knees and hip. Excessive load on joints lead osteoarthritis to progress fast and heavily.

-        Genetic Structure: Having their bone mass above normal level is a risk factor for osteoarthritis in elderly women.

-        Occupational Strain: Labour-intensive textile workers, shipmen, and carpenters are at risk.

-        Sport Activities: Some branches of sport (football, volleyball, cycling, wrestling) increase the risk of OA on joints².

What Are The Symptoms of Osteoarthritis?

Pain related to using the joint (pain at rest and night) tubercle, eburnation, joint stiffness after hypokinesia (similar to morning stiffness, less than 30 minutes), functional constraint and disability (decrease in social activities) are among the symptoms.

There may be long periods without any complaint like there may be inflammation periods, when the symptoms increase.

How to Diagnose Osteoarthritis?

As laboratory findings do not give exact information regarding the illness, diagnosis is based upon clinical evaluation. Imaging methods (computed tomography, ultrasonography) are also crucial in the sense that they are complementary to diagnosis.

How to Cure Osteoarthritis?

With appropriate treatment, patients with OA can be relieved to a large extent and quality of their life and their functional conditions can be rehabilitated. The primary aim at treatment is to enhance the life quality of the patient by managing their pain and symptoms, preserve and heal their joints' functions, prevent injuries, and coach the patient. While planning the treatment, patient's age, general state of health, and the type of their ache (chronic or acute) should be taken into consideration.

Diet: Relieving the load that would overlap joints, sorting out weight problem would lessen destruction.

Resting: The use of the damaged joint should be lessened.

Warm/Cold Compress: While heat avails by decreasing the pain threshold in the aching location, coldness reveals relaxing impact on the inflamed location especially in soft tissue injuries.

Pharmacotherapy: In osteoarthritis, analgesics and nonsteroid anti inflammatory drugs (NSAI) are used in the treatment of pain and stiffness. It is stated that the hyaluronic acid, which is imposed in joints, lessens the pain up to 6 months.

The approach of physical medicine and rehab can also aid in decreasing loss of function and physical spoilage³.

What Is Rheumatoid Arthritis (RA)?

Rheumatoid arthritis is a chronic, systemic, and inflammatory immune system disease, which can occupy several joints at the same time. Leading to malformation, joint involvement may cause fundamental disabilities in due course. It is observed that about 0.5-1% of the total population all over the world suffer from this disease. It starts between the ages 35-60 at the latest and is encountered in women 2-3 times as much as men.

How Does Rheumatoid Arthritis Begin?

It occurs in consequence of an attack by the immune system against the membrane called synovium which surrounds joints. This inflammation leads the membrane to thin and the cartilage and the bone to wear and tear in time. Tendons and ligaments, which hold joints together, weaken and strain. In the end, joint structure loses its shape and formation.

What Are The Risk Factors of Rheumatoid Arthritis?

Even though there has been no certain info up till now, it is considered that viruses or bacteria feature at the onset of the illness. It is anticipated that the illness emerges when the body encounters an infection. The illness is seen in more than one person in the same family. For example, the risk of rheumatoid arthritis development in a person among whose first degree relatives there is someone with rheumatoid arthritis is increased 16 times as much as the society. Therefore; it is known that genetic factors are important, too.

In the studies made, it has been seen that rheumatoid arthritis occurs more often in women as against men. In this respect, it is considered that hormonal factors have an effect. Even though the illness may emerge at any ages, in general, it is seen more often in those who are over 40.

It is stated that consumption of coffee and cigarettes has to do with rheumatoid arthritis⁴.

What Are the Symptoms of Rheumatoid Arthritis?

At the first stage, the illness occupies small joints (like knuckle and toe joints) and begins suddenly. Fever, tubercle, and pain are observed at joints. General symptoms like hypokinesia after getting up in the morning or movement restriction (morning stiffness), fatigue, exhaustion, fever, night sweat, and probably weight loss in consequence of involvement of more joints over time and persistence of the inflammation are monitored. In patients whose illness progress heavily, other organs like eyes, heart, membrane of heart, lungs, pleura, nerves, and blood vessels may also additionally participate in the illness. The involvement at joints is symmetrical.

How to Diagnose Rheumatoid Arthritis?

Early and correct diagnosis is very important with regard to obstructing the destruction caused by the illness. In physical examination, such criteria as tubercle, stiffness that have been continuing for more than 6 weeks on three or more joints, and morning stiffness that lasts an hour are grounded. In blood analysis, inflammation findings and rheumatoid factor values are examined. Imaging methods also inform about the course of disease.

How to Cure Rheumatoid Arthritis?

There is no definite treatment for rheumatoid arthritis. Thanks to early diagnosis; progression of disease is ceased and permanent joint damages of the patient are avoided as long as the treatment is initiated in first two or three months. Remedies lessen the inflammation, halt the ache, and slow down the joint destruction. If there is serious destruction on joints, a surgery might be required. The treatment should be planned personally for every patient. Patients with rheumatoid arthritis and their relatives should be trained about the illness, and the patients should be provided with social support.

Nonsteroid anti inflammatory drugs (NSAİ), which are quite effective at eliminating arthralgia and morning stiffness, are often favoured. Second line drugs are those that are accepted as changing the course of the disease. Steroids annihilate the inflammation yet they are not used for long because of their side effects.

The medicines used in RA treatment can be called first line and second line drugs. The first line drugs are underlain by nonsteroid anti inflammatory drugs (NSAİ), which are quite effective at eliminating arthralgia and morning stiffness. The second line drugs are those that are accepted as changing the course of the disease (DMARD = Disease Modifying Anti Rheumatic Drugs). These drugs prohibit and decelerate the appearance of the injuries when used appropriately. Their effects can be prolonged even after pharmacotherapy is stopped though they emerge late. It should be decided by the doctor which medicine to be used at the beginning of the treatment. There are opinions indicating that such alternative methods as hot-water therapy and massage also avail^{5, 6}.

What Things Should Be Taken Care Of During Rheumatoid Arthritis?

The life styles of the people who suffer from this illness has a great effect as well as their drug therapy. It plays an essential role at the stage of coming to terms with the illness to learn to live with a chronic illness and to take psychological support so as to be prepared for the difficulties one might run into in business and daily life. Physical exercises that are done regularly and suitably without overcharging the body (such as swimming, gym, dance) both make the patient feel better and ensure stress to be fought against by strengthening the immune system.

 Healthy and balanced diet for overweight patients especially helps reduce the load on lower extremities and joints together with providing weight loss.

Soft Tissue Diseases

What Are Soft Tissue Diseases?

 It is the traumatisation of extra-osseous tissues (muscle, tendon, ligament), from which active and working individuals may suffer as well as mainly those who are interested in sports. Musculoskeletal injuries compose 3% of the total number of patients who have an outpatient treatment. Frequent soft tissue diseases are as follows:

Tendinitis: Inflammation of the tendons that attach muscles to bones.

Tenosynovitis: Inflammation of tendon sheath, which surrounds tendons.

Tenovaginitis: Inflammation of the tendon sheath that can be seen on hands or fingers.

Bursitis: It is the inflammation of the fluid-filled vesicles (bursa) that are present at pressure points and that are the cushion among the bones, tendons, and muscles around joints. Articulars that are painful, tumourous, and that have difficulty in moving are observed.

 Periarthritis (frozen shoulder syndrome): Inflammation of joint capsule, which surrounds diarthrosis, and the tissues around the capsule.

 Sprain: It results from the tear or distention that arises in the ligaments that bind muscles to bones. It usually occurs on ankle.

 Distension: Strain or tear of muscle or tendon. It generally occurs on back and waist.

 Contusion: It is emergence of bleeding in the form of seeping due to traumatisation of cutaneous and subcutaneous vessels because of an impact. Pain, panicula and, change of color are observed.

How Do Soft Tissue Diseases Ingenerate?

They emerge by exceeding deterioration limits in the wake of experiencing a bloated force with the whole body or a part of it.

What Are The Risk Factors of Soft Tissue Diseases?

Factors like fatigue and over loading, woundings that were suffered but not completely healed, cold, muscle and joint stiffness that develops depending upon determinants like overextension and infection, muscle weaknesses caused by lack of education or previous wounding, intermuscular unbalance of power, insufficiency of sports equipment, incomplete bodily preparation, lack of warm up, the unsuitability of the sport branch to the athlete, insufficient technique, not being ready psychologically, fierce competition, competitive sports, and illnesses can be regarded among the reasons of sports injuries⁷.

What Are The Symptoms of Soft Tissue Diseases?

Generally, in soft tissue diseases, pain, tubercle, rash, movement restriction, colour change, stiffness, fatigue, and sensitiveness are observed.

How to Diagnose Soft Tissue Diseases?

First of all, evaluation with clinical examination is tried. It may even be sufficient to be able to get detailed info only by asking the patient about the occurrence of the wounding. Doctor’s manoeuvre regarding the location where the wounding is and palpating give information to a large extent. In cases when clinical examination is not enough, when the findings must be backed by laboratory data, when neighbouring tissues are doubted to have been involved in the happening, and when tracking is needed; especially when the level of the wounding cannot be recognized clearly with examination, radiological analyses are consulted. X-ray, ultrasonography, and magnetic resonance (MR) imaging are the analyses that are applied.

How to Cure Soft Tissue Diseases?

First response approach is expressed with the English abbreviation PRICES and its practice is fairly important for the quality of recovering and shortening the duration of treatment⁸. (P: protect, R: rest, I: ice, C: compression, E: elevation, S: support)

P (Protect): The goal is to shroud the wounded tissue so that a new wounding will not occur and the degree of the current wounding will not increase.

R (Rest): The patient is provided to rest and the wounded location is brought into rest position. Further damage that may occur due to movement is avoided.

I (Ice): What is actually expected from this practice is to lower metabolic rate, to decrease blood flow, to limit inflammation and tubercle, and to control pain. Ice is applied on the location where the wound occurs for 15-20 minutes with 1-2 hours of time gap. The ice applying methods that are used most frequently are ice bag, cold pack (frozen gel pack), ice friction, plunging into iced water, cold compression devices, and cool sprayers. All this cold applications should be done locally. Ice should not directly contact the skin and should be applied in a wrapped, wet towel in pieces as small as possible.   

C (Compression): It is stated as external pressurization and as well as being practicable with criotherapy, it provides benefit when practised separately, too. The mechanical effects compression would create assists with both preventing the wounding from extending and providing a quick and quality recovery.

E (Elevation): The impact of force of gravity is taken advantage of by lifting the wounded limbs slightly up the heart level. In this way, both the edema to arise would be de-escalated and the extra fluid that might occur in the wounded tissue depending upon gravity would be prevented.

S (Support): Using support materials such as taping, brace, splint with the aim to maintain continuity for protecting the location.⁸

References

1.    Bodur H.  A contemporary outlook on osteoarthritis in the world and Turkey; epidemiology and socioeconomic dimension. 14/ Special 1 / 2011

 (7-14). Turkish Journal of Geriatrics Supplement 4, 2011.

2.    http://www.mayoclinic.com/health/osteoarthritis/DS00019

3.    Sarıdoğan ME. Osteoarthritis. Rheumatic Diseases. Symposium Series No: 34, 2003, 11-18.

4.    Akar S. Epidemiology of Rheumatoid Arthritis. Turkish Clinics J Int Med Sci 2006, 2(25):1-6.

5.    Hamuryudan V. Rheumatoid Arthritis. Rheumatic Diseases. Symposium Diseases No: 34, 2003, 19-29.

6.    Ataman S. et al. Treatment of Rheumatoid Arthritis: Suggestions for Consensus of Turkish Association of Research and Fight Against Rheumatism. Turk J Rheumatol 2011;26(4):273-294.

7.    Sakallı FM. Traumatizations of Athletes In Sports and Its Risk Factors. Journal of Fırat Health Services, Volume:3, Issue:7 (2008)

8.    Bayraktar B,  Yücesir İ. Soft Tissue Traumatizations, Recovery Period and Therapeutic Approaches. Clinical Development. 60-67.