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 most common cases among rheumatic
diseases are osteoarthritis, rheumatoid arthritis, and soft tissue diseases.
Is Osteoarthritis (Calcification)?
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.
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.
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
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.
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.
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.
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.
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
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.
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.
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.
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.
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 avail5, 6.
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.
and balanced diet for overweight patients especially helps reduce the load on
lower extremities and joints together with providing weight loss.
Are Soft Tissue Diseases?
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
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.
It results from the tear or distention that arises in the ligaments that bind
muscles to bones. It usually occurs on ankle.
Strain or tear of muscle or tendon. It generally occurs on back and waist.
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.
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.
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.
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.
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.
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)
(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.
(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.
(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.
(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.
(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.
(Support): Using support materials such as taping,
brace, splint with the aim to maintain continuity for protecting the location.8
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.
ME. Osteoarthritis. Rheumatic Diseases. Symposium Series No: 34, 2003, 11-18.
S. Epidemiology of Rheumatoid Arthritis. Turkish Clinics J Int Med Sci 2006,
V. Rheumatoid Arthritis. Rheumatic Diseases. Symposium Diseases No: 34, 2003,
S. et al. Treatment of Rheumatoid Arthritis: Suggestions for Consensus of Turkish
Association of Research and Fight Against Rheumatism. Turk J Rheumatol
FM. Traumatizations of Athletes In Sports and Its Risk Factors. Journal of Fırat
Health Services, Volume:3, Issue:7 (2008)
B, Yücesir İ. Soft Tissue Traumatizations, Recovery Period and Therapeutic
Approaches. Clinical Development. 60-67.