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The term musculoskeletal disorder covers any injury, damage or disorder of the musculoskeletal system (that is, muscles, nerves, tendons, ligaments, joints and bones).

Dynamic interactions between a person withrheumatic disease and environment

Management of musculoskeletal conditions is multidisciplinary: rheumatologists, or orthopaedic surgeons, rehabilitation, physiotherapy and occupational therapy, supported by specialist nurses, orthotics, prosthetics, podiatry, dietetics and all the other relevant disciplines.

The normal function of bone requires an adequate supply of amino acids for the synthesis of collagen, the chief component of the organic matrix; of calcium and phosphate for mineralization of the organic matrix; and of other organic compounds and mineral elements.

Growth, repair, and remodeling of the bone tissue require a precisely regulated supply of hormones, vitamins, and enzymes.

The source of calcium in optimizing bone health seems to be important. Various observational and epidemiological studies indicate that consuming milk and other dairy foods during childhood and adolescence is a primary determinant of bone health

Osteoporosis is a condition in which the bones become less dense and more likely to fracture.

Risk factors for developing osteoporosis thinness or small frame, family history of the disease being postmenopausal and particularly having had early menopause, abnormal absence of menstrual periods (amenorrhea), prolonged use of certain medications, such as those used to treat lupus, asthma, thyroid deficiencies, and seizures low calcium intake lack of physical activity smoking excessive alcohol intake.

In women with breast cancer, chemotherapy with drugs such as cyclophosphamide and methotrexate can cause the ovaries to stop functioning.

Cancer-related bone loss can occur for many reasons, including issues due to cancer therapies, such as surgery and certain medications, and metastatic disease to the bone.

Surgery: Because the ovaries are the bodys primary site for estrogen production, women who have their ovaries surgically removed (called an oophorectomy) experience a substantial drop in estrogen production

Radiation therapy to treat cancers of the pelvic area is known to make bones more fragile.

Hormonal therapy: Estrogen-sensitive tumors are commonly treated with medicines known as aromatase inhibitors.Arimidex (anastrozole), Aromasin (exemestane), and Femara (letrozole)

In men, a type of prostate cancer treatment called androgen-deprivation therapy suppresses male sex hormones, including testosterone.

Types of androgen-deprivation therapy include drugs that suppress testosterone production such as Lupron (leuprolide) and Zoladex (goserelin), known as LHRH (luteinizinghormone-releasing hormone) or GnRH (gonadotropin-releasing hormone) agonists, and the drug Firmagon (degarelix), an LHRH antagonist. Medicines called anti-androgens, such as Eulexin (flutamide) and Casodex (bicalutamide), interfere with the bodys use of androgens.

Arthritis is a general term for conditions that affect the joints and surrounding tissues. The two most common types of arthritis are osteoarthritis and rheumatoid arthritis.

Rheumatoid arthritis (RA) is an autoimmune inflammatory disease that usually involves various joints in the fingers, thumbs, wrists, elbows, shoulders, knees, feet, and ankles.

Rheumatoid arthritis is a chronic systemic inflammatory arthritis of auto-immune origin that affects primarily the synovial joints, usually in a symmetrical pattern.

While protein seems to have a direct anabolic effect on bone, the relation between protein intake and bone is further complicated by the potential negative effect of overall dietary acid-base balance.

Urinary calcium has been found to be increased with acid-forming foods, such as meat, fish, eggs, and cereal, and negatively associated with plant foods and is likely determined by the acid-base status of the total diet.

Perhaps more concern should be focused on increasing the intake of alkalinizing fruits and vegetables rather than reducing protein sources.

Protein intake increases urinary calcium loss, but whether negative calcium balance results will depend on dietary calcium intake.

Gout Diet

Many cases of gout occur after eating certain foods or drinking alcohol. This is because these foods, and alcohol, contain certain compounds called purines which the body metabolizes into uric acid.

Mechanisms of monosodium urate crystal formation and induction of crystal-induced inflammation

Nutritional Status and Dietary Management

Essential Components of Nutritional AssessmentNutritional status is determined by assessing an individuals nutrition and health related ABCDEFs.

Anthropometric Measurements Biochemical IndicesClinical IndicesDietary IntakeEnvironmental FactorsFunctional Status Specific Aspects of Nutritional Status Assessment for Various Arthritic and Rheumatoid Diseases

Environmental Factors [Environmental factors may influence intake and contribute to over- or malnutrition in individuals, including the identification of physical and social influences on intake]

Specific Aspects of Nutritional Status Assessment for Various Arthritic and Rheumatoid Diseases

Patients with RA are often underweight and malnourished. Indicators of malnutrition also include rheumatoid cachexia, which involves muscle wasting that is often replaced with fat.

Specific Aspects of Nutritional Status Assessment for Various Arthritic and Rheumatoid Diseases

Medication-related effects on biochemical indices of folic acid and iron status are also common. Some medications such as methotrexate also affect calcium and vitamin D status.

Specific Aspects of Nutritional Status Assessment for Various Arthritic and Rheumatoid Diseases

Impact the ADLs and IADLs as well as other aspects of health-related quality of life. Pain is a common problem in RA, greatly affecting health-related quality of life.

Specific Aspects of Nutritional Status Assessment for Various Arthritic and Rheumatoid Diseases: GOUT

It difficult to obtain accurate anthropometric measurements. As the crystals continue to deposit in the joints, deformities may occur. Fatness and obesity increaseRisk of developing gout and gout attacks.

Specific Aspects of Nutritional Status Assessment for Various Arthritic and Rheumatoid Diseases: GOUT

Comorbid diseases also affect nutritional status. Central obesity and serum uric acid levels are associated with insulin resistance, hypertension, high serum lipids, and renal failure.

Specific Aspects of Nutritional Status Assessment for Various Arthritic and Rheumatoid Diseases: GOUT

The greatest complication in progression of gout is renal failure and calculi. Additionally, patients often have high blood pressure, dyslipidemia, insulin resistance, and high blood sugar.

Specific Aspects of Nutritional Status Assessment for Various Arthritic and Rheumatoid Diseases: GOUT

Determine intake of alcohol, nonalcoholic beverages, and purine rich foods. Alcohol intake is associated with high serum uric acid.Adequate hydration is important if the patient is at risk for renal calculi.

Specific Aspects of Nutritional Status Assessment for Various Arthritic and Rheumatoid Diseases: GOUT

Important to determine intake of purine-rich foods because individuals may be more sensitive to these foods and have a greater reaction, or they may be able to take lower drug doses

Specific Aspects of Nutritional Status Assessment for Various Arthritic and Rheumatoid Diseases: GOUT

Nutrition-related biochemical indices: CRP may be elevated when systemic inflammation and fever are present.

Specific Aspects of Nutritional Status Assessment for Various Arthritic and Rheumatoid Diseases; GOUT

Patients with gout are often prescribed medications for inflammation and uric acid control. Drugs that influence uric acid synthesis or excretion include probenecid, sulfinpyrazone, and allopurinol

Specific Aspects of Nutritional Status Assessment for Various Arthritic and Rheumatoid Diseases; GOUT

Patients with rheumatic disease are at risk of compromised nutritional status for a variety of reasons. Careful consideration of a patients nutritional status using basicprinciples of assessment, and addressing problem areas, can contribute to a patients overall well-being.

Specific Aspects of Nutritional Status GOUT

Overall balance of carbohydrates, proteins, and saturated and unsaturated fats needs to be optimal for both your general health and the control of gout.

Specific Aspects of Nutritional Status GOUT

These would include any food high in purines: organ meat, anchovy, some pulses, beers and stouts, herring, asparagus, and the richer meats, to name but a few.

Drugnutrient interactions can change both the therapeutic efficacy of medications and the nutritional requirements of patients.

Mechanisms of Drug nutrient InteractionsAlteration of Pharmacokinetics by Food.Modulation of Biological Mediators of Rheumatic Diseases by nutrients.Change in Nutritional Status by Drugs

Disease-modifying Anti-rheumatic Drugs

Medications can deplete or cause lower levels of certain nutrients. Methotrexate treatment decreases folate levels and corticosteroid treatment can cause low calcium and zinc status. Side effects of NSAIDs, such as ulceration and GI bleeding, can cause iron deficiency in patients.