THESIS MODIFIED
ARTHROPATHY IN TRUNCAL OBESITY PATIENTS AND ASSOCIATED
COMORBIDITIES AND THIER OUTCOMES
Introduction
Comorbidity is when a person has more than one disease
or condition at the same time. Conditions described as comorbidities are often
chronic or long-term conditions. Other names to describe comorbid conditions
are coexisting or co-occurring conditions and sometimes “multimorbidity” or
“multiple chronic conditions.(1)
Comorbidities are common among adults with arthritis.
Everyone in this group has some type of co morbidities and
later developed arthritis
People in this group are those with other chronic conditions
such as heart disease diabetes, hypertension ,copd etc who also have arthritis.
NEED FOR THE STUDY
The association between comorbidities and arthritis has been
traditionally attributed to underlying shared risk factors of age and obesity.
Emerging evidence suggests that alterations in lipid metabolism and
hyperglycemia might have a direct impact on cartilage health and subchondral
bone that contribute to the development and/or progression of OA.( 1)
While the above association is well studied and documented,
patients with truncal obesity and osteoarthritis are likely to have their
illness outcomes considerably influenced by other comorbidities that are likely
to affect their outcomes. This has not been studied earlier as per our review
of literature and hence the need for this study
AIM :
To study the arthropathy changes in truncal obesity patients
and associated co morbidities and their outcomes
OBJECTIVESTo identify the spectrum of truncal obesity
patients with comorbidities with arthropathy coming to general medicine
To study the clinical , radiological , and laboratory
profile of the spectrum of people with arthropathy
To study the comorbidities among people with arthritis.
Everyone in this group has arthritis and at least one other chronic condition
To compare the result
of present study with already available data
STUDY DESIGN
Prospective, Observational study.
INCLUSION CRITERIA
1.Patients
having two of the variables
a]Patients with comorbidities and trucal
obesity
b]Patients with arthropathy
2.Both men and females with arthropathy
and diabetes mellitus
3.Both men and females with arthropathy
and hypertension
4.Written informed consent from each patient or
legal guardian prior to enrollment
EXCLUSION CRITERIA
Patients with arthropathy related to
coexisting autoimmune diseases
Patients not willing to give consent for study
STUDY PERIOD : JAN 24 TO DEC 25
SAMPLE SIZE : 50
METHODOLOGY
Patients having two of the variables
Patients with comorbidities and trucal obesity
Patients with arthropathy
are selected from CASUALTY, OPD, IPD in Kamineni Institute
of Medical Sciences, Narketpally.
Consent is taken for study participation as well as
deidentified data sharing from the patient and their advocates/relatives after
explaining the potential harms and benefits along with need for further follow
up.
Patients with abdominal girth(measured using measuring
tape) above normal limits are selected
Their diabetic, hypertension and other comorbidity status is
evaluated
Their duration of illnesses are compared with duration
of Arthropathy
Joints are evaluated clinically and radiologically
Xrays are used for knowing radiological status of joints
Hba1c is used to confirm diabetic status
Hypertension is evaluated with spygmomanometer and from anti
hypertensive usage history
PROFORMA
SERIAL NO:
NAME:
AGE:
OP/IP NO.:
EDUCATION:
OCCUPATION:
PHONE NUMBER:
ADDRESS:
COMPLAINS –
joint pains
polyuria
polyphagia
polydipsia
headache
History of present illness
Complaints and durations
Treatment history of
DIABETES MELLITUS
Hypertension
CAD
CVA
THYROID DISORDERS
COPD
PAST HISTORY –
significant
or not
PERSONAL HISTORY –
ALCOHOL HISTORY
SMOKING HISTORY
FAMILY HISTORY
History of similar illness in family
GENERAL EXAMINATION:-
BLOOD PRESSURE MONITORING/ MEAN ARTERIAL PRESSURE
PULSE RATE
RESPIRATORY RATE
TEMPERATURE
OXYGEN SATURATION
Height
Weight
BMI
ABDOMINAL CIRCUMFERENCE
PALLOR
ICTERUS
CLUBBING
CYANOSIS
LYMPHADENOPATHY
PEDAL OEDEMA
CARDIOVASCULAR SYSTEM
INSPECTION
JVP:
APICAL
IMPULSE
PALPATION
APICAL
IMPULSE
THRILL
HEAVE
AUSCULTATION
S1
S2
S3
S4
MURMURSRESPIRATORY EXAMINATION
Movements of chest:
Air entry:
Breath sounds:
CENTRAL NERVOUS EXAMINATION
Higher mental functions:
Motor and sensory system:
Cerebellar functions:
Meningeal signs:
GCS:
PER ABDOMEN EXAMINATON:
Inspection: Shape of abdomen, Engorged Veins, Umbilicus: Inverted/Everted
Palpation: Tenderness, Organomegaly
Percussion : Shifting dullness
Auscultation: Bowel sounds
SPECIFIC JOINT EXAMINATION:-
Inspection :-
Attitude,
swelling,
skin over swelling
Palpation :-
local rise of temperature
Tenderness
Bony components
Movements:-
range
associated with pain or not
associated sounds
Abnormal mobility
PROVISIONAL DIAGNOSIS
INVESTIGATIONS
CBP
RFT
LFT
LIPID PROFILE
FBS
PLBS
HBA1C
X RAY
FINAL DIAGNOSIS
OUTCOMES:
Truncal obesity and arthropathy and no other co morbidities
Truncal obesity with arthropathy and other co morbidities
Truncal obesity with nil co morbidities
CONSENT
I/WE, relative of the patient have read and understood the
information provided in the patient information sheet and have been informed
the purpose of the evaluation in the language I understand.
I am aware of the fact that I may not derive any benefit from the evaluation
and that I deserve the right to opt out of the study at any point of time.
I willingly agree to participate in this study
Patients sign/thumb
impression:
witness sign/thumb impression
Name:
name:
Date:
date:
Residents sign:
Resident name:
dనేను/మేము అనగా రోగియొక్క బంధువులం రోగి సంబంధిత సమాచార పత్రము
అందించిన
సమాచారాన్ని చదివి అర్థం చేసుకున్నాను మరియు నేను అర్థం
చేసుకునే
భాషలో అధ్యయన ప్రయోజనం మరియు స్వభావాన్ని వివరించారు.
నేను
అధ్యయనం నుండి ఎటువంటి ప్రయోజనం పొందలేనని మరియు ఏ
సమయంలో
అయినా అధ్యయనంనుండి వైదొలిగే హక్కును నేను కలిగిఉన్నానని నాకు
తెలుసు.
నేను
అధ్యయనంలో పాల్గొనేందుకు ఇష్టపూర్వకంగా అంగీకరిస్తున్నాను.
సంతకం/బొటనవేలిముద్ పేరు :
తేదీ
:
సాక్షి
సంతకం/బొటనవేలిముద్ర :ate:
PATIENT INFORMATION SHEET
A Study is conducted by the undersigned in the department
of general medicine at Kamineni
Institute of Medical Sciences, Narketpally .I invite you to participate in the
above study. Relevant history needed for study will be collected from the
patients. No cost will be incurred by the patients. No monetary gains or
financial assistance will be provided to the patients. The data collected in
the study will be used only for research purpose and will be kept strictly
confidential. Your participation in this study is voluntary and you have the
right to refuse at any point of time during the period of study. Refusal to
participate in the study will not affect the treatment or relation with the
clinician.We are thankful for your cooperation
నార్కెట్పల్లిలోని కామినేని ఇన్స్టిట్యూట్ ఆఫ్ మెడికల్ సైన్సెస్లో _______ విభాగంలో దిగువ సంతకం చేసిన వారిచే ఒక అధ్యయనం నిర్వహించబడుతుంది.పై అధ్యయనంలో పాల్గొనమని
నేను మిమ్మల్ని ఆహ్వానిస్తున్నాను. అధ్యయనం కోసం అవసరమైన సంబంధిత చరిత్ర రోగుల నుండి సేకరించబడుతుంది. రోగులకు ఎలాంటి ఖర్చు ఉండదు. రోగులకు ఎలాంటి ద్రవ్య లాభాలు లేదా ఆర్థిక సహాయం అందించబడదు.అధ్యయనంలో సేకరించిన డేటా పరిశోధన ప్రయోజనం కోసం మాత్రమే ఉపయోగించబడుతుంది మరియు ఖచ్చితంగా గోప్యంగా ఉంచబడుతుంది. ఈ అధ్యయనంలో మీ
భాగస్వామ్యం స్వచ్ఛందంగా ఉంటుంది మరియు అధ్యయనం సమయంలో ఏ సమయంలోనైనా తిరస్కరించే
హక్కు మీకు ఉంది. అధ్యయనంలో పాల్గొనడానికి నిరాకరించడం వలన వైద్యునితో చికిత్స లేదా సంబంధాన్ని ప్రభావితం చేయదు.మీ సహకారానికి మేము
కృతజ్ఞులం
2nd
topic –occurance of orthostatic hypotension in geriatric population in
hypertension vs non hypertension
3rd
topic-capsulitis and osteoarthritis in dm2 people with or without hypertension
NAME OF
THE GUIDE: Dr. RAKESH BISWAS
NAME OF
THE CO-GUIDE : DR HARINADH
NAME OF
THE HOD: Dr. RAKESH BISWAS
NAME OF
THE PRINCIPAL : Dr. SHRUTI MOHANTY
References
1}.
Theis KA, Brady TJ, Helmick CG. No one dies of old age anymore: a coordinated
approach to comorbidities and the rheumatic diseases. Arthritis Care Res
(Hoboken). 2017;69(1):1–4. DOI: 10.1002/acr.23114.
2}Arthritis
as a potential barrier to physical activity among adults with diabetes - United
States, 2005 and 2007. MMWR Morb Mortal Wkly
Rep. 2008;57(18):486–489.
3}. Zhuo
Q, Yang W, Chen J, Wang Y. Metabolic syndrome meets osteoarthritis. Nature
reviews. Rheumatology. 2012 Dec;8(12):729–737.
4}. Findlay
DM. Vascular pathology and osteoarthritis. Rheumatology. 2007
Dec;46(12):1763–1768.
5} Arthritis
as a potential barrier to physical activity among adults with diabetes - United
States, 2005 and 2007. MMWR Morb Mortal Wkly Rep. 2008;57(18):486–489
6 }Toda
Y, Toda T, Takemura S, Wada T, Morimoto T, Ogawa R. Change in body fat, but not
body weight or metabolic correlates of obesity, is related to symptomatic
relief of obese patients with knee osteoarthritis after a weight control
program. J Rheumatol. 1998 Nov;25(11):2181–2186.
7. Fallon EA, Boring MA, Foster AL, et al. Prevalence of diagnosed
arthritis—United States, 2019–2021. MMWR Morb Mortal Wkly ep 2023;72:1101–1107.
8.Bekaryssova
D, Mruthyunjaya Vijaya P, Ahmed S, et al (2023) Revisiting articular syndrome
in the peri-pandemic COVID-19 era. Rheumatol Int 43:2157–2166.
