Musculoskeletal System

Most musculoskeletal system disorders are caused by the degeneration of tissue or damage to muscles or bone

Skeletal System

Made up of over 200 different bones, which are stiff connective tissues in the human body. Bones ensure that our bodies have structure, allows movement, and protects internal organs. They are formed by immature cells called osteoblasts. As bone cells mature they become osteocytes

Bone marrow is responsible for the production of red blood cells and platelets

Functions of bones:

  • Protecting internal organs

  • Synthesizing blood cells

  • Storing necessary minerals

  • Providing the muscular system with leverage to create movement

Joint: The point at which a bone is attached to another bone

Tendons: Connect muscle to bone

Various connective tissues join the parts of the skeleton together to other systems, including ligaments and cartilage.

Disease states that affect the skeletal system are arthritis, gout, and osteoporosis

Arthritis: Inflammation in the joints of the body, damaged bone joints lead to arthritis

Gout: Inflammation and pain in the joints caused by a uric acid imbalance within our bodies

Osteoporosis: Causes bone tissue to wear away and makes bones weak and frail. This weakness increases a patient’s chance of obtaining a bone fracture; poor bone mineral density due to the loss or lack of production of calcium content in bone cells, which makes bones more likely to fracture.

Arthritis

  • Degenerative

  • Inflammation and pain in joints

  • SX: Swollen and red skin, limited joint movement, and joint pain

  • Osteoarthritis - Large joint wear and tear

  • Rheumatoid Arthritis (RA) - autoimmune disease that destroys connective tissue

Osteoarthritis

  • Most common form of arthritis, usually presents in the hands, knees, hips, lower back and neck, however, can affect any joint

  • Can degrade cartilage, change bone shape, and cause inflammation resulting in pain, stiffness, and loss of mobility

  • There is no cure so therapy is aimed at minimizing pain, continuing physical activities and maintaining a good quality of life.

Symptoms: Pain, joint stiffness, limited range of motion, clicking/popping sound around the joint, muscle weakness around the joint, and joint instability.

Treatment of Osteoarthritis

Treatment includes pain and anti-inflammatory medications, which includes various dosage forms (pills, liquids, patches, creams, and injectables)

Analgesics: APAP and Opioids

NSAIDS: ASA, ibuprofen, naproxen, and celecoxib; when NSAIDS are dose low you get pain coverage, however, you need the higher dose for inflammation coverage

Cymbalta

Lyrica

Corticosteroids (CCS): Prednisone (Deltasone)

  • Decrease inflammation

  • Immunosuppressants

  • Provide fast relief

  • Short amount of usage time, 3 months or less

SE: Adrenal insufficiency, increases in blood sugar which can lead to permanent diabetes, bone loss, bone death, weight gain, increased risk of cataracts and glaucoma, hypertension, infections, mood changes, skin changes

Counseling: Take with Food

Topical OTC Product to Treat Arthritis

  • Capsaicin comes from cayenne peppers; warms the skin and blocks the chemical in the nerve cells that sends pain signals to the brain

    • Examples include Capzasin-HP (0.1%) and Zostrix (0.025%)

    • Capsaicin works best if used several times a day. It might take up to two weeks to feel relief.

    • Wear gloves when applying, make sure to wash your hands thoroughly after application

  • Salicylates are what relieve pain in aspirin

    • Topical treatments include Aspercreme

  • Counterirritants make the skin feel short or cold. Those feelings might block pain and signals

    • Counterirritants might contain menthol or camphor

    • Examples include Icy Hot, Biofreeze, and Tiger Balm

  • Anesthetics: Topical anesthetics cause numbness, which blocks transmission of nerve messages (pain)

    • Ex) Lidocaine comes in a cream, gel, spray, or patch

    • Examples include LidoPatch (Lidocaine 3.6% and menthol 1.25%) and Icy Hot Max (Lidocaine 4% and menthol 1%)

Rheumatoid Arthritis (RA)

  • Inflammatory autoimmune condition where the body’s immune system mistakenly attacks its own body tissues. In RA the lining of the joints is attacked and results in a chronic inflammatory disorder of the joints but can also affect other organs.

  • The synovium produces a liquid to help the joint move smoothly. In RA the inflamed synovium gets thicker and makes the joint area feel painful, tender, red, swollen, and painful to move the joint.

  • Most cases are symmetrical (affect both sides of the body) and normally begin with the small joints, affecting the hands, knees, and ankles.

  • Symptoms: Joint pain longer than 6 weeks, morning stiffness 30 minutes or longer and affects more than one joint on both sides of the body.

  • There is no cure for RA; goal is to treat early and aggressively to decrease or stop inflammation leading to clinical remission.

  • To treat RA many drugs must turn off the immune system, which makes the body susceptible to infections, cancer, and other diseases.

Biosimilars: What Patients Need to Know

  • A biosimilar and its original biologic are made from the same types of sources - and have the same treatment risks and benefits

  • Biosimilars are a type of biologic medication that is safe and effective for treating many illnesses

  • A biosimilar and its original biologic have the same treatment risks and benefits

  • Biosimilars may be available at a lower cost than the original biologics

Gouty Arthritis (Gout)

  • Sudden, severe attacks of pain, swelling, redness, and tenderness in one or more joints. These attacks can come and go

  • Caused by accumulation of urate crystals in the joint which lead to inflammation and intense pain due to improper production, decreased kidney excretion or uric acid, and diet

  • Big toe is usually the first joint affected, may also present in the ankles and knees

  • GA peak after 12-14 hours and slowly go away on their own; Resolves in 3-10 days with treatment

  • Inherited, more common in men

What to Avoid

  • Diuretics

  • Alcohol

  • Aspirin

  • Niacin

  • Red meat

  • Organ meats

  • Sugary foods

Muscular System

Primary function is movement: Muscle contracts and relaxes, resulting in motion

3 Types of Muscle:

  1. Cardiac muscle: Only found in the heart. Heart contracts involuntarily, creating the heartbeat and pumping of blood

  2. Visceral (Smooth) Muscle: Tissue found in many of the body’s essential organs including the stomach and intestines. It contracts involuntarily to move nutrients, blood, and other substances throughout the body.

  3. Skeletal Muscle: Responsible for voluntary movement and linked to the skeletal system

Osteoporosis

  • Poor bone mineral density due to the loss or lack of production of calcium content in bone cells, which makes bones more likely to fracture

  • Deficiency in estrogen, calcium, and vitamin D

  • Reduction of bone production which leads to decreased bone mass

  • Occurs in at a faster rate > 50 years old

  • Risk factors include gender, heredity, and age

  • Risk increased with alcohol consumption and smoking

Treatment of Osteoporosis

  • Weight bearing exercise

  • Calcium

  • Vitamin D

  • Biphosphonates

  • Selective Estrogen Receptor Modulator

  • Estrogen

Muscle Spasms

Muscle cramps: Involuntary muscle contractions (spasms) that cause intense pain

  • A muscle spasm is a sudden and involuntary contraction of one or more muscles

  • Can result from: Muscle overexertion, pain, or fatigue

  • Limbs and spine are most often involved

  • Acute Spasms: Result of muscle injury or overuse

  • Chronic Spams: Result from prolonged injury or underlying medical condition

  • Muscle Relaxant: A drug that reduces or prevents skeletal muscle contraction and spasms and provides pain relief. Also used to reduce spasticity in multiple sclerosis, cerebral palsy, and skeletal muscle injuries.

Skeletal Muscle Relaxants

Antispastics:

  • Disruption in muscle movement patterns that cause certain muscles to contract all at once when you try to move or even rest

  • Usually caused by damage to nerve pathways within the brain or spinal cord that control movement and stretch reflexes

  • Act on spinal cord and skeletal muscle directly to improve muscle tightness and involuntary spasms

  • ex) baclofen

Antispasmodics:

  • Musculoskeletal pain and muscle spasms

  • Potential for abuse so prescribed for brief periods of time

  • Act as CNS depressants and cause a sedative effect or prevent nerves from sending pain signals to the brain

  • ex) carisoprodol, cyclobenzaprine, methocarbamol

Tizanidine and Diazepam treat both types of muscle relaxants