Public Health Illness And Society

Introduction

Health is referred to the state of complete psychological, physical and social well-being and not only the lack of disease in the body. The importance of promoting public health is that it would assist to reduce the increased prevalence of diseases and encourage healthy living. The function of public health is to execute an assessment of diseases, develop health policy and created assurance of diseases prevention in order to educate, inform and empower people regarding health issues.

Brief information about arthritis

Overview of Arthritis

Arthritis is referred to the auto-immune disease in which inflammation of one or several joints are experienced that worsen with age. There are different natures of arthritis out of which rheumatoid arthritis and osteoarthritis are commonly found in individuals (McInnes and Schett, 2017). Rheumatoid arthritis refers to the swelling of the joints that results in painful and swollen joints. The osteoarthritis is referred to the nature of arthritis in which the cartilage of the joints and underlying bones are broken down resulting in severe pain in the joints with stiffness (Glyn-Jones et al. 2015).

Mechanism and Causes of Arthritis

There are different mechanisms involved that give rise to arthritis out of which overtake of positive feedback mechanisms related with certain antigens like the IgG Fc (Immunoglobulin G Fc) that is bounded by rheumatoid factors and citrullinated fibrinogen that is bounded by the antibodies to citrullinated peptides through negative feedback mechanism increases susceptibility of the disease among individuals (Rombouts et al. 2015). Moreover, abnormal presence of glycosylated antibodies in people with arthritis is believed to create inflammation of joints. The plasma cells that are derived from B lymphocytes are seen to produce rheumatoid factors along with ACPA of the IgG and IgM classes in large amount. These activated macrophages with the help of Fc receptor and complementary binding cause intense inflammation of joints that is seen in people with rheumatoid arthritis. In this case, the binding of the Fc receptors with the autoreactive antibody is seen to be executed through the N-glycans of the antibody that are altered for promoting the inflammation of the joints in people with arthritis (Hua et al. 2017).

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The arthritis is seen to progress through formation of granulation tissues on the edges of the synovial lining, pannus with angiogenesis and tissues damage caused by enzymes (Abildtrup et al. 2015). The thickening of the synovium along with disintegration of the cartilage and bone and deterioration of the joints due to raised level of calproteins is seen to act as biomarkers for causing the event of arthritis (Hassan et al. 2019). The chemokines and cytokines are seen to accumulate as well as attract immune cells such as B and T cells macrophages and monocytes from activated fibroblasts in the spaces between the joints. They by signalling through RANK (Receptor activator of nuclear factor κ B) and RANKL (Receptor activator of nuclear factor kappa-Β ligand) eventually trigger production of osteoclast that degrades tissues of the bone leading to formation of arthritis (Tanaka and Ohira, 2018).

The Tumor necrosis factor alpha (TNF-α) is seen to play an essential role in regulation of the inflammatory responses in rheumatoid arthritis that causes inflammation of the joints (Roubille et al. 2015). The cytokines such as IL-1 and IL-6 are seen to be released in the synovial environment have paracrine, endocrine and autocrine that lead to the manifestation of arthritis in individuals. The soluble mediators of inflammation such as matrix metalloproteinases, leukotrienes, prostaglandins which may get diffused from the blood are locally formed in the cavity of the joints. The prostaglandins cause pain sensation through localised inflammation and some impact on the bone. The leukotrienes are seen to cause chemotaxis and vascular permeability and the matrix metalloproteins are involved in enzymatic degradation of the collagen matrix of the bone cartilage resulting inflammation of the joints (Larsson et al. 2015; Fischer et al. 2015; Iagnocco et al. 2015). Thus, the following mechanism is involved which causes rise of arthritis among individuals.

The arthritis is mainly caused as a result of natural ageing of the joints such as in osteoarthritis the water content of the cartilages is seen to increase and degeneration of the protein present in the cartilage occurs as a result of biological process of ageing. This causes the cartilage to form tiny crevasses through degradation resulting in broken bones as seen in osteoarthritis (Rahmati et al. 2017). The worn out joints being used in repetitive nature over the years causes inflammation and irritation of the cartilage resulting in joint pain often encountered by the arthritis patients (Varela-Eirin et al. 2018). This is because it results in loss of the cushions between the bones that promotes increased friction leading to development of pain and limited mobility of joints. The secondary osteoarthritis which is another form of arthritis may also be caused by diseases such as obesity, diabetes, gout, repeated surgery or trauma experienced by the joints, hormonal disorder and others (Amir et al. 2018). The osteoarthritis occurs as a result of obesity because in this nature of disease increased stress on the joint is experienced by the individuals that cause trauma to the joint leading to the development of the disease. The deposition of uric acid crystals in the cartilage causes the development of arthritis (Reber et al. 2017). (Refer to Appendix 1)

Demographic and epidemiological data regarding arthritis

The demographic and epidemiological data derived from Arthritis, UK indicates that around 400,000 adults in the country are suffering from rheumatoid arthritis and more than 20,000 new cases of the disease are reported every year in the UK (www.arthritisresearchuk.org, 2018). The figures indicate that the prevalence of the disease is at a concerning stage in the UK as wide number of individuals are affected by arthritis each year in the UK. The figures also indicate that rheumatoid arthritis is three times more common in women compared to men (www.arthritisresearchuk.org, 2018). This informs that the women are more vulnerable compared to men in relation to the disease in the UK. As mentioned by Alpizar-Rodriguez et al. (2017), women are more prone to develop arthritis because of their body structure. This is evident as the hip structures of the women are wider than men which lead to create greater pressure on the knees to maintain proper alignment of the body. Thus, due to increased stress on the knees leads the women to be more prone to develop the disease. The statistics regarding Arthritis in the UK informs that 8.75 million in the country have still now use treatment for osteoarthritis and most of the people, in this case, are aged above 45 years (www.arthritisresearchuk.org, 2019). This also indicates that in the UK the prevalence of arthritis is more among the older population compared to younger individuals.

Arthritis UK mentions that 4.11 million individuals in England have faced osteoarthritis in the knee joints (www.arthritisresearchuk.org, 2018). This figure indicates that the most common location of the impact of arthritis in the knees. The estimated figures indicate that by 2020 people with osteoarthritis on the knee would increase by 6.5 million in the UK (www.arthritisresearchuk.org, 2018). This indicates that effective intervention is to be taken so that the rise of the disease in the knees can be controlled. Further, the other figures indicate that 2.46 individuals in England are suffering from osteoarthritis of the hip and 11% of these population are aged over 45 years with 16% women over the age of 75 are the ones who have taken treatment for osteoarthritis of the hip region (www.nras.org.uk, 2018). The other data indicates that 1.77 million people in the UK have accessed treatment for osteoarthritis in the ankle or the foot and 1.56 million for the disease in the wrist or hand (www.arthritisresearchuk.org, 2018).

In the UK, 97% of the knee replacements are reported to be due to osteoarthritis with 85,920 knee replacement in the initial stage of osteoarthritis are reported in England, Wales and North Ireland in 2013 (www.arthritisresearchuk.org, 2018). The statistics inform that osteoarthritis is causing a serious defect of the knee due to which increased number of knee replacement is being done to ensure the patients can be properly mobile. In the UK, 80% of the people are seen to have reported that footwear is causing them to develop osteoarthritis (www.arthritisresearchuk.org, 2018). This is because lack of proper footwear is causing the individuals to walk inappropriately that are causing inflammation and increased friction of the bones leading to development of the disease.

The reports in 2018 inform that 40% men and 44% women in the poor household in the UK and 30% women and 24% men in the rich household suffer from chronic pain and arthritis (www.arthritisresearchuk.org, 2018). The people who are between the age of 45-60 in the UK in the deprived areas are more than double (21.5%) affected by arthritis compared to number of individuals of the age (10.6%) in the least deprived areas (www.arthritisresearchuk.org, 2018). These statistics indicate that effective treatment regarding arthritis have still not reached the poor household and more deprived areas in the UK which have resulted the individual in the poor region compared to the rich suffer increased prevalence of the disease.

Discussing the various consequences and concept related to arthritis

Signs and Symptoms of arthritis

The different signs of symptom of arthritis based on the kind of the disease such as in rheumatoid arthritis the development of fatigue are the most common symptom. The fatigue is referred to the overall feeling of lack of energy which is mainly caused in rheumatoid arthritis as a result of inflammation of the joints, poor sleep, medications and others (Van Steenbergen et al. 2017). The development of fatigue has an alternate effect on the mood and emotions of the individuals suffering from arthritis. The presence of joint pain is one of the key symptoms in rheumatoid arthritis which caused as a result of inflammation. The swelling of the joints occurs as a result of thickening of the lining tissue (synovium) in the joint and development of excess fluid. This swollen and inflamed joint irritates and stretches the capsule which is surrounding the joints. The nerve endings present in the capsule with the inflammation immediately send pain signals to the brain making the person to perceive pain in the joints (Savtekin and Şehirli, 2018).

The joint tenderness is another common symptom seen in patients suffering from rheumatoid arthritis. The tenderness of the joint arises as the joint tissues that are inflamed cause irritation to the nerves present in the joint capsule and when the joints the pressed a tender feeling is experienced (Cheung et al. 2016). The pressing of the joint in rheumatoid arthritis also elucidates pain through compression of the inflamed tissues in the joints leading to extreme pain sensation. The joint swelling and redness in the joints are other signs related to rheumatoid arthritis. The redness in the joints in the rheumatoid arthritis patients is seen as the inflamed joints causes the skin capillaries to be expanded making them dilated (Williams et al. 2017). The warmth of the joint is regarded as one of the active sign of inflammation of rheumatoid arthritis. The stiffness of the joints is another symptom related to rheumatoid arthritis which leads to cause hindered mobility in individuals with the disease (Paolino et al. 2017).

The hindrance in making mobility and stiffness of the joints is also a key symptom of osteoarthritis (Buttgereit et al. 2015). As a result of the symptom, the people suffering from this nature of arthritis cause restricted mobility as well as faces hindrances in walking, climbing and others. The presence of osteoarthritis in the hip region causes the individuals to face hindrance in moving and bending as the movement of the hip is restricted in the disease (). The back pain is one the key symptom in this nature of osteoarthritis.

Describing the way arthritis is affecting the daily life of people and the surrounding people in society

The presence of arthritis adversely affects the everyday life of people as well as individuals in the society which is evident as people suffering from the disease out of pain and inflammation of the joints experiences hindrances and restriction in walking freely. This leads individuals to require using supporting devices and materials such as canes, wheelchairs, walkers and others to make movement who are suffering from the disease to keep proper balance of the body and avoid falls while walking (Thomsen et al. 2019). The inability to make free movements without support as a result of arthritis slows down the pace of walking of the individuals. The climbing of stairs which is often regarded as a normal activity in everyday life is also hindered as a result of arthritis. This is because of the rise of physical limitations caused by osteoarthritis in the hip, ankle, knee and foot (Strand et al. 2018). Thus, it indicates that people suffering from arthritis in everyday life are more prone to suffer falls and bruises while climbing stairs as they have restricted mobility. The people who are living in the society where they have to access their homes by climbing stairs are going to face issues with navigation.

The common daily activities require some form of bending, kneeling, stopping and others. However, people with arthritis due to back pain and inflamed joints faces restriction in executing the tasks thus making them dependent on others to assist them execute their activities (Allam et al. 2015). This means that the individuals with arthritis become burden of care on other individuals in the society as they require assistance in making everyday movement. The people with arthritis due to lack of freedom to make movements and becoming dependent on others and assistive devices to execute mobility impact them to have negative psychological state (Wilson et al. 2017). This is because individuals with arthritis out of their restricted mobility feel they have lost their freedom to move and execute things and have become burden for others which makes them feel depressed. The individuals who are suffering from arthritis experience issues with keeping proper hygiene in everyday life which make them prone to other diseases. This is because the restricted movement in the hands, knees, ankle as others due to arthritis makes it hindrance for the individuals to properly wash and clean on their own leading to unhygienic conditions (Taylor et al. 2016).

The people suffering from arthritis are regarded as burden for the society as people in the surroundings are require caring for the patients so that the patients are able to live properly and do not encounter unnecessary accidents. Arthritis in the hands and fingers weakens the finger gripping of the individuals which leads the individuals to be prone to drop things (Bouhouche et al. 2017). Thus, the people experience hindrance in writing as they cannot hold the pens, issues with eating due to lack of grip on spoon and others. Therefore, arthritis interferes with eating and drinking as well as writing in everyday life. The knee replacement surgery required to resolve arthritis in the knee is a costly process (Taylor et al. 2016). Thus, people suffering from arthritis experiences financial liability to spend more finances to ensure they receive proper medical treatment. Moreover, the medications to be used in treatment of arthritis are often costly in nature which creates a financial burden on the patients to arrange economic resources to receive proper treatment for the disease (Strand et al. 2018). The people with arthritis due to restricted movement are unable to enjoy and participate in social and religious activities (Strand et al. 2018). This leads the individuals to face isolation from society and get confined in homes which add to the development of depression of the people suffering from arthritis.

Relationship between health professionals, patients and people around regarding the
way social relationships are going to affect the patient’s condition

Key insight into illness

The individuals suffering from arthritis are offered different medications based on the varied symptoms and nature of arthritis for treatment of the disease. The Non-steroidal anti-inflammatory drugs (NSAIDs) and counterirritants are seen to be prescribed by the health professionals to the patients suffering from arthritis to reduce their pain and inflammation in the joints (Roubille et al. 2015). The impact of the administration of the medication helps the individuals suffering from arthritis to feel relived due to lack of pain making them able to walk and move properly without feeling of pain. The Disease-modifying antirheumatic drugs (DMARDs) target the immune system of the body to stop them from causing attack to joints that result in pain and inflammation of joints in patients with arthritis. The biological response modifiers are medications that target different protein molecules which are involved in targeting the immune system to act properly to stop causing attack to the joints (Ramiro et al. 2017). The medications are effective for the patients suffering from rheumatoid arthritis to avoid further degradation of their joints. This helps the individuals in everyday life to remain mobile and move without feeling of pain and inflammation in the joints due to arthritis.

The medications when are ineffective to control arthritis the patients are suggested by the health professional to perform surgery. The joint repair surgery and joint replacement is the most frequent nature of surgery executed among people suffering from arthritis in the knee. In the joint repair surgery, the joints surfaces are realigned or smoothed for reducing pain and enhance their functions in making free movements (Suto et al. 2017). The joint replacement surgery is referred to the surgical process in which the damaged joint is removed and replaced with artificial joints (Clarke et al. 2016). The impact of the surgical treatment on the daily life of patients suffering from arthritis is mostly positive as they are able to regain their ability to freely walk without any support or help from other individuals or resources.

Cultural meaning of Arthritis

Arthritis is stigmatised as disease of the elderly people by most cultures as the individuals suffering from the disease are mainly above the age of 45 (www.arthritisresearchuk.org, 2019). However, the osteoarthritis may be regarded as coming of age disease but Rheumatoid arthritis is seen to occur among women and men between the age of 15-45 years which mentions that it is not only the disease of the elderly. This is evident as in UK nearly 2.7 million people who are under the age of 35 years that is nearly 15.4% of the total population are suffering from musculoskeletal diseases that are related with arthritis (www.arthritisresearchuk.org, 2018). This indicates that society and all the culture perceive it as a disease that mainly affects the adults ignoring the fact that it is equally able to affect the younger individuals. It has result the young people in the society be ignored of proper diagnosis of the disease at the early stage making them suffer intense medical complications. The society and all the cultures mean arthritis to be just pain and aches ignoring the fact regarding degree of pain and nature of disability that can be developed by the individuals suffering from arthritis in case proper medication and treatment are not offered (Corker et al. 2016; Morgan, 2018; Corker et al. 2016). This nature of perception regarding arthritis has lead many individuals ignore attentive steps to gain treatment for the disease at the early stage. It has led to the consequence that many individuals seek medication and help after the disease has progressed to a worst stage.

Experimental dimension of Arthritis

The individuals who are suffering from any kind of arthritis often experience intense pain and inflammation of the joints. It is seen to create interference with their daily activity as due to intense pain many individuals reports that they fear and avoid making sudden or intense movements and limits their mobility. This is because increased mobility further intensifies their painful feeling as well as they feel they may fall as they would be unable to keep proper balance of the body due to stiffness of joints experienced while suffering from arthritis. The patients suffering from arthritis informs that the disease makes them dependent on others to help them in making movement and this makes them feel being burden of care on others. The individuals due to long term suffering from the pain of arthritis and being burden of care on others as a result of their restricted movement often feel depressed (Matcham et al. 2016; Katz et al. 2016; Matcham et al. 2015). This is because the individuals due to restricted movement of the joints and stiffness feel lack of freedom to make movements such as walk, climb and others. It is evident as individuals suffering from arthritis inform that limp, use walking stick or support to walk, take help from others while climbing stairs and others.

Biomedical dimension of Arthritis

The medical field explains arthritis as a disease which affects the joints where the bones degrade as a result of hindered immune system activity within the body. The medical knowledge also informs that changes in hormone along with mutation in genes and heredity factors contribute to the rise of arthritis among individuals. The biomedical dimension explains that osteoarthritis mainly occurs among people who are above the age of 45 but rheumatoid arthritis is seen to occur among young as well as older individuals. This is because rheumatoid arthritis occurs as a result of improper functioning of the immune system. The biomedical dimension informs that people suffering from arthritis feels pain and inflammation in the joints due to degradation of the bone structure and thickening of the lining tissue (synovium) in the joint along with deposition of excess fluid. According to medical knowledge, the individuals suffering from arthritis feels restricted movement, stiffness of joints, fatigue, pain and inflammation and others (Banderas et al. 2017; Hassan et al. 2019; van Steenbergen and van der Helm-van Mil, 2016).

Conclusion

The above discussion informs that arthritis is mainly two kinds that are osteoarthritis and rheumatoid arthritis and it is mainly seen among the older individuals but presence of the disease in younger generation is equally possible. The key signs and symptoms of the disease include pain and inflammation in the joints, redness of joints, joint stiffness and others. In UK, nearly 17.8 million people are suffering arthritis and among them, women are mostly affected in compared to men. The stigma regarding the disease is that it only occurs in individuals who are above the age of 45 and older and the pain is not much as mentioned to be perceived by the individuals. The treatment includes administration of medication and in intense cases, surgery is used which is seen to assist the individuals suffering from arthritis regain proper ability to be mobile and avoid pain and inflammation of the joints.

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Appendix 1:

The causes of rheumatoid arthritis include genetic factor, age, sex, joint injury and others (Withrow et al. 2016). The development of rheumatoid arthritis is strongly linked with genes that are inherited with the tissues type that is major histopcompatibility complex (MHC) antigen HLA-DR4. The single-nucleotide polymorphisms are seen to be found around different hundred of genes that are associated with rheumatoid arthritis (Tan et al. 2018). The increase in age is also linked with any nature of arthritis as it is regarded as coming of age disease. The women are more prone to develop arthritis compared to men as after menopause the oestrogen hormone is produced in less amounts. The oestrogen is the sex hormone that promotes the activation of osteoblasts cells which produce bone cells. Thus, lower oestrogen level after menopause in women leads them to loss proper capability to maintain bone health making them more prone to get arthritis (Alpízar-Rodríguez et al. 2016). The exposure to silica, smoking and alcohol are regarded as agents that promote the development of arthritis in individuals (Zeng et al. 2018; Murphy et al. 2018).


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