الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Work-related musculoskeletal disorders (WRMSDs) are a serious occupational health problem among workers worldwide. Its prevalence is mainly related to high physical demands that are still not well studied. They are correlated with higher costs incurred by employers such as absenteeism, lost productivity, increased health care, disability, and workers’ compensation costs. Although they are more severe, they are significantly underestimated compared to other occupational nonfatal injuries or illnesses. Physically demanding work duties as operators, fabricators, laborers and technical persons as well as sales and administrative support occupations constitute 58% of MSDs cases.
Worldwide, osteoarthritis is the leading cause of chronic disability among workers and has been designated a ‘priority disease’ by the World Health Organization (WHO). OA occupies one of the ten most disabling diseases in developed countries. Knee OA has been ranked eleventh for its high contribution to global disability. There are a broad range of industries whose workers become afflicted with knee OA. Worldwide, Knee OA is the commonnest disease of the joints, which always lead to pain and loss of function. A common pitfall in the diagnosis of OA is misinterpretation, misdiagnosis of the patient’s symptoms and signs and also malingering by patients. Accurate early diagnosis of knee osteoarthritis (OA) is the key for appropriate management, prevention of further destruction and early intervention to decrease pain, improve function, stay productive, and lower health care costs. The initiating factors for knee OA remain controversial, and this controversy underlies some companies’ reluctance to pay knee OA-related claims. So the urgent need for an objective testing that explain the levels of reported pain and other symptoms of knee OA.
Currently, Osteoarthritis is diagnosed through physical examination, and also with x-ray, MRI scan and arthroscopy if necessary. Though, those diagnostic tools have low sensitivity and specificity. At this time, there are no OA biomarkers that can be used in clinical practice. Treatment of OA includes, treating accompanied pain, injections of intra-articular hyaluronate, injections of intra-articular corticosteroid and joint replacement surgery.
In our present study, 180 workers suffering from musculoskeletal complaints were randomly selected from the outpatient clinics of Agouza for Physical Medicine and the Rehabilitation Center of the Armed Forces in Cairo. They were performing two types of jobs, physically demanding and office jobs. After checking of all of them and after applying clinical and radiographic American college of Rheumatology diagnostic criteria we found that 123 workers who met the criteria were diagnosed with knee OA and classified as (group I) and 57 workers were diagnosed as healthy and classified as (Group) II). X-rays as a diagnostic tool are used in combination with patient interview and physical exam to confirm the diagnosis. Laboratory investigations as ESR and hsCRP to rule out any other inflammatory diseases. Plain radiography is important in confirmation of the diagnosis, but is insensitive for detection of early OA changes.
Recently, biomarkers for OA had become a special area of interest. The goal of biomarkers is identification the earliest stages of the disease, stratifying those with high risk of disease progression, and enabling early interventions innovation. Our study concentrated on a cartilage degeneration biomarker of urinary CTX-II, because it is one of the main OA pathologies. We found that no statistical significant difference between urinary CTX-II levels in osteoarthritis workers (group I) and age, residence, smoking status and sport practice. A high significance between urinary CTX-II levels in osteoarthritis workers and WOMAC index scores. A strong association was found between severity of symptoms and signs of osteoarthritis in (group I) and urinary CTX-II levels. There were positive correlation between pain and physical function subscales of WOMAC index and urinary CTX-II biomarker, suggesting that increased CTX-II in urine can predict the level of pain and physical function reported by workers.
A statistical significant difference was found between the two groups regarding work shifts. Also we found that the mean CTX-II in urine in (group I) increased with increased work duration years and increased total working hours. No statistical significance difference was found between nature of job of workers, work shifts in (group I) and urinary CTX-II biomarker.
In our study, comparing urinary CTX-II levels in knee OA (group I) ACR diagnosed group and healthy group (group II), we found that mean±SD was 456.32± 243.5 and 246.37±143.05 respectively, indicating that CTX-II levels show marked increase in osteoarthritis, so it can be used as a diagnostic marker for knee OA. Also we found that by comparing urinary CTX-II levels in KL 2, 3, 4 grades (group I) , it was found that mean±SD was 263.60 ± 24.77, 356.06 ± 30.54 and 676.66 ± 244.75 respectively which proved that uCTX-II biomarker can detect knee OA progression diagnosed by x-ray. According to our study we found that CTX-II in urine and can predict clinical diagnostic criteria and x-ray progression in osteoarthritis, so it can be used as a as a tool for diagnosis of knee OA.
Finally, according to the United Nations, it is projected that by 2050, 130 million people will face OA, and about 40 million will be have severe disability by disease. The Costs of adaptive aids, devices, medicines, surgery, and time off at work are the main costs correlated with OA. Physical disability resulting from pain and loss of functional ability lowers the quality of life and elevates the risk of more morbidity. Till now no pharmaceutical product can reverses OA onset, so the urgent need for more researches for osteoarthritis biomarkers to detect the disease early and avoid its destructive consequences.
Conclusions:
1. Work related musculoskeletal disorders account for almost 400,000 injuries every year. They have a huge financial burden to all societies and considered a huge occupational problem due to lost productivity and temporary or permanent disability.
2. Osteoarthritis represents the most common reason of mobility disability worldwide and its overall effect as a reason of years lived with disability and limited quality of life is increasing. Knee osteoarthritis considered the most common type of OA diagnosed among many occupational settings.
3. The routine diagnosis of WRMSDs is based on self-reports of symptoms as pain a patient is experiencing in addition to doctor physical examination who depend on medical history, specific criteria to diagnose each different musculoskeletal disorder with X-rays to confirm diagnosis and sometimes lab tests (to rule out other inflammatory conditions).
4. Radiographic knee OA has long been considered the reference standard although patients may have radiographic OA without evidence of clinical OA. Sometimes knee OA definitively diagnosed when destruction of joint is irreversible. Alternative methods for early diagnosis are needed to detect any changes in the knee joint in a sensitive, quantitative and reliable manner.
5. Since symptoms of knee OA are often nonspecific, poorly localized, episodic, misleading, and exaggerated by workers. So the urgent need appears for objective tests for diagnosis to detect workers malingering, and decrease compensation claims and sick leaves.
6. Urinary CTX-II biomarker is a unique osteoarthritis biomarker in osteoarthritis diagnosis. It is non-invasive, conclusive and one simple step test.
7. It is associated with disease severity and prolonged duration of work.
8. The study found that there is a strong association between severity of symptoms and signs of osteoarthritis and urinary CTX-II levels.
9. High urinary CTX-II levels were found in knee OA workers compared to healthy workers denoting that uCTX-II could be used as tool for diagnosis of knee OA.
10. High levels of urinary CTX-II were strongly associated with increased radiographic severity in OA. High uCTX-II levels was associated with high radiographic grades denoting that urinary CTX-II can be a tool for knee OA progression.
11. Urinary CTX-II biomarker as proved by ROC curve is significantly important as sensitive and specific biomarker in diagnosis of knee OA.
Recommendations:
• Urinary CTX-II biomarker is recommended to be used as a screening test with routine investigations at periodic examination of workers for early detection of OA and early avoidance of any unwanted medicolegal issues.
• The field of study of WRMSDs diagnosis should pay more attention as a strategy for preventing or delaying the disease onset as there is no effective cure for OA at the advanced stage. Osteoarthritis biomarkers is an important area for additional investigations and further studies.
• Correct management of cases in early reversible stages is the main health and legal purpose to stop the disease progression and avoid expensive compensations.
• It is necessary to define more biomarkers of OA that can be applied on a larger scale from the very early stage to the final stage of OA, to design better management systems for patients with arthritis, to slow the progression and alter the natural course of the disease.