Exploring the Role of Rheumatic and Musculoskeletal Diseases in Multimorbidity

Non-communicable diseases (NCDs) frequently aggregate due to shared pathophysiological mechanisms, either as sequential steps in the same causal pathway or as common results of the same exposures, leading to a high prevalence of disease co-occurrence, a phenomenon known as multimorbidity. Multimorbidity is a patient-centered concept where all morbidities are regarded of equal importance irrespective of whether they started before or after any other disease in question. Rheumatic and musculoskeletal diseases (RMDs) are among the most prevalent groups of NCDs, and probably due to their high incidence and low case fatality, they are highly susceptible to multimorbidity. Complex patients, such as some of those with multimorbidity, are nowadays the norm, implying a growing concern that clinical practice guidelines fail to adequately address the care of complex patients. The ramifications of suffering from multimorbidity unfold for each patient, within their social, educational, cultural, behavioral, economic, and environmental contexts, which in turn affect disease management.

Enkephalin Therapy Improves Relapsing-Remitting Multiple Sclerosis

Multiple sclerosis (MS) is accompanied by decreases in serum endogenous enkephalin/endorphins and alterations in inflammatory cytokines. This retrospective analysis of serum levels was conducted in 53 patients with established relapsing-remitting MS treated with the disease-modifying therapies (DMT) glatiramer acetate, dimethyl fumarate or with the biotherapeutic low dose naltrexone (LDN) to elevate enkephalins, an off-label alternative. Opioid growth factor (OGF), an inhibitory endogenous opioid involved in modulating cellular replication, was measured and correlated to serum β-endorphin, IL-17A and TNFα. Results revealed that MS leads to a significant reduction in OGF levels in subjects on DMTs, but patients on LDN had OGF levels comparable to non-MS controls. Individuals on DMTs had significantly elevated TNFα levels, while IL-17A levels were significantly elevated only in patients taking dimethyl fumarate. A direct correlation was established between OGF and IL17A indicating a potential interaction between the OGF-OGFr axis and pro-inflammatory T-helper cells providing insight into the disease etiology.

Presbycusis-Related Tinnitus and Cognitive Impairment: Gender Differences and Common Mechanisms

Presbycusis-related tinnitus and cognitive impairment are common in the elderly and generate a massive burden on family and society. Except for age, the study explored the gender differences in the prevalence of the three diseases. We found that women have an advantage in maintaining better cognitive and auditory functions. Recent studies suggest the complex links among the three diseases. Peripheral hearing loss can affect sound coding and neural plasticity, which will lead to cognitive impairment and tinnitus. The deficits of the central nervous system, especially central auditory structures, can, in turn, cause the presbycusis. The interaction among three diseases indicated that comprehensive assessment, intervention and treatment in consideration of hearing loss, tinnitus and cognitive impairment are important to decay aging.

Audiovestibular Dysfunction and Hearing Loss in Patients with Psoriasis and Psoriatic Arthritis

Psoriasis is now considered a T cell-mediated chronic systemic inflammatory disease rather than only a simple skin disease. The relationship and coexistence of this common disease with many other comorbidities have gained increasing attention in recent years. Although psoriatic skin lesions are seen frequently in the auricle and external auditory canal, there are not many studies evaluating the possible effect of psoriatic disease (psoriasis with or without joint involvement) on the auditory system. Hearing impairment detected in psoriasis patients is mostly seen as subclinical hearing loss at high frequencies, but it can also have a significant impact on patients’ health and quality of life due to the possible risk of developing sudden sensorineural hearing loss. In this chapter, the frequency, pattern, and patient-related risk factors of hearing impairment and audiovestibular dysfunction in patients with psoriasis and psoriatic arthritis were extensively reviewed and discussed. In conclusion, it was emphasized that subclinical sensorineural hearing loss is a neglected but an important comorbidity in patients with psoriasis and psoriatic arthritis. The relationship between psoriatic disease and audiovestibular dysfunction supports the need for further studies aimed at better identification of the underlying pathogenic mechanisms, and accordingly to update diagnostic and even treatment approaches.

Cognitive Impairment in Chronic Lung Diseases

The increase in life expectancy has been accompanied by an escalation of age-related disease incidence. Mild cognitive impairment (MCI) is a decline of cognitive function higher than expected for a certain age, but not severe enough to meet the criteria for dementia. Hypoxemia, smoking history, ageing and several comorbidities are risk factors for both chronic respiratory diseases and cognitive deficit. Up to 70% of patients with chronic obstructive pulmonary disease (COPD), obstructive sleep apnea (OSA) or idiopathic pulmonary fibrosis (IPF) have a form of cognitive impairment. Furthermore, a low neuropsychological performance is an independent predictor of disability and mortality in these populations. Efficient tools for cognitive assessment have been validated for these patients and should be used for better clinical outcomes. The physiopathological mechanisms, clinical impact and prevention strategies for cognitive dysfunction in chronic respiratory diseases will be detailed in the following chapter.

Traditional Chinese Medicine in Geriatrics, Evidences, and the Guideline

The average life span of Japanese is 90 years. So that Japan is an unprecedented super-aging society. However, healthy life span is 10 years shorter than life span. Many spend an average of 10 years in frailty. People become frail, and reached to “geriatric syndrome.”