This book is about three formidable skeletal diseases; osteoporosis, osteoarthritis and rheumatoid arthritis, which are severely threatening the public health system and increasing the chronic disease burden. Identification and prevention of this agonizing triad are complex, composite and complicated, as several molecular culprits collaborate and contribute to their development and progression. Fragile, flamed and fractured elements of bone affiliated to these disorders have been examined from several perspectives but contradictions and controversies have further amassed to their complexity. This family of skeletal triad has many uninvited and unsolicited related effects in the form of pain, stress and anxiety that their remedial prescriptions to get rid of them become confusing and perplexing. Commoners perceive these health issues either casually or as artefact of misconceived notions and fall prey to unqualified quacks and half-baked practitioners. It is equivocally accepted that there are many underlying mechanisms and mediators that commonly as well as individually influence the pathology of osteoporosis, osteoarthritis and rheumatoid arthritis. Recent scientific work has identified some frightful perpetrators and their modus operandi in the initiation, development and progression, but the troubled bones demand further investigations.
The present eBook, “Osteoporosis, Osteoarthritis and Rheumatoid Arthritis: An Agonizing Skeletal Triad” intends to bring together insightful leads on the latest news, views, and reviews from authors, scientists, and clinicians from different regions of the world on these skeletal abnormalities. This compendium is a sincere effort to have input of internationally acclaimed scholars and thinkers to reveal those cellular and molecular culprits who participate but are absconding from the scene of pain and suffering posed to our elderly population afflicting them by these musculoskeletal problems.
In the first chapter, “Osteoporosis and Chronic Liver Disease”, the author Yi-Liang Tsai, sheds light on the close inter-relationship of chronic liver disease with osteoporosis. A substantial percentage of chronic liver disease patients suffer from osteoporosis because of disturbed calcium homeostasis. The liver is an important organ that plays a crucial role in several physiological, metabolic and immune-related processes. Composed of hepatocytes, biliary epithelial cells, stellate cells, kupffer cells and hepatic sinusoidal endothelial cells, the liver controls endocrine growth signaling pathways, blood volume regulation, cholesterol homeostasis, nutrient metabolism, and immune system regulation. The role played by the liver in distressed form causing disturbed calcium homeostasis and dysregulated nutrient balance in relation to bone mass has been elaborated on in this chapter.
The second chapter, “Detection of Knee Osteoarthritis using Artificial Intelligence” enriches our knowledge regarding the identification of knee osteoarthritis with artificial intelligence. Knee osteoarthritis is a degenerating joint disorder that affects joints and causes functional disability and pain if left untreated. Therefore, the identification of knee osteoarthritis at an early stage is crucial for better management and prevention, but early identification is complicated, confusing, and sometimes missed. It is envisioned and analysed by Thongpat and co-authors in this chapter that artificial intelligence involving a Convoluted Neural Network (CNN) can predict the early stage of knee osteoarthritis. Such a wonderful effort can substantiate the already existing identification techniques (Kellgren Lawrence grading) from radiographic images that hold a promising future in the direction of better prognosis, diagnosis and therapeutic modalities of knee osteoarthritis.
The third chapter, “Role of Cytokines and Chemokines in Rheumatoid Arthritis” exhibits the details of inflammation, which is the chief culprit in rheumatoid arthritis. Rheumatoid arthritis is a chronic auto-inflammatory disease having progressive cartilage deterioration, synovial inflammation and periarticular calcium erosion. The causes are multifactorial and complex which have fostered diverse therapeutic modalities for its remission, which is possible but challenging because of heterogeneous symptoms, late referrals, or mimicking with other pathologies. A better understanding of the ways that inflammatory mediators trigger and propagate the deterioration of joints is imperative for developing efficient treatments. In the pursuit of a better understanding of inflammation in rheumatoid arthritis, the role and relevance of cytokines and chemokines must be probed as cellular and molecular determinants. Details of some such pro-inflammatory mediators; tumour-necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), IL-8 along with CC chemokines (CCL2, CCL3, CCL4 and CCL5) and CXC chemokines (CXCL5, CXCL8, CXCL9 and CXCL10) have been reported in this chapter.
The fourth chapter, “Vitamin D and Immune System: Implications in Bone Health” has introduced that the host immune system interacting with vitamin D plays a significant role in maintaining calcium and mineral turnover along with the preservation of bone strength. Vitamin D supplementation helps in absorbing calcium, and bone minerals and has great immunomodulatory potential, which not only serves as a guard against bone resorption but also facilitates healing and repair. The showcasing of the importance of vitamin D through the interaction of the immune system and maintenance of calcium homeostasis within the scenario of osteoimmunology is wonderfully presented.
In the fifth chapter, “Bone Water: Effects of Drugs on Bone Hydration Status”, Dr. Khan reviewed an unforeseen but important aspect of bone hydration. Water is a crucial nutrient that constitutes approximately 20 percent of the cortical bone by volume. It influences mechanical properties, agility and quality of bone whereas, bone dehydration can stimulate stress-induced deformity (modulus of elasticity). The ill effects of bone dehydration increase manifold in elderly individual where dehydration of the bone interacts with frailty and cause fragility of the bone leading to susceptibility to fractures. The author has shown that bone dehydration also supplements disease severity and worse outcomes in diseases like diabetes, osteoporosis, and osteogenesis. Drugs also induce hypo-hydration of the bones and the interaction between drugs and bone water vis-à-vis skeletal health has been highlighted in this chapter.
The sixth chapter, “Dietary Patterns and Rheumatoid Arthritis” has exhibited the importance and necessity of a balanced diet to resist the formidable pangs of pain and suffering in rheumatoid arthritis. The authors have highlighted different forms of diets and dietary patterns and have explained their pros and cons in the pathology of rheumatoid arthritis. It is proposed that a good balanced diet can regulate the underlying inflammatory and immunomodulatory pathways influencing the disease's severity and its outcome.
Chapter seven,” Self-perceived Quality of Life in South Asian and British White Rheumatoid Arthritis Patients in the East Midlands, UK” has investigated the heterogeneity of pain, pain-affiliated disease severity and quality of life in rheumatoid arthritis patients of South Asia and British White residing in East Midlands, UK. The analysis of self-perceived quality of life between these two groups has revealed that reduced mobility and physical activity are associated with higher pain perception in South Asian rheumatoid arthritis patients. Such studies have important implications for setting interventional guidelines for pain-resolving treatment outcomes as an individual’s culture, education, financial situation, diet, and family support have a strong impact on pain realization and perception.
I am deeply indebted to Mr. Nitin Kumar and Ms. Srishti Valecha for their extended help in the style editing of the book. I extend my heartfelt gratitude to Ms. Noor ul Ain Khan, Manager Publications, Mr. Obaid Sadiq, Manager, Mrs. Humaira Hashmi, Editorial Manager Publications and especially Mr. Mahmood Alam, Director Publications, Bentham Science Publishers for their kind support, encouragement and help.