Chapter 11

Other Chronic Diseases and Conditions

Chronic Diseases: What Are They, and Why Are They Important?

• Diseases that persist for a long time

• Rarely cured completely

• Chronic diseases (including heart disease and cancer) cause more than half of deaths around the world.

• Almost all women will be affected by at least one chronic disease.

Chronic diseases are common, and they also affect women more than men.

Chronic diseases are responsible for 70% of deaths in the U.S. (men and women).

Women have greater rates of arthritis, immune diseases, Alzheimer’s disease, as well as:

– Osteoporosis (4x more common)– Lupus (9x more common)– Hypothyroidism (50x more common)– Fibromyalgia (7x more common)

Women are also more likely to be caretakers for other people with chronic diseases.

Racial/Ethnic and Socioeconomic Dimensions

• White and Asian women have osteoporosis more often than African American women

• African American women are more likely than white women to die following a hip fracture

• American Indians and Alaskan Natives have the highest prevalence rates of diabetes

• Blacks and whites have somewhat equal rates of arthritis, but blacks have a higher rate of activity limitations due to arthritis and a higher prevalence of severe pain.

Estimated Annual CostsConditions Costs

Arthritis $130 billion

Diabetes $180 billion

Alzheimer’s disease and dementia

$180 billion

Cardiovascular disease

$300 billion

Bone fractures $12–18 billion

Economic Dimensions

Osteoporosis

• Literally “porous bone”• Caused by gradual loss of calcium that weakens bone

structure• Usually occurs without symptoms

Osteoporosis, Cont.

Nonmodifiable Risk Factors for Osteoporosis

• Being female

• Increased age/postmenopausal

• Small frame and thin-boned

• White or Asian

• Family history of osteoporosis or fractures

Modifiable Risk Factors for Osteoporosis

• Diet low in calcium and vitamin D• Sedentary lifestyle• Cigarette smoking• Estrogen deficiency• Low weight and body mass index• Certain medications

–Glucocorticoids, anticonvulsants• Amenorrhea• Anorexia nervosa or bulimia

Screening and Diagnosis for Osteoporosis

Women who should be tested:

• All postmenopausal women younger than age 65 who have one or more additional risk factors for osteoporosis besides menopause

• All women age 65 and older

• Postmenopausal women with fractures

• Women who are considering therapy for osteoporosis or who want to monitor the effectiveness of certain osteoporosis treatments

Treatment and Prevention of Osteoporosis

• Adequate supply of calcium (ideally from food)

• Vitamin D

• Participate in weight-bearing and muscle-strengthening exercises

• Estrogen replacement therapy

• Drugs: alendronate (Fosamax), risedronate (Actonel), raloxifene (Evista), teriparatide (Forteo), nasal calcitonin spray

• Fall-prevention strategies

Arthritis

Arthritis—inflammation of the joints—affects an estimated 50 million Americans (1 in 5 adults)

– Osteoarthritis: degenerative joint disease

– Rheumatoid: chronic inflammatory disease

– Gout: excess uric acid in the body

Arthritis is most common in the south and midwest

Arthritis, Cont.

Healthy Joint vs. Osteoarthritic Joint vs. Rheumatoid Arthritis

Risk Factors for Arthritis

Symptoms of Arthritis• Achy, stiff joints• Small bony knobs on fingers (osteoarthritis)

Diagnosis of Arthritis• No single test can diagnose arthritis• Family history and physical exam to check joints,

reflexes, and muscle strength• Radiographs• Blood tests• Joint aspiration

Prevention and Treatment of Arthritis

• Maintaining weight through diet and exercise

• Avoiding contact sports and repetitive joint motion

• Preventing Lyme disease (vaccine, insect repellent)

• Treatment may consist of drugs (NSAIDs, topical pain relievers, corticosteroids, immunosuppressants) or surgery

Diabetes Mellitus

• 18.6 million cases of diabetes—half of the cases are women

Types of diabetes

• Type 1: Usually appears during childhood

• Type 2: Most cases of diabetes

• Gestational diabetes: Develops in 2% to 5% of pregnant women

Risk Factors for Diabetes

• Having a first-degree relative with diabetes

• Being overweight

• Not getting regular exercise

• Unhealthful diet

• Having hypertension, abnormal high-density lipoprotein (HDL) or triglyceride levels

• Racial groups: African American, Hispanics, American Indians/Alaskan Natives

Symptoms of Diabetes

Type 1

• Frequent urination

• Unusual thirst

• Extreme hunger

• Unusual weight

• Extreme fatigue

• Blurred vision

Type 2

• Any type 1 symptoms

• Frequent infections

• Cuts/bruises that are hard to heal

Complications of Diabetes If poorly managed, diabetes

can damage nearly every organ in the body, greatly reduce quality of life, and cause early death.

If managed well (healthful diet with balanced amounts of carbohydrate, blood sugar monitored regularly, and with regular exercise, people with diabetes can live long, healthy lives.

Diagnosis of DiabetesRoutine tests• Fasting plasma glucose test/oral glucose tolerance

test• Normal sugar level = 70–110 mg/DL; blood sugar

level above 126 mg/dL on at least two occasions

Treatment and prevention of diabetes• Daily insulin injections• Diet control• Physical activity• Home blood glucose testing several times a day

Fibromyalgia

• Disease characterized by constant, widespread pain

• Still poorly understood• Treatment focuses on improving quality of life

and reducing symptoms (regular exercise, therapy to cope with pain and adjust, antidepressants)

• Most likely to appear in women and during middle age

Autoimmune Diseases

• Diseases in which the body’s immune system turns inward rather than outward.

• More than 80 different illnesses, usually occurring among women.

• Hormone related?

Lupus: A Poorly Understood Disease

Autoimmune Diseases

• Immune system forms antibodies that target healthy tissues and organs

• Primarily a disease of young women of childbearing age (affects women 10 to 15 times more often than men), more likely to affect African American women

• Symptoms can go away and then return• Types

–Discoid (cutaneous) lupus–Systemic lupus erythematosus (SLE)–Drug-induced lupus

Lupus, Cont.

Symptoms:• Painful, swollen joints or arthritis• Skin rash

–Butterfly-shaped across face

–Triggered by sun exposure• Frequent fevers• Prolonged or extreme fatigue• Anemia• Kidney involvement

Exact cause(s) is unknown. Genetic, hormonal, and environmental factors appear to be involved.

Lupus, Cont.

Diagnosis of lupus

• Take note of symptoms

–Skin rash, joint pain, chest pain, seizures, photosensitivity, review of history of medications

• Complete blood count

• Antinuclear antibody test (ANA)

• Urinalysis

Lupus, Cont.Treatment and prevention of lupus

• Avoid sun exposure and use sunscreen

• Exercise

• Nonsteroidal anti-inflammatory drugs (NSAIDs)

• Corticosteroids

• Antimalarial agents

• Immunosuppressant drugs

• Steroids

Thyroid DiseaseThyroiditis: inflammation of the thyroid, the gland

controlling the body’s metabolismTwo forms:

• Hypothyroidism: underactive thyroid—body burns energy too quickly

• Hyperthyroidism: overactive thyroid—body burns energy too slowly

Risk Factors for Thyroid Disease

• Age and gender (women over age 20)

• Family history of a family member with thyroid disease

• Previous thyroid concerns or conditions

Hashimoto’s Disease (Hypo) Graves’ Disease (Hyper)

• Weight gain • Weight loss

• Fatigue and listlessness • Increased energy expenditure

• Difficulty concentrating • Nervousness and irritability

• Dry skin • Sweating more than normal

• Sensitivity to cold • Heat intolerance

• Constipation • Diarrhea

• Goiter • Bulging of the eyes

Symptoms of Hashimoto’s Disease and Graves’ Disease

Diagnosing and Treating Thyroid DiseaseDiagnosis of thyroid disease

• Thyroid-stimulating hormone (TSH) test

• Blood tests measuring levels of thyroxine (T4) can confirm presence of disease

Treatment and prevention of thyroid disease

• Annual checkups

• Thyroxine for Hashimoto’s disease

• Antithyroid drugs for Graves’ disease

Alzheimer’s Disease

Alzheimer’s Disease, Cont.Risk factors for Alzheimer’s disease• Age• Female gender (related to women living longer?)• Genetic background

– Familial Alzheimer’s disease (FAD)• Other possible factors

– Lifestyle– Severe or repeated head injuries– Lower education levels– Environmental agents

Alzheimer’s Disease, Cont.Symptoms of Alzheimer’s disease

• Memory loss

• Decline in ability to perform simple tasks

• Less clear thinking and forgetfulness

• Affected language and reasoning skills

• Lack of ability to make judgments

• Personality changes

• Emotional outbursts

• Wandering and agitation

Alzheimer’s Disease, Cont.Diagnosis of Alzheimer’s disease

• Person’s history, complete physical exam; various laboratory tests; brain scans; tests for measuring memory, language skills, and other brain activities

Treatment of Alzheimer’s disease

• Controlling symptoms and delaying memory loss with drugs

• Maintaining a calm, safe, structured environment

Discussion: Informed Decision Making

• Prevention, when possible

• If prevention isn't possible, find the disease early, and manage it to reduce symptoms and promote healthier living

• Examples?

• Does anyone know anyone living with a chronic condition? What strategies do they use?