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Arthritis
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A survey of more than 4,000 people,in the U.K.,carried out by the voluntary organization Arthritis Care showed that they often had severe pain,which was left untreated,faced descrimination and social exclusion,were unable to obtain useful,reliable information about the safest and most appropriate treatments and found getting or keeping jobs difficult. And yet a staggering 72 % of people with arthritis meet the legal definition of disability as set out in the Disability Discrimination Act of 1995. This means six million people have the legal redress under the act.
 
"It is extraordinary that the single biggest cause of disability has been marginalized" said Neil Betteridge,Head of public policy for Arthritis Care. "However,these findings paint a bleak picture,we at Arthritis Care,will be using them for campaining purposes across the U.K.
 
Results of a U.S. survey conducted by the Arthritis Foundation prove many Americans don't realize they already may be showing signs of arthritis,and far more do not realize the implications or risk of getting arthritis.
 
"Many people wait to see a doctor because they think they are too young to have arthritis,yet millions of Americans,especially baby boomers will reach retirement and not be able to live the way they had hoped".,said Dr. John Klippel director of Arthritis Foundation. The survey showed ;* 67 % were found to be at risk for arthritis. * 52 % were not aware they were at risk for developing arthritis. * More than half (53 %) were already exibiting symptoms of some form of arthritis.
 
Arthritis means inflammation in the joint. Inflammation is painful and is a very common medical problem. Arthritis is not the same as arthralgia,aches,or pains many people feel upon awakening or after over-exertion of a muscle when exercising, or at work. If aches and pains are like a summer breeze,arthritis is like a storm,and rheumatoid arthritis is like a hurricane.
 
Some inflammatory diseases that are lumped under the heading "arthritis" do not significantly affect the joints,and inflammation is not a primary symptom of osteoarthritis,the most common type of arthritis.
 
There are over 100 different types of musculoskeletal conditions that can have a significant impact on a patient's physical and pschological functioning. Musculoskeletal conditions affect of 40 million people in the United States. These can be  anything from relatively mild forms of tendonitis and bursitis to crippling forms of rheumatoid arthritis (over 2 million).
 
There are pain syndromes like fibromyalgia and arthritis-related disorders,such as systemic lupus erythematosus,that can involve every part of the body,depending upon individual case,and type of lupus. There are other forms of the disease such as gout,that most people do not associate with arthritis,and there are other conditions-like osteoarthritis-that a good many people think,is the only form of the disease (type1 and 2). There are autoimmune system affected arthritis and non-autoimmune involvement disease types.
 
The common denominator for all these conditions is joint and musculosketal pain,which is why they are grouped together as "arthritis". Furthermore arthritis can be classified as either inflammatory or non-inflammatory. Inflammatory arthritis features inflammatory white blood cells in the joint fluid. Forms of inflammatory arthritis include rheumatoid arthritis,lupus arthritis,gout and many others.
 
Forms of non-inflammatory arthritis include osteoarthritis,arthritis of thyroid disease,arthritis after injury and many others. Inflammation is involved in many forms of arthritis. It is the body's natural response to injury.
 
There are more than 100 joints connecting the body's 206 bones. Most of the major bone connections in the body are joints designed to allow a broad range of motion. There are different kinds for different functions. Different types of arthritis are caused by problems in different parts of the joints. Just as the car can break down for many reasons. Damage to the bone leads to abnormal wear,destruction of cartilage,and inflammation. Damage to the cartilage leads to osteoarthritis. Rheumatoid arthritis results from inflammation of the synovial membrane,or joint lining.
 
Complicating the picture is the interaction of tendons ligaments, tissue,muscles etc.,of the body which can adversely affect a certain arthritic condition more, than another,and in some cases not be involved at all.
 
No one knows what causes arthritis,though scientists have uncovered a host of clues. Something can be done to manage most forms of arthritis,but its very important that a correct diagnosis is established early. Most therapies work best when started early in the disease process.
 
At this time,the only type of arthritis that can be cured is that caused by infections. Although symptoms of other types of arthritis can be effectively managed with rest,exercise,and medications,there are no cures. Some people claim to have been cured by treatment with herbs,oils,chemicls,special diets, radiation,or other products. There are a small minority.who are allergic to certain foods which can be helped by elimination of certain foods in the diet.
 
However,there is no scientific evidence that such treatments are helpful in patients with arthritis,and,moreover,they may actually cause harm with the developments of side effects. Patients should talk to their doctor before using any therapy that has not been prescribed or recommended by the health care team caring for the patient. Nearly everyone has a theory on the cause and treatment of"arthritis".
 
RA,for example,is a serious,autoimmune and debilitating disease that affects the whole body.  However,many patients with RA gets lost in a maze of "treatment options" that are scientifically unfounded.. While climbing the treatment pyramid, valuable opportunity to control the disease without causing irrepairable damage is lost.Symptoms of RA differ considerably from those of other types of arthritis, such as gout and OA.
 
Gout tends to cause intermittent joint inflammation with a sudden onset,and episodes that last a few days. OA,on the other hand,tends to cause chronic use-related pain. In addition,OA is associated with minimal or no inflammation and involves fewer joints than does RA. Morning stiffness,a typical feature of RA, is uncommon in OA.
 
Studies show that an estimated 18 percent of Americans who have arthritis or other rheumatic conditions believe that their condition limit their activities. People with arthritis may find that they no longer can participate in some of their favorite activities,which can affect their overall well-being. Even when arthritis impairs one joint,a person may have to change many daily activities to protect that joint from further damage and reduce pain.
 
When arthritis affects the whole body,as in RA or fibromyalgia,many daily activities have to be changed to deal with pain,fatigue,and other symptoms. Some of the  medications used in treating diseases such as RA complicate the problem further by the side effects caused by the medications,itself. The amount or strength of the doseage and type is a common contributing factor.
 
Changes in the home may help a person with chronic arthritis continue to live safely,productively,and with less pain. People with arthritis may become weak,lose their balance,or fall in the bathroom. Installing grab bars in the tub or shower and by the toilet,placing a secure seat in the tub,and raising the height of the toilet seat can help.
 
Special kitchen utensils can accomadate arthritic hands to make meal preparations easier. An occupational therapist can help people with rheumatic conditions identify and make adjustments in their homes to create a safer,less painful,and more efficient environment.
 
Friends and family can help a patient with rheumatic conditions by learning about that condition and understanding how it affects the patient's life. Friends and family can provide additional emotional and physical assistance.Their support,as well as support from other people who have the same disease,can make it easier to cope. Quality,and accurate,education on all aspects of a particular disease is essential for successful control and therapy.
 
The most formidable hurdle to management of arthritis is cost. Insurance and government health plans are,of necessity,wary of unlimited authorization of the newer medications However,as it becomes ever more clear that they can stop joint destruction more effectively than any other available medications,it also becomes more clear that they are cost-effective--the follow -up expenses for a patient with improved function and no pain are significantly less.
 
Furthermore,it is expected that with new technologies,production costs of these and other agents under investigation,will be hopefully reduced.

Arthritis symptoms and signs vary according to type and severity of condition. A symptom is an abnormal experience, such as pain or stiffness, that a person may describe to someone else (including their doctor).

Joint pain (a symptom) is often not caused by arthritis, but instead may be related to tendinitis, bursitis or degenerative joint disease (without actual arthritis, or joint inflammation).

A sign is an abnormality a person may observe or detect in another; an example is the finding of joint swelling a doctor may see when examining a joint.

Symptoms

* Pain; sensation of swelling and stiffness in or near a joint, especially in the morning
* Limited joint function and increased pain with movement
* Fatigue, a feeling of weakness, a loss of appetite (only in some "systemic" forms of arthritis)

Signs

* Joint swelling
* Joint redness
* Joint warmth
* Joint deformity
* Loss of joint motion


Some forty million Americans suffer from some type of arthritis,yet it remains a poorly understood disease. The term arthritis comes from the Greek words arthro ( joint ) and itis ( inflammation ). But some inflammatory diseases that are lumped under the heading "arthritis" do not significantly affect the joints,and inflammation is not a PRIMARY SYMPTOM of osteoarthritis,the most common type of arthritis.
 
Some arthritic diseases are also referred to as rheumatism,from the archiac Greek word rheuma,meaning -to flow. this is because most arthritic diseases (osteo-excepted) feature periodic inflammations and fluid buildup in and around joints or organs Arthritic disease fall into one of two distinct categories of disorders,each charachterized by a differnt set of effects,symptoms and causes.
 
To muddy the water further,although osteoarthritis patients,generally do not have inflammatory arthritis,and is classified, non-inflammatory,there is a group-minority of patients who do have "erosive-inflammatory arthritis" signs .Only,it is not systemic. It is more mono.
 
Patients often say "I have RA,or Lupus",but it is the severity,and other factors   which distinguishes the differences. Some patients in RA or Lupus will have a short course,while others will suffer for the rest of their lives.One may have osteoarthritis with occasional pain,or some seniors will have it with no apparent symptoms,while some will have serious,delibelating disease such as in the hips,which may force  termination of a career. We all have pain in arthritis,but there are many different factors involved. A  diagnosis of a certain disease is just a part of the total equation..
 
"Connective tissue disease "is another word used indiscrimanently,just like "arthritis'. --When one really analyzes the words.--meaningless !!
 
When you consider the advances in medicine in recent years,public education is light years behind.

Rheumatism refers to painful musculoskeletal conditions which arise from the soft tissues such as the muscles, ligaments, bursas and tendons rather than the bones or joints. Rheumatism may hurt as much as arthritis but it does not cause crippling or deformity.
 
There may or may not be tender points when pressure is applied to certain areas of the soft tissues. The diagnosis is made by a thorough history and physical examination. A few simple tests might be done to rule out other disorders such as a low functioning thyroid gland or polymyalgia rheumatica.
The symptoms wax and wane chronically but the condition can sometimes disappear completely. The cause is not known. Symptoms can worsen with weather, poor physical conditioning, sedentary lifestyle, overexertion, muscle tension, emotional distress and depression. It can be associated with poor sleep, fatigue, headaches, vague numbness and tingling, temporomandibular joint syndrome and irritable bowel syndrome.
 
Symptoms can be helped by various exercise programs, relaxation techniques, heat, massage, acupuncture, good sleep, relief of emotional distress and depression, reduced caffeine, mild analgesics, nonsteroidal anti-inflammatory drugs, certain antidepressants and muscle relaxants.

Old AOL Rheumatoid Arthritis Page

Guidelines For Pain Management:
 
Baltimore,MD--3/15/02--The American Pain Society (APS),the leading United States professional organization devoted to pain management,today released its new clinical guideline for treating acute and chronic pain associated with arthritis,a chronic disease that affects one in six Americans.
 
Among the major recommendations in the APS Arthritis Pain Management guidelines are:
 
1) All treatment for arthritis should begin with a comprehensive assessment of pain and function.
 
2) For mild arthritis pain,acetaminophen is the drug of choice for its mild side effects,over-the-counter-availability and low cost.
 
3) For moderate to severe pain from both osteoarthritis and rheumatiod arthritis, COX-2 non-steriodal anti-inflammatory drugs (NSAIDs),such as Celebrex and Vioxx,are the drugs of choice for their pain-relieving potency and absence of gastrointestinal side effects.
 
Use of non-selective NSAIDs should only be considered if the patient is non-reponsive to acetaminophen and COX-2 drugs and is not at risk for NSAID-induced GI side effects. Due to the high cost of the COX-2 agents,some patients might benefit from taking non-specific NSAIDs and a medication to moderate GI distress.
 
4) Opiod medications, such as oxycodone and morphine,are recommended for treating severe arthritis for which COX-2 drugs and non-specific NSAIDs do not provide substantial relief (there will be objections from the established medical community,no doubt) --ACR does not recommend indiscriminate use of narcotic medication.
 
5) Unless there are medical contraindications,most people with arthritis, including the obese and elderly,should be referred for surgical treatment when drug therapy is ineffective and functional imparity is severely impaired to prevent minimal physical activity. It is advised that surgery be recommended before the onset of severe deformity and advanced muscular deterioration.
 
In addition to specific treatment options,the APS Guideline specifies that arthritis patients should maintain an ideal body weight and adhere to a balanced diet. Adults should lose weight if their BMI is greater than 30 and follow a weight-management program.
 
Also,referrals should be made for physical therapy/or occupational therapy to evaluate and reduce impairements in range of motion,strength,flexibility and endurance. DMARDs therapy which will ensure control of the disease will also result in less pain.
 
Since arthritis is a chronic and progressive disease,clinicians must be sure that regular exercise or physical therapy are important components of  a comprehensive management program. 

Chondrocalcinosis ( Calcium Crystal Disease ) : 
 
The X-ray findings of cartilage calcification is common,but in most cases it means nothing. It's found with increasing frequency with advancing age. On rare occasion it's found in someone under 50,it may be linked to an underlying disorder-most often hyperoarathyroidism ( abnormally high activity of the parathyroid gland ) or hemochromatosis ( a disease charachterized by abnormal iron stores in the body ) Chondrocalcinosis can not be inherited. Osteoarthritis theory suggests OA is a inherited disease,unlike what we are talking about.
 
CC is without symptoms in the majority of patients with the X-ray abnormality. Symptomatic CC-the peak decade for symptoms is 65 to 75 can take two forms  The "pseudo-gout" CC may be suspected as a cause of an acutely swollen joint in an older person if an x-ray shows evidence of chondrolcalcinosis. Joint infection,or even Gout are valid possibilities. Diagnostic certainty requires that the joint be aspirated and the synovial fluid examined for crystals and bacteria. There is no blood tes to detec this condition.
 
Chronic pain due to chondrocalcinosis may be mistakenly be labeled "osteoarthritis' because many of the shared features-the pain and crepitus ( frinding-sensations or sounds ) with use,a tendency to involve joints like knees and hips,and the appearance of later x-rays (which,because of advanced deterioration,may no longer show the telltale cartilage calcification)
 
CC may be one of the most important causes of OA. Its presence should be suspected when X-ray changes like those of OA are seen in joints that are rarily ffected by OA-shoulders,elbows,wrists and the knuckles at the base of the long index fingers,or when there is prolonged morning stiffness or too much joint warmth and swelling. Such evidence of inflmmation can be so impressive that rheumatoid arthritis is often diagnosed.
 
Chronic arthritis due to CC is usually only slowly  progressive,so most peope cope with it well in the long run. Knee and hips,though,often eventually become so troublesome that surgery is necessary, Overall, when compared to patients with osteoarthritis,people with this form of CC do much better.
 
A feature that distinguishes CC from gout is that crystal formation occurs only in cartilage, CC pyrophosphate,which is a common product of cell metabloism,seems to come mostly from cartilage cells. Why it conbines with calcium to form CPPD is unknow,but there may be different reasons for different patients. In most.the phenomenon is linked to aging. In other,truma is a factor e.g.,CC very often ocurs in the remaining cartilage after surgical removal of a torn knee cartilage.. The excessive weight load borne by the cartilage that remains seems to be the problem. In some cases,high levels of calcium (hyperparathyroidism) or iron (hemochromatosis )-somehow favors the formation of CPPD crystals.
 

Osteoarthritis (OA) is sometimes called degenerative joint disease or osteoarthrosis. It's the most common type of arthritis,yet technically speaking it isn't "arthritis" at all.because "itis" means inflammation.
 
OA USUALLY has very little to do with inflammation (synovitis has been detected in some OA patients of the hands). It usually,isn't even a single disease. The best definition is that osteoarthritis is what happens when joint cartilage fails.
 
Though OA can be found in any joint,it seems to affect primarily four regions-the knees,hips,hands and spine.
 
Osteoarthritis of the knee is one of the most common forms of OA. It occurs in about 10 % of people over 65,and in about 2 % of adults.
 
A few knee OA involves mostly the lateral compartment (outer half ),giving the patient knock-knees. This happens in about a quarter of patients with knee OA.
 
Other parts of the knee are more commonly affected: the medial compartment (inner half ) and the patellofemoral space (between the kneecap or patella and the end of the thighbone or femur ). Some have OA in more than one compartment of the knee. When the inner half of the knee is affected,the resulting deformity is bow leg.
 
When OA occurs behind the kneecap (patellofemoral OA ) there is often much more muscle weakness,pain and disability than with other kinds.
 
Knee surgery has advanced leaps and bounds in recent years.
 
Another type of patient develops knee OA. These patients are much younger and have had some sort of knee injury and often knee surgery. Only one side is affected in OA.
 
Nodal osteoarthritis of the hands is very common. Many will show local inflammation when the swelling first develops. Warmth and marked tenderness usually settle down after several months,leaving the knuckles characteristically boney and lumpy. Individual knuckles may be affected at different times.
 
The lumpiness is due to new bone being laid down as the margins of the joint. When this lumpiness affects the end (DIP) joints,it's called Heberden's nodes. Bouchard's nodes affect the middle (PIP ) joints,sometimes referred to as knobs. Only very rarely are the MCP joints involved,and when they are,there may be another kind of arthritis involved.
 
OA may also occur at the base of the thumb,where it pivots on the wrist ( the thumb CMC,or carpometacarpal joint. This isn't clearly linked to either DIP or knee OA,and it tends to be worse in the non-dominant hand. (on the left on a right-handed person ).
 
Nodal OA may be quite uncomfortable at times (and without symptoms in others). It may make the fingers look bent,and may make gripping difficult It does not,cause the kind of disability that is associated with finger involvvement in other kinds of arthritis. People with nodal OA,like those with obesity,are more likely to have OA of the knee.
 
OA of the hip is common and the hip joint is the only one involved in this kind of OA. In a few rare cases there's an obvious cause,such as bith abnormality. Hip OA can occur at any age,but most common in people in ther 60s and 70s. Some cases are like knee OA,and go on for a long time with minor symptoms before surgery is necessary. A very few,less than 5 % heal on their own. But most patients are ready for surgery within a few years.
 
A few patients have what doctors call,"referred pain". They feel most of the pain in the thigh and knee area,and not where it belongs-in the froin. Most patients who complain of  hip pain.or pain in on the outside of the upper thigh or in the buttock,while,pain in these areas may be associated with hip problems,it's usually caused by something else.
 
Spinal OA is so common that its difficult to consider as a disease. Rather,like gray hair,it's something to be expected as we age, The disks between the vertebrae lose some of their water content,shrink and become less bouncy. Most lose an inch in height.
 
The facet joints at the back of the vertebrae,which stabilizes the spine while still allowing movement,are pushed together. New bone grows in places where mechanical stress is high. Most of the time,we are not aware this process is going on.
 
 Sometimes,there is local irritation and we experience pain,the supporting muscles go into spasm to keep movement to a minimum,more pain and a doctor visit results. Only very rarely is there a serious problem like nerve pressure,and more rarely surgery is indicated.

American Pain Society Link