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arthritis

arthritis

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Rheumatoid arthritis

Rheumatoid arthritis (RA) is a long-term disease that leads to inflammation of the joints and surrounding tissues. It can also affect other organs. Causes The cause of RA is unknown. It is considered an autoimmune disease. The body's immune system normally fights off foreign substances, like viruses. But in an autoimmune disease, the immune system confuses healthy tissue for foreign substances. As a result, the body attacks itself. RA can occur at any age. Women are affected more often than men. RA usually affects joints on both sides of the body equally. Wrists, fingers, knees, feet, and ankles are the most commonly affected. The course and the severity of the illness can vary considerably. Infection, genes, and hormones may contribute to the disease. Symptoms The disease often begins slowly, with symptoms that are seen in many other illnesses: y y y y y Fatigue Loss of appetite Low fever Swollen glands Weakness

y y y y

Chest pain when taking a breath (pleurisy) Eye burning, itching, and discharge Nodules under the skin (usually a sign of more severe disease) Numbness, tingling, or burning in the hands and feet

Joint destruction may occur within 1 - 2 years after the disease appears. Exams and Tests A specific blood test is available for diagnosing RA and distinguishing it from other types of arthritis. It is called the anti-CCP antibody test. Other tests that may be done include: y y y y y y y Complete blood count C-reactive protein Erythrocyte sedimentation rate Joint ultrasound or MRI Joint x-rays Rheumatoid factor test (positive in about 75% of people with symptoms) Synovial fluid analysis

Regular blood or urine tests should be done to determine how well medications are working and whether drugs are causing any side effects. Treatment RA usually requires lifelong treatment, including medications, physical therapy, exercise, education, and possibly surgery. Early, aggressive treatment for RA can delay joint destruction. MEDICATIONS

Eventually, joint pain appears. y Morning stiffness, which lasts more than 1 hour, is common. Joints can even become warm, tender, and stiff when not used for as little as an hour. Joint pain is often felt on both sides of the body. The fingers (but not the fingertips), wrists, elbows, shoulders, hips, knees, ankles, toes, jaw, and neck may be affected. The joints are often swollen and feel warm and boggy (or spongy) to the touch. Over time, joints lose their range of motion and may become deformed.

y y

Disease modifying antirheumatic drugs (DMARDs): These drugs are the current standard of care for RA, in addition to rest, strengthening exercises, and antiinflammatory drugs. y Methotrexate (Rheumatrex) is the most commonly used DMARD for rheumatoid arthritis. Leflunomide (Arava) may be substituted for methotrexate. These drugs may have serious side effects, so you will need frequent blood tests when taking them.

y y

y

Other symptoms include:

BIOLOGIC AGENTS: Biologic drugs are designed to affect parts of the immune system that play a role in the disease process of rheumatoid arthritis. It may be weeks or months before you see any benefit from these medications. For some patients. surgery is needed to correct severely affected joints. y y y Infections from bacteria. These surgeries can mean the difference between being totally dependent on others and having an independent life at home. your doctor will start biologic drugs sooner. are recommended. ankle replacement. Surgeries can relieve joint pain and deformities. infliximab (Remicade). as well as 8 to 10 hours of sleep per night. and teach how to best protect and use joints when they are affected by arthritis. viruses. and fungi Leukemia Possibly psoriasis SURGERY Occasionally. Because of long-term side effects. and certolizumab (Cimzia) Interleukin-6 (IL-6) inhibitors: tocilizumab (Actemra) y Biologic agents can be very helpful in treating rheumatoid arthritis. Corticosteroids: These medications work very well to reduce joint swelling and inflammation. However. such as ibuprofen. heat and cold treatments. hip replacement. etanercept (Enbrel). They may be given when other medicines for rheumatoid arthritis have not worked. Most of them are given either under the skin (subcutaneously) or into a vein (intravenously). see arthritis support group. y Although NSAIDs work well. people taking these drugs must be watched very closely because of serious risk factors: . despite limitations caused by RA. They also show people how to better cope with day-to-day tasks at work and at home. Support Groups For additional information and resources. The first surgical treatment may be a synovectomy. total knee. Outlook (Prognosis) The course of rheumatoid arthritis differs from person to person. At some point. long-term use can cause stomach problems. the disease y Antimalarial medications: This group of medicines includes hydroxychloroquine (Plaquenil) and sulfasalazine (Azulfidine). and is usually used along with methotrexate. which is the removal of the joint lining (synovium). shoulder replacement. corticosteroids should be taken only for a short time and in low doses when possible. PHYSICAL THERAPY Range-of-motion exercises and exercise programs prescribed by a physical therapist can delay the loss of joint function. and possible heart problems. Talk to your doctor about whether COX-2 inhibitors are right for you. Occupational therapists can create splints for the hand and wrist. In extreme cases. and splints or orthotic devices to support and align joints may be very helpful. such as ulcers and bleeding. but it is labeled with strong warnings about heart disease and stroke. Frequent rest periods between activities. Joint protection techniques. There are different types of biologic agents: y y White blood cell modulators include: abatacept (Orencia) and rituximab (Rituxan) Tumor necrosis factor (TNF) inhibitors include: adalimumab (Humira). along with other rheumatoid arthritis drugs. and others may be done. At times. Celecoxib (Celebrex) is another antiinflammatory drug. total joint replacement is needed. golimumab (Simponi).Anti-inflammatory medications: These include aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs). Sometimes therapists will use special machines to apply deep heat or electrical stimulation to reduce pain and improve joint mobility.

Possible Complications Prevention Rheumatoid arthritis has no known prevention. heart attack. knee. Swelling and inflammation of the outer lining of the heart (pericarditis) and of the heart muscle (myocarditis). immediately tell your health care provider. Almost everyone has some symptoms by age 70. However. the cause of OA is unknown. Both of these conditions can lead to congestive heart failure. and foot joints Fractures or other joint injuries can lead to OA later in life Long-term overuse at work or in sports can lead to OA y y y Medical conditions that can lead to OA include: y y y Bleeding disorders that cause bleeding in the joint.becomes less aggressive over time and symptoms may improve. and nerve problems that cause pain. it is often possible to prevent further damage to the joints with proper early treatment. such as hemophilia Disorders that block the blood supply near a joint can lead to avascular necrosis Other types of arthritis. Many people with RA work full-time. after many years. As a result. Other factors can also lead to OA. y Cartilage is the firm. y Rheumatoid arthritis is not only a disease of joint destruction. Sjogren syndrome Often. Treatment for rheumatoid arthritis has improved. bleeding stomach ulcers. The symptoms of OA usually appear in middle age. numbness. or tingling. It can involve almost all organs. and stiffness. or subcutaneous nodules seem to have a more severe form of the disease. y Problems that may occur include: y y y Anemia due to failure of the bone marrow to produce enough new red blood cells Damage to the lung tissue (rheumatoid lung) Injury to the spinal cord when the cervical spine (neck bones) becomes unstable as a result of RA Rheumatoid vasculitis (inflammation of the blood vessels). Vasculitis may also affect the brain. and unable to do simple daily living tasks such as washing. Bony spurs or extra bone may form around the joint. . which can cause stroke. ankle. rubbery tissue that cushions your bones at the joints. It is mainly related to aging. such as chronic gout. swelling. Causes Osteoarthritis is caused by 'wear and tear' on a joint. Before age 55. Other people develop a more severe form of the disease. the bones rub together. OA occurs equally in men and women. or heart failure. After age 55. about 10% of those with RA are severely disabled. these symptoms may be minor. or rheumatoid arthritis The treatments for RA can also cause serious side effects. Cartilage can break down and wear away. and eating. If you experience any side effects. However. causing pain. which can lead to skin ulcers and infections. nerves. y y y y OA tends to run in families Being overweight increases the risk of OA in the hip. dressing. People with rheumatoid factor. it is more common in women. pseudogout. Osteoarthritis Osteoarthritis (OA) is the most common joint disorder. and allows bones to glide over one another. and the ligaments and muscles around the hip become weaker and stiffer. People who develop RA at younger ages also seem to get worse more quickly. the anti-CCP antibody. However. When to Contact a Medical Professional Call your health care provider if you think you have symptoms of rheumatoid arthritis. and heart.

although they do not seem to help your joint grow new cartilage. or crackling sound when you move the joint. It may relieve pain for 3 . are especially helpful. such as swimming. It may even wake you up at night. While you can always have surgery. If your pain continues. However. You may notice a rubbing. You may need to be watched for side effects. the pain may get worse with activity and feel better when you are resting. The phrase "morning stiffness" refers to the pain and stiffness people feel when they first wake up in the morning. Treatment OA cannot be cured. Taking acetaminophen or another pain pill before exercising is okay. It is improved by mild activity that "warms up" the joint. stinging sensation when you first apply the cream. After a while. can help with OA symptoms. Stiffness usually lasts for 30 minutes or less. Exams and Tests A physical exam can show: y y y y y Joint movement may cause a cracking (grating) sound. The pain is often worse after exercise and when placing weight or pressure on the joint. there will be a wearing down of the ends of the bone and bone spurs. An x-ray of affected joints will show a loss of the joint space. y Most doctors recommend acetaminophen (Tylenol) first. and naproxen. they can often delay surgery. However. Many people use over-the-counter remedies such as glucosamine and chondroitin sulfate. More than two or three injections a year may be harmful. Although these treatments cannot make the arthritis go away.6 months. even though x-rays show the changes of OA. Hyalgan) can be injected into the knee. In advanced cases.Symptoms Pain and stiffness in the joints are the most common symptoms. ibuprofen. do not overdo the exercise because you have taken medicine. Artificial joint fluid (Synvisc. Some people might not have symptoms. Your joints become stiff and harder to move over time. This sensation goes away after a few days of use. y No blood tests are helpful in diagnosing OA. the pain may be present when you're resting. Ask your health care provider to recommend an appropriate home exercise routine. y y y Corticosteroids injected right into the joint can also be used to reduce swelling and pain. LIFESTYLE CHANGES Exercise helps maintain joint and overall movement. because it has fewer side effects than other drugs. During the day. your doctor may recommend nonsteroidal anti-inflammatory drugs (NSAIDs). However. Some doctors recommend a trial period of 3 months to see whether glucosamine and chondroitin work. grating. It will also most likely become worse over time. If you are taking pain relievers on most days. These drugs may also increase the risk for heart attacks and strokes. tell your doctor. You may feel a warm. Types of NSAIDs include aspirin. other therapies can improve your pain and make your life much better.2 weeks. These drugs help relieve pain and swelling. called crepitation Joint swelling (bones around the joints may feel larger than normal) Limited range of motion Tenderness when the joint is pressed Normal movement is often painful MEDICATIONS Over-the-counter pain relievers. . relief only lasts for a limited time. Pain relief usually begins within 1 . your OA symptoms can be controlled. Capsaicin (Zostrix) skin cream may help relieve pain. Water exercises. such as ulcers and bleeding. which you can buy without a prescription. y These supplements may help control pain.

Make sure you work with an experienced massage therapist who understands how to work with sensitive joint areas. then it likely will not work at all. or cooking Decreased ability to walk Surgical complications y y When to Contact a Medical Professional Call your health care provider if you have symptoms of OA. Possible Complications y y Adverse reactions to drugs used for treatment Decreased ability to perform everyday activities. ALTERNATIVE TREATMENTS Acupuncture is a treatment based on Chinese medicine. Treatment generally improves function. Some studies have found that acupuncture may provide short-term pain relief for people with OA. S-adenosylmethionine (SAMe. y PHYSICAL THERAPY Physical therapy can help improve muscle strength and the motion of stiff joints. shoulder replacement. Therapists have many techniques for treating OA. pronounced "Sammy") is a man-made form of a natural byproduct of the amino acid methionine. usually in the spine (arthrodesis) Total or partial replacement of the damaged joint with an artificial joint (knee replacement. ankle replacement. such as personal hygiene. keeping up with everyday activities may become more difficult or painful. . Some prevent the joint from moving. Outlook (Prognosis) Every person with OA is different. It has been marketed Support Groups For more information and support. You may need to adjust your work area or change work tasks. Massage therapy may also help provide short-term pain relief. others allow some movement. but scientific evidence to support these claims is lacking. and pain. household chores. People whose work is causing stress in certain joints should find ways to reduce trauma. see arthritis resources. BRACES Splints and braces can sometimes support weakened joints. Your movement may become very limited.Other lifestyle recommendations include: y y y y y Applying heat and cold Eating a healthy. while others are able to maintain an active lifestyle that includes sports and other activities. Surgical options include: y y y y Arthroscopic surgery to trim torn and damaged cartilage Changing the alignment of a bone to relieve stress on the bone or joint (osteotomy) Surgical fusion of bones. Using a brace the wrong way can cause joint damage. You should use a brace only when your doctor or therapist recommends one. stiffness. SURGERY Severe cases of OA might need surgery to replace or repair damaged joints. elbow replacement) As the pain from your hip or knee OA becomes worse. hip replacement. balanced diet Getting rest Losing weight if you are overweight Protecting the joints as a remedy for arthritis. If therapy does not make you feel better after 6 8 weeks. How it works is not entirely clear. Pain and stiffness may prevent one person from performing simple daily activities. y Sometimes making changes around the home will take some stress off your joints. and relieve some of the pain. as well as your sense of balance.

The exact cause is unknown. such as hydrochlorothiazide and other water pills. y y Acute gout is a painful condition that typically affects one joint. crushing. DJD. The joint appears warm and red. Exams and Tests Tests that may be done include: y y y y y Synovial fluid analysis (shows uric acid crystals) Uric acid . After one gouty attack. There may be a fever. They may drain chalky material. y y y y Causes Gout is caused by having higher-than-normal levels of uric acid in your body. Your body may make too much uric acid.Prevention Weight loss can reduce the risk of knee OA in overweight women. Tophi usually develop only after a patient has had the disease for many years. which may involve more than one joint. OA. If too much uric acid builds up in the fluid around the joints (synovial fluid). Arthritis ± osteoarthritis The condition may occur after taking medicines that interfere with the removal of uric acid from the body. may have higher levels of uric acid in the blood. knee. or have a hard time getting rid of uric acid.urine . Alternative Names Hypertrophic osteoarthritis. more than half of people will have another attack. but may return from time to time. Some people will go months or even years between gouty attacks. The big toe. Gout may run in families. or ankle joints are most often affected. Tophi are lumps below the skin around joints or in other places. Osteoarthrosis. These crystals cause the joint to swell up and become inflamed. uric acid crystals form. people will have no symptoms. The pain frequently starts during the night and is often described as throbbing. or excruciating. Degenerative joint disease. Symptoms Symptoms of acute gouty attacks: y Symptoms develop suddenly and usually involve only one or a few joints. Not everyone with high uric acid levels in the blood has gout.blood Joint x-rays (may be normal) Synovial biopsy Uric acid . Chronic gout is repeated episodes of pain and inflammation. and people who drink alcohol. The condition may also develop in people with: y y y y y Diabetes Kidney disease Obesity Sickle cell anemia and other hemolytic anemias Leukemia and similar types of disorders After a first gouty attack. postmenopausal women. Gout Arthritis Gout is a kind of arthritis that occurs when uric acid builds up in the joints. It is more common in males. They will have joint pain and other symptoms most of the time. but others may have no further attacks. Some people may develop chronic gouty arthritis. It is usually very tender (it hurts to lay a sheet or blanket over it). Those with chronic arthritis develop joint deformities and loss of motion in the joints. People who take certain medicines. Additional attacks usually last longer. The attack may go away in several days.

acute. Podagra. Your health care provider may occasionally prescribe strong painkillers such as codeine. Proper treatment of acute attacks allows people to live a normal life. y y y y See also: Kidney stones Outlook (Prognosis) . Gout .Treatment Treatments for a sudden attack or flare-up of gout: y Your doctor will recommend that you take nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen. kidney. Possible Complications y y y Chronic gouty arthritis Kidney stones Deposits in the kidneys. consommé. Gout . legumes (dried beans and peas). If you are losing weight. Quick weight loss may cause uric acid kidney stones to form. or indomethacin as soon as your symptoms begin. sardines. Limit how much meat you eat at each meal. but you may be able to avoid things that trigger your symptoms. Chronic gout.acute. and fried foods. cauliflower. anchovies.chronic. swelling. Your doctor may prescribe these medicines if: y y y You have several attacks during the same year You have signs of gouty arthritis You have uric acid kidney stones Some diet and lifestyle changes may help prevent gouty attacks: y Avoid alcohol. Hyperuricemia. and sweetbreads). Tophaceous gout. leading to chronic kidney failure y When to Contact a Medical Professional Call for an appointment with your health care provider if you have symptoms of acute gouty arthritis. herring. hydrocodone. Acute gout. Avoid fatty foods such as salad dressings. Limit alcohol consumption and follow a low-purine diet. You will need to take prescriptionstrength medicines for 4 . Alternative Names Gouty arthritis . and inflammation. oils. and is completely relieved in 48 hours. spinach. the acute form of the disease may progress to chronic gout. lose it slowly. asparagus. The pain often goes away within 12 hours of starting treatment. naproxen. Prevention The disorder itself may not be preventable. organ meat (liver. Eat enough carbohydrates. and baking or brewer's yeast.10 days. A prescription medicine called colchicine helps reduce pain. However. gravies. and oxycodone. Your doctor may inject the inflamed joint with steroids to relieve the pain. ice cream. Corticosteroids can also be very effective. Tophi. mushrooms. Acute gouty arthritis y y y Daily use of allopurinol or probenecid decrease uric acid levels in your blood.

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