Alternative Medicine for Arthritis Found

Cure Arthritis Naturally

This ebook gives you the tools that you need in order to cure your arthritis in 21 days or less, using techniques that modern doctors do NOT tell you; that would mean less money from them, because it takes away from the work that they do. Doctors HATE any method that allows you to heal yourself Like this program! You will learn what you need to do to get rid of arthritis in the first place. You will learn how techniques from Asian will give you the relief that you need. You will notice in Asian countries that people with arthritis are almost nonexistent! That is completely due to their medical system And ours could afford to take some notes! All you need to do is carefully follow the directions set out in this ebook and learn how to get the relief you need, keep the arthritis away, and help rebuild the damage that has been done to your joints. Getting rid of arthritis shouldn't be all about surgery and cutting Make it easier on yourself! Continue reading...

Cure Arthritis Naturally Overview


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Effect of Scoliosis Osteoarthritis Osteophytes Surgery and Fracture on BMD in the Proximal Femur

Structural changes and artifacts that interfere with DXA proximal femoral BMD measurements occur less often than at the spine. Osteoarthritic change in the hip joint may cause thickening of the medial cortex and hypertrophy of the trabeculae in the femoral neck, which may increase the BMD in the femoral neck and Ward's area (36). The trochanteric region is not apparently affected by such change and has been recommended as the preferred site to evaluate in patients with osteoarthritis of the hip (37). Osteophytes in the proximal femur are apparently much less common than osteophytes in the lumbar spine (19). They also appear to have little effect on the bone densities measured in the proximal femur. In patients with scoliosis, however, lower bone densities have been reported on the side of the convexity (38). If a worst-case measurement is desired, the bone density in the proximal femur should be measured in the femur on the side of the convexity. Proximal femur fracture and surgically...

Monarthritis Polyarthritis Differential Diagnosis

Differential Diagnosis For Polyarthritis

The number of joints and the time course during which a joint disorder develops guide the approach to differential diagnosis. Acute monarthritis may represent septic arthritis, which is a rheumatologic emergency. Prompt diagnosis and treatment of a potentially septic process are required. The single abnormal joint that persists beyond 2 months presents a different diagnostic challenge. In each case, one must view the overall clinical presentation, including factors such as associated extraarticular visceral involvement, constitutional signs and symptoms, severity of illness and limitation of function, potential foci of infection, skin lesions, hyperuricemia, and history of trauma or bleeding disorders. Usually, an aggressive initial approach is indicated, including joint aspiration with synovial fluid analysis and occasionally referral for synovial biopsy or arthroscopy. Therapy will vary significantly depending on the presumptive diagnosis. Specific therapy of each disease is...

Arthritis Or Rheumatism

Pranic Healing

Arthritis and rheumatism are very broad terms used in relation to muscle pain and disorder of t he j oints. Di sorder of t he j oints m ay be c aused by solidification of li quid c alcium, accumulation o f urates, c halky s alts of u ric ac id, or t he d egeneration o f the protective shock-absorbing cartilage in the joints. Arthritis or rheumatism manifests as pranic depletion of the minor chakras on the arms and legs and partial pranic depletion in some major chakras. Orange and red pranas are used in treating mild arthritis or rheumatism. For simple muscle pain or mild arthritis in the joints, apply localized sweeping and energize with light whitish-orange prana for 5 breathing cycles a nd then with l ight whitish-red prana for 5 breathing cycles. In most cases, the relief is immediate. 4) If t he a rms or fingers are affected, apply lo calized s weeping a nd e nergizing wi th l ight green prana, then with a lot of light violet prana on the armpit, elbow, and hand chakras. If the...

Articular Facet Osteoarthritis

Articular facet osteoarthritis is a common cause of low back pain in adults. The facets can be a direct source of pain, as the synovial linings and joint capsules are richly innervated (12). Sciatica can be caused by nerve root compression due to facet hypertrophy, focal osteophytes, subluxation, or expansion of the joint capsule due to effusion (1). SPECT imaging is more sensitive than planar imaging in detecting facet joint lesions (13-15) and can be used in selecting appropriate patients for treatment with facet injections (15,16). Ryan et al. compared SPECT imaging with radiography and CT in 34 patients with low back pain referred from a rheumatology clinic (14). SPECT identified 18 lesions of the facet joints. Seventeen of these corresponded to articular facet osteoarthritis on CT or radiography. Planar bone scintigraphy was positive in only two of these lesions. Holder et al. also compared SPECT and planar bone scintigraphy in the diagnosis of facet syndrome (15). All patients...

Approach To Monoarticular Arthritis

Almost any joint disorder may begin as monoarthritis, or inflammation of a single joint however, the primary concern is always infectious arthritis, because it may lead to joint destruction and resultant severe morbidity. For that reason, acute monoarthritis should be considered a medical emergency and investigated and treated aggressively. Monoarthritis may be a result of infection (e.g., bacterial, fungal, Lyme disease, tuberculosis) or crystal-induced arthritis (e.g., pseudogout and gout) less often, it may be the presentation of a systemic disease typically associated with polyarticular disease, such as rheumatoid arthritis or systemic lupus erythematosus. It may also be a result of noninflammatory causes such as trauma or osteoarthritis. Accurate diagnosis starts with a good history and physical examination supplemented by additional diagnostic testing, such as synovial fluid analysis, radiography, and occasionally synovial biopsy. A history of episodes of arthritis suggests...

Joint Pain or Arthritis

Two main kinds of arthritis are recognized clinically, osteoarthritis and rheumatoid arthritis. In osteoarthritis the joints have bacteria living on the deposits left there. In rheumatoid arthritis the bacteria come from larger parasites wormlets actually living in these joints. The worms are the common little roundworms whose eggs hatch into microscopic wormlets that travel. Osteo or Common Arthritis Carol Lachance was diagnosed with arthritis of her back and knees. (She had spurs in both places.) She was positive for Trichinella, Ascaris and Dirofilaria (she also had pain over the heart). They had an outdoor dog. Her blood test showed a high phosphate and alkaline phosphatase level showing she was dissolving her bones. After changing her diet to include milk, extra oyster shell calcium (one a day), magnesium oxide and vitamin B6, and reducing her meat and grain consumption her phosphate level went down to normal (below 4). She did the kidney cleanse and liver cleanse as well as...

Proposed classification system of septic arthritis according to Tan et al [126

Part of the difficulty in reporting outcomes in infected shoulder patients is the lack of a uniform classification system for septic joints. A number of systems exist to describe osteomyelitis or infection around a total joint, but none are universally accepted. The ideal system will allow for stratification of the disease, improve decision making, and facilitate outcome reporting that is suitable for meaningful comparison. To our knowledge, a comprehensive classification system for septic arthritis of the shoulder, as such, does not exist at this time. I Periarticular soft-tissue infection without pyarthrosis II Isolated septic arthritis III Septic arthritis with soft-tissue extension, but no osteomyelitis IV Septic arthritis with contiguous osteomyelitis The clinical setting takes into account the duration of symptoms and aggressiveness of the organism. We have grouped patients with less than 5 days or symptoms and infection with a less virulent bacterial strain into group 1. Those...

Pyogenic Arthritis Pyarthrosis

Pyogenic Arthritis The Shoulder

Pyogenic arthritis is a septic condition of a joint. As in acute osteomyelitis, acute pyarthrosis may result from (a) hematogenous spread of bacteria with direct synovial lodgment, (b) transphyseal (across the growth cartilage) spread of a primary infective focus in the long-bone metaphysis, (c) contiguity, or (d) penetration or operation. The most common offenders are micrococci and gram-negative bacilli. Radiographically, the acute infected joint shows capsular distension, joint space narrowing, and periarticular bone erosions (Fig. 8.8A). The infective arthritis aborted by the early institution of proper treatment may also show similar findings but with a relatively well-preserved joint space (Fig. 8.9A). In the chronic phase the joint is deformed with ebur-nation and bony ankylosis may ensue (Fig. 8.10A). In children, pyohip can occur as an extension of acute osteomyelitis in the ipsi-lateral femoral neck, and both conditions can be diagnosed by radiography (Fig. 8.11). of the...

Generalized Osteoarthritis

Whole Body Bone Scan

Generalized osteoarthritis designates a multiarticular involvement pattern of five or more joints at one time with osteoarthritis. It is divided into primary and nodal type according to the absence or presence of Heberden's nodes. Kellgren et al. (1963) have reported high rates of its occurrence in both male relatives (36 ) and female relatives (49 ) compared to respec- Fig. 9.52 Value of whole-body bone scintigraphy in the diagnosis of generalized osteoarthritis. Anterior (left) and posterior (right) whole-body bone scans in a 56-year-old female show asymmetrical multiarticular involvement including the lower lumbar spine Fig. 9.52 Value of whole-body bone scintigraphy in the diagnosis of generalized osteoarthritis. Anterior (left) and posterior (right) whole-body bone scans in a 56-year-old female show asymmetrical multiarticular involvement including the lower lumbar spine Fig. 9.53A, B Magnified scintigraphy can uniquely provide metabolic information on the individual...

Degenerative Joint Diseases

Subcortical Cyst Knee

Osteoarthritis Degenerative joint diseases include osteoarthritis, osteoarthrosis, osteochondrosis and others, and are the most common joint disorders that gradually disable patients. These recently receive greater attention because of the unprecedented prolongation of life expectancy and the availability of efficient prosthetic therapy. The terms describing degenerative joint diseases are many and used more or less loosely and even interchangeably. Osteoarthritis and osteoarthosis designate degraded states of a synovial joint with and without significant inflammation, respectively. Osteoarthritis is classified into primary or idiopathic and secondary, and inflammatory when there is significant synovial involvement with effusion. A number of factors have been implicated as causative, but mechanical wearing down of the articular cartilages and supportive structures due to aging and obesity appears most important. According to Mitchel and Cruess (1977), osteoarthritis results from an...

Osteoarthritisrheumatoid arthritis

Exercise in three to five sessions per week are recommended. Patients with rheumatoid arthritis (RA) should be advised not to exercise during periods of exacerbations flare-ups. This will depend on individuals and their symptoms. Low-impact activities are generally recommended in order to avoid stress on the lower limb joints. Comparable workload intensity to high-impact exercise can be achieved by adding dynamic upper limb exercises to low-impact exercises. Water-based activity may be suitable for arthritis.

Approach To Polyarticular Arthritis

Articular Manifestations

The first and most important step in evaluating a patient with polyarticular joint pain is determining whether or not synovitis arthritis is present, producing soft tissue swelling, joint effusion, tenderness, warmth of the joint, and limitation of both active and passive range of motion. If the only finding is pain without inflammatory changes, then the diagnostic considerations include noninflammatory diseases such as osteoarthritis (OA), fibromyalgia, hypothyroidism. neuropathic pain, and depression. The presence of soft tissue swelling and tenderness with limited active range of motion but normal passive range of motion suggests the problem is extraarticular soft tissue inflammation, such as bursitis or tendonitis. If there is active synovitis arthritis. it is clinically useful to distinguish between monoarticular oligoarticular arthritis (see Chapter 21) and polyarticular arthritis. In polyarticular disease, the next diagnostic clue is the duration of symptoms. If symptoms are...

Arthritis Bibliographi

Etiopathogenesis of reactive arthritis and ankylosing spondylitis. Curr Opin Rheumatol 1995 7 290. Clegg DO, et al. Comparison of sulfasalazine and placebo in the treatment of reactive arthritis (Reiter's syndrome). Arthritis Rheum 1996 39 2021. Cremers MCW, et al. Second-line treatment in seronegative spondyloarthropathies. Semin Arthritis Rheum 1994 24 71. Inman RD. Treatment of seronegative spondyloarthropathies. In Klippel J, Weyand CM, eds. Primer on the rheumatic diseases. Atlanta Arthritis Foundation, 1997 193. Thomson GT, et al. Post- Salmonella reactive arthritis late clinical sequelae in a point source cohort. Am J Med 1995 98 13. Gout is a heterogeneous disorder with primary and secondary forms characterized by hyperuricemia and urate crystal-induced arthritis.

Classifications for rheumatoid arthritis

Glenoid Arthritis

In rheumatoid arthritis 102 * Low-grade, intermediate, and severe involvement. There is a great deal about rheumatoid arthritis that is poorly understood. We do not know its cause or have a specific diagnostic test. In our present state of ignorance, it is helpful in making clinical decisions to classify the disease as low-grade, intermediate, or severe. Post-operative rehabilitation is much easier in those with mild disease. Bone loss is apt to occur more slowly, and they may develop marginal osteophytes similar to those seen in osteoarthritis. In the more severe form of rheumatoid arthritis, there may be rapid destruction of the joint surfaces with early ascent of the humerus and involvement of the rotator cuff. If shoulder arthroplasties are postponed unnecessarily, severe bone loss and rotator cuff damage can occur needlessly. In one major rheumatoid hospital in the United States, patients underwent an average of four other major arthroplasties (hips, knees or elbows) prior to the...

Box 2 Triggering microbes of reactive arthritis

Other types of inflammatory arthritis in which bacteria may Poststreptococcal ReA, Lyme disease, and Whipple's disease are all caused by bacterial infections. Their clinical symptoms include inflammatory arthritis but they all have enough different features that are not part of traditional ReA that they should be considered separate. Poststreptococ-cal ReA includes small joint involvement, vasculitis, glomerulonephritis, and increased prevalence of HLA-DRB1*01 59 . A migratory arthritis with central nervous system involvement is typical of Whipple's disease. Lyme disease includes a characteristic rash (erythema migrans) with central nervous system symptoms. demonstrated the routine presence of both Ct and Cpn in the synovial tissue of patients with the postchlamydial arthritis 27,28,36,37 . One important difference is that these chlamydiae exist in a persistent metaboli-cally active state, whereas the postenteric organisms do not, with the possible exception of Yersinia 26 . The...

Classifications of Osteoarthritis of the shoulder

Rotator Cuff Arthropathy Classification

13.2 Classification of glenoid morphology in primary glenohumeral osteoarthritis according to Walch et al. 134 * Fig. 53. Different morphological types of the glenoid in primary glenohumeral osteoarthritis Fig. 53. Different morphological types of the glenoid in primary glenohumeral osteoarthritis 13.5 Classification of osteoarthritis with massive rotator cuff tears according to Favard et al. 38 * Group 1 is characterised by upward migration of the humeral head, superior gleno-humeral joint space narrowing, an acromion changed in shape due to the imprint of the humeral head and subacromial arthritis (Fig. 56 a). 13.8 Classification of glenoid erosion in glenohumeral osteoarthritis with massive rupture of the cuff according to Sirveaux et al. 120 Fig. 59. Radiological classification of glenoid erosion in osteoarthritis with massive rupture of the cuff. (From 120 ) Fig. 59. Radiological classification of glenoid erosion in osteoarthritis with massive rupture of the cuff. (From 120 )

Is there an association between hepatitis C virus infection and arthritis

The topic of HCV infection and arthritis has attracted more attention from the rheumatologists than the infectious diseases specialists, yet the prevalence of HCV among patients who have arthritis is comparatively low, whereas the prevalence of arthritis among patients who have HCV infection is comparatively high. Data on the first topic is scant. Maillefert and colleagues 15 in France found that of 309 patients who had rheumatoid arthritis according to criteria by the American College of Rheumatology (ACR) (formerly the American Rheumatism Association ARA ), 2 had anti-HCV antibodies and only 1 of them was HCV-RNA positive. Subsequent data by the same group 16 again showed that of 232 patients seen for initial evaluation of various recent-onset inflammatory arthritides only 6 had anti-HCV antibodies detected. Interestingly, despite this relatively low prevalence, the authors found that it is not infrequent for rheumatolo-gists to screen their patients for HCV 17 . Conversely, data on...

Joint Manifestations Arthralgia Arthritis and Ankylosing Spondylitis

Peripheral arthralgia and arthritis are the most common EIM in IBD patients and are mainly reactive. When the colon is inflamed, the prevalence of joint manifestations in both CD and UC varies between 26 and 39 whereas in Crohn's ileitis it is 8 . It has recently been demonstrated that lymphocytes from CD patients react with human synovia, thus confirming the importance of common antigens in the pathogenesis of these manifestations 19 . Arthritis in IBD is usually pauciarticular and asymmetrical, and it affects knees, ankles, wrists and elbows while joints such as the hands and shoulders are less involved. It has a migratory pattern and is transient and generally nondeforming although it may become chronic and erosive in 10 of patients 20 . The onset of arthralgia usually parallels intestinal disease activity whereas arthritis often develops independently, and joint manifestations may precede bowel disease by years 21 . Orchard distinguished between two types of arthritis type 1...

Tuberculous Arthritis of Peripheral Joints

Tubercuiosis The Clavicle

Tuberculosis in the peripheral joints runs an insidious, chronic course as tuberculosis elsewhere. For the most part, the mode of infection of tuberculous arthritis is blood-borne with a primary focus usually in the lung. It may also arise from direct contamination with tuberculosis in the neighboring bone. Granulomatous tissue and pannus erode and dissolve articular cartilages and subchondral bones, causing irregular narrowing and disfiguring. Tuberculosis affects any joint (Enarson et al. 1979), but larger joints such as the hip, knee, and sacroili-ac joint are sites of predilection (Lee et al. 1995 Campbell and Hoffman 1995). The sternocla-vicular joint, glenohumeral joint, elbow, wrist, ankle, and joints of the hand and foot are less commonly affected. The occurrence is usually monarticular (Evanchick et al. 1986). truction, articular narrowing, and soft-tissue swelling (Figs. 8.22A and 8.23A). Unlike in py-arthrosis or rheumatoid arthritis, the bone destruction tends to be...

Juvenile idiopathic arthritis

Scaphoid Ischemia

To consolidate terminology for classifying chronic childhood arthritis, the International League Against Rheumatism adopted the term juvenile idiopathic arthritis (JIA), which encompasses the diseases previously known as juvenile rheumatoid arthritis and juvenile chronic arthritis 111 . In patients who have JIA, the wrist is a very commonly involved joint, second only to the knee, and is affected in approximately 54 to 59 of patients 112,113 . Initial radiographic

Pisotriquetral arthritis

Symptoms Arthritis Wrist

Chronic pain in the pisiform area may be caused by tendinitis of the insertion of the flexor carpi ulnaris, bony fractures, or osteoarthrosis of the pisotriquetral joint, which some report as a frequent site of osteoarthritis slightly less common than the scaphotrapezial osteoarthrosis 52 . Although pain and tenderness on the palmar and ulnar aspects of the wrist in the area of the pisiform bone is fairly common, refractory pisotri-quetral osteoarthritis was unusual enough for Green to be able to make a case report of simple excision of the pisiform back in 1979 53 . Subper-iostal excision of pisiform bone is customarily performed after unsuccessful initial nonoperative treatment, and although the postoperative results seem to be rather good, Beckers and Koebke 54 have recently reported on some functional limitations resulting from pisiform excision. Osteoarthritis of the pisotriquetral joint is most often caused by acute and chronic trauma and instability. The symptoms of...

Lunotriquetral arthritis

Lunotriquetral Arthritis

Although degenerative problems associated with scapholunate dissociation are a very common cause of wrist arthritis, isolated lunotrique-tral arthritis is rare unless it is encountered as a result of a partial carpal coalition 36 . Coalition of carpal bones is relatively common, and the lu-nate-triquetrum fusion is the most frequent carpal coalition 36,37 . This finding is almost always coincidental and asymptomatic (Fig. 5) however, when the coalition is incomplete, patients who have this problem may have ulnar-sided wrist pain 38 and arthritic changes in the remaining lu-notriquetral joint. As discussed earlier, isolated lunotriquetral arthritis is rare unless it is the result of a partial carpal coalition. This is one of the few clear indications for isolated lunotriquetral arthrodesis. Treatment of ligamentous injuries to the lunotri-quetral articulation is more controversial. lunotriquetral fusion or a four-bone fusion must be performed. If there is positive ulnar variance along...

Distinguishing Pars Injuries From Facet Arthritis Using Spect

Abnormal uptake in the pars interarticularis is usually due to a stress injury or spondylolysis. Facet lesions are usually arthritic although fractures and osteoid osteomas may be present. Lesions in the vertebral arch must be accurately localized to differentiate between these disorders. SPECT is particularly useful in lesion location because multiple projections can be reconstructed (1). It is difficult to distinguish a pars injury from facet arthritis in the coronal and transverse reconstructions. However, these lesions can be distinguished in sagittal projection constructed slightly off midline toward the affected side (Fig. 2). Sagittal imaging shows the relationship between the lesion to the disc space and the posterior column of the vertebral body (1). The apophyseal joints are on the same horizontal plane as the disc space whereas the pars

Collageninduced arthritis a versatile model

Both humoral and cellular responses have been implicated in the pathogenesis of CIA. Antibodies against CII are detectable 9 days following immunization and an immunoglobulin M (IgM) response peaks within 2 weeks peak IgG levels are attained at 4-5 weeks postimmunization. Anti-collagen IgG levels coincide with the onset of arthritis, suggesting a role for autoantibodies in the pathogenesis of CIA. Collagen arthritis Adjuvant arthritis Pristane arthritis Cell wall arthritis Antigen arthritis Proteoglycan arthritis

Induction Of Collageninduced Arthritis In Rats

Collagen-induced arthritis (CIA) using the rat was originally described by Trentham et al. (1977). Subsequently, this model has gained widespread acceptance and has proven valuable in the study of autoimmune-mediated polyarthritis. Although the mouse model of CIA is often favored for study because of its well-characterized genetic system and plethora of immune reagents, the rat model possesses a number of features that make it desirable. These include the availability of many CIA-susceptible strains, quicker onset of arthritis, and the fact that induction of CIA in rats does not require complete Freund's adjuvant. As with the mouse model, autoimmune arthritis in the rat is dependent on both a T cell and B cell response to the immunogen CII. However, unlike the mouse model, CIA in the rat can only be induced by immunization with native CII. The use of mycobacteria-containing adjuvants (e.g., complete Freund's adjuvant) is not recommended because complete Freund's adjuvant alone can...

Use in rheumatoid arthritis

In rheumatoid arthritis the most commonly used gold salts are sodium aurothiomalate and aurothioglucose (3). There is some reason to believe that adverse effects are less frequent with the suspensions (of aurothioglu-cose or aurothiosulfate) than with the more rapidly absorbed solution (of sodium gold thiomalate) (SEDA-16, 233) (4).

Patellofemoral Osteoarthritis

Mri Image Chondromalacia Patella

Patellofemoral osteoarthritis is an extremely common cause of anterior knee pain. This is encountered primarily in older individuals, but can be seen in younger patients with accelerated degenerative changes brought on by comor-bidities such as obesity. The classic radiographic features of PO include loss of articular cartilage with joint space narrowing, subchondral sclerosis and or cyst formation, and osteophyte formation along the posterior margin of the patella. The symptoms commonly seen with PO include morning knee joint stiffness, loss of mobility, pain with ambulation (particularly walking up an incline or along a flight of stairs), and weakness about the knee joint.

Adultonset Stills disease See juvenile arthritis

Alexander technique This technique was developed by an actor, F. M. Alexander, to improve his voice. He believed that the way we breathe affects the function of our bodies and that the relationship between the head, neck, and upper body are the primary controls of posture. Abnormal posture causes abnormal muscular tension in one muscle group and can adversely affect the whole body. Treatment with the Alexander technique usually involves individual or group lessons during which a teacher observes the posture and tension in a student. The teacher then explains, using touch and instructions, more efficient posture, movement, and breathing. The Alexander technique has not been adequately evaluated in well-designed studies. Apart from anecdotal experience, little scientific evidence is available with which to evaluate the Alexander technique as a therapy for arthritis-related problems.

Heat Shock Proteins And Juvenile Chronic Arthritis

Initially expression of hsp 60 was studied in synovial membranes of rats with adjuvant arthritis and in adult patients with either reumatoid arthritis or osteoarthritis (11). Later on hsp 60 expression was also studied in patients with JCA (12). The monoclonal antibodies used in the first studies were raised in mice ML-30 against hsp 60 of Mycobacterium leprae,TB-78 against hsp 60 of M. tuberculosis, and F-8 raised against the arthritogenic nonapeptide of M. tuberculosis (Table 2). Juvenile Chronic Arthritis and Hsp Table 2 Expression of Hsp 60 in Synovial Membranes of Rats and Humans C. Juvenile Chronic Arthritis a T-Cell-Mediated Disease the clinical observation that viral infections that cause suppression of cellular immunity, for example, measles (22-24) or cytomegalovirus infection (W. Kuis, personal communication)), may lead to remission of disease activity in patients with JCA. Furthermore, chronic arthritis is found in patients with B-cell deficiencies such as common variable...

Role of Chemokines During the Different Phases of Rheumatoid Arthritis

A great deal of the data available thus far regarding the pathogenic mechanisms in arthritis has been derived from animal models. For instance, the identification of TNF-a as a therapeutic target, one of the effective immunotherapeutic agents in RA so far, was established in studies conducted in animal models (5,9,10). Collagen type II (CII)-induced arthritis (CIA) in the arthritis-susceptible DBA 1j mouse strain is one of the most commonly used immunization-based models in which many of the pathologic features of human RA are recapitulated (11-16). The role of chemokines during the four phases described above can be clearly appreciated in the CIA model. At the conclusion of the induction phase in CIA, CII-specific T cells and plasma cells producing high levels of anti-CII antibodies would initiate the early effector phase of the disease. Recently, Wipke et al. (24) have proposed a four-step model to describe how certain autoantibodies promote the effector phase of arthritis (Fig. 1...

Effects of Chemokine System Inactivation in Arthritis

Now, one must rely on results obtained with testing the effects of the blockade of the chemokine system in animal models of arthritis. Indeed, in several experimental models of arthritis, blockade of chemokines and their receptors has been shown to be effective (Tables 4 and 5). This broad array of potential targets is somehow encouraging, but also, it is reminiscent of the state of affairs in other model systems of autoimmune diseases such as type I diabetes (TID). In experimental TID, there has been a surprisingly high rate of effective research treatments that when administered early in the natural history of the disease had profound effects. However, in the clinical arena, the great majority of these research treatments have failed to demonstrate clinical benefit (49). 10.3.1. Study of Chemokines in Different Experimental Models of Arthritis Different approaches have been used to probe the role of chemokines and their receptors in experimental models of arthritis for instance,...

Signaling Cascades Underlying the Effects of Chemokines in Arthritis

It is clear that chemokines mediate their effects via seven-transmembrane domain receptors, a subset of G protein-coupled receptors (GPCRs). Interestingly, recent approaches have allowed study of the potential downstream signaling cascades engaged by these chemokine receptors (66). In rats, arthritis development is associated with increases in tyrosine phosphorylation of CCR1 and CCR2. More interestingly, in immunoprecipitation studies, Janus kinase (JAK-1), signal transducer and activator of transcription 1 (STAT-1), and STAT-3 were associated with CCR1, CCR2, and CCR5 expression at different time points during the disease course. Immunohistologic analysis revealed that CCR5, phosphorylated STAT-1, and phosphorylated STAT-3 are present in different cell types in the inflamed synovial tissue of the joints, including lining cells, macrophages, and endothelial cells (66). Collectively, these studies suggest that effects of the chemokines in RA may be related to the ability of chemokine...

Some Unsolved Issues Regarding Chemokines in Arthritis

As mentioned earlier, a 32-base pair (bp) deletion in the CCR5 gene (A32) results in a frameshift and premature termination in the region encoding the second extracellular loop of the CCR5 receptor, producing a nonfunctional receptor that remains intracellular (67). About 1 of the Caucasian population is likely to be homozygous for A32 (68). Notably, Gomez-Reino et al. (69) reported that in their cohort of 673 Spanish patients with RA, there were no patients homozygous for A32, but the frequency of this A32 mutation was normal in lupus patients and healthy controls. This striking observation was not replicated later on in four other studies performed in different populations in which RA patients homozygous for A32 were found, suggesting that CCR5 deficiency does not prevent rheumatoid arthritis (70-73). A recent study of 516 RA patients and 985 healthy controls (74) also failed to find A32 homozygous RA patients, while 1.2 of the healthy controls were homozygous. 10.5.2. Role of CCR2...

Effects of Chemokines in Rheumatoid Arthritis Beyond Cell Recruitment

Effect on osteoclast differentiation, although it is unknown whether chemokines are mediators of osteoclastogenesis and bone loss in arthritis. The osteoclasto-genic properties of the chemokine CCL3 have been extensively studied. CCL3 is present in inflamed joints in RA and experimental arthritis. Injection of recombinant CCL3 in vivo promotes a striking increase in osteoclast differentiation (96). Moreover, in the context of multiple myeloma, a disease in which just like RA, there is significant degree of localized bone reabsorption, CCL3 has been shown to promote osteoclastogenesis (97). CCL3 promotes osteoclast differentiation via CCR1 and CCR5 (98), and its effects are not fully dependent on the actions of the master osteoclast differentiation factor RANKL (99). Notably, chemokines such as CCL2 and CCL5 may also have a synergistic action on the ability of RANKL to promote osteoclast differentiation (100,101). multifaceted function for this chemokine in the pathogenesis of...

Topological Approach to Quantitation of Rheumatoid Arthritis

Clinical radiologists require not only visual representations of MRI and CT data but also quantitative measurements representing the progression of chronic conditions such as rheumatoid arthritis of the knee. Since inflammation is confined to a thin irregularly shaped region called the synovial capsule it is necessary to segment a suitable approximation of the capsule, then compute quantitative measurements within the segmented region. We report preliminary results on applying topological tools to identify the desired region visually and to extract quantitative information, along with a protocol for clinical validation of the method.

Collagen Induced Arthritis

Animal models of arthritis have been used in many different kinds of experiments, including the evaluation of novel therapies, the identification of proin-flammatory cytokines, the identification of genes associated with disease susceptibility, and in the identification of markers of disease progression (9). Collagen-induced arthritis (CIA) is probably the most widely used model for studies of therapeutic intervention although data arising from such studies should be interpreted with caution because much depends on the timing of treatment (i.e., before or after onset of arthritis). For example, a number of T-cell-targeted therapies (e.g., anti-CD4, anti-interleukin IL -12, CTLA4-Ig) have been shown to be effective when given at the time of immunization but ineffective when given in established disease (10-13). CIA exhibits many pathological similarities to RA (14), including similar patterns of synovitis, pannus formation, erosion of cartilage and bone, fibrosis, and loss of joint...

Adjuvant Arthritis Disrupts Normal Chronobiological Organization

We have examined a number of immune and neuroendocrine circadian rhythms in FCA-injected rats by looking for changes in the preclinical phase of arthritis (2 to 3 days after FCA injection) as well as in the acute phase of the disease (18 days after FCA injection) (Tables 3.1 to 3.3). Generally, changes in circadian rhythms in lymph node immune function tended to be more profound at the preclinical phase of the disease. For example, B-cell- and T-cell-mediated mitogenic activity of lipopolysaccharide (LPS) and concanavalin (Con A), respectively, were modified in amplitude or acrophase during the preclinical phase (Esquifino, Castrillon, Chacon, Cutrera, and Cardinali 2001) while exhibiting few or none changes during the acute phase of experimental arthritis (Garcia Bonacho, Cardinali, Castrillon, Cutrera, and Esquifino 2001) (Table 3.1). Similarly, 24-h variations of B and T cells, as well as of CD4+ (T helper) and CD8+ (T cytolytic) cells became significantly changed during the...

The Arthritis Foundation

Http www. arthritis .org This site is an outstanding resource for patients with arthritis and their families. The organization provides books and brochures for patients with arthritis, referrals to rheumatologists in an area, and publishes a magazine, Arthritis Today. Call tollfree 800-283-7800 or go to the web site. The web site has extensive information that is clearly written about all aspects of arthritis including surgery and drugs. The popular Drug and Supplement Guides are available. Other areas covered include financial planning, exercise, tips for living with arthritis, travel, marriage and dating, alternative therapies, and specific rheumatic diseases.

The Rat Adjuvant Arthritis Is an Experimental Model of Rheumatoid Arthritis

Rheumatoid arthritis is a systemic inflammatory disorder that mainly affects the diarthrodial joint. It is the most common form of inflammatory arthritis and affects about 1 of the population, in a female male ratio of 2.5 1. The disease can occur at any age, but it is most common among those aged 40 to 70 years. The geographic distribution of rheumatoid arthritis is worldwide, with a notably low prevalence in rural areas (Goodson and Symmons 2002 Reginster 2002). Although it initially presents as a symmetrical polyarticular synovitis with prominent hand involvement, rheumatoid arthritis has multiple potential systemic manifestations. The clinical course of the disorder is extremely variable, ranging from mild, self-limiting arthritis to rapidly progressive multisystem inflammation with profound morbidity and mortality. Fever and weight loss can be part of the acute symptoms, while splenomegaly, vasculitis, neutropenia, and amyloidosis are some of the disease's complications, which...

Common Types Of Arthritis

Osteoarthritis or degenerative joint disease affects 86 of persons over 70 years of age, although symptoms may start in the fifth or sixth decade of life. This common form of arthritis is the result of deformation or mismatched joint surfaces, rather than an inflammatory disease. Symptoms include joint stiffness that usually lasts only a few minutes after initiating movement and perhaps an aching pain in weight-bearing joints. Early disease stages may respond to local heat and nonprescription analgesics. Later stages may require orthopedic or other interventions. Rheumatoid arthritis usually occurs between 30 to 70 years of age and occurs more often in women than in men. Early symptoms may include feelings of fatigue and weakness, joint pain and stiffness, and, joint swelling several weeks later. Joints are inflamed (warm, red, swollen) and often are limited in range of motion. This is a progressive disease that leads to joint deformity. Aspirin and aspirin-type products (NSAIDs) and...

Assessing benefit in osteoarthritis

The medical management of pain in osteoarthritis is by definition nonsurgical. However, it is important to appreciate that surgical intervention in osteo-arthritis can be particularly important in overcoming pain as well as having positive effects in reducing disability and specifically improving mobility. Joint replacement surgery is particularly effective, but it lies outside the themes explored in this review. Most trials use simple assessments of pain and disability. Pain is recorded using visual analog scales or five-point Likert scales. Pain can be recorded globally or in specific situations such as at rest or during exercise. There are also specific scales that record pain, stiffness and function in osteo-arthritis the most widely used is the Western Ontario and McMaster Osteo-Arthritis (WOMAC) Scale 6 . Table 9.1 Strength of evidence for treatments in knee osteo-arthritis largest systematic reviews compared for effective treatments Table 9.1 Strength of evidence for treatments...

Osteoarthritis of the Knee

More than 20 million Americans have osteoarthritis (OA) of the knee. This clinical entity is one of the most frequent causes of physical disability among adults ( news pr dec2004 nccam-20.htm). A recent study conducted at the University of North Carolina at Chapel Hill suggested that nearly 50 of US adults and nearly two-thirds of obese adults will develop painful knee OA by age 85 ( September 2, 2008). According to the, OA of the knee is listed among the top 10 most expensive medical condition, costing 34 billion dollars. Berman et al. (1999) investigated the efficacy of acupuncture as an adjunctive therapy in elderly patients suffering from OA of the knee using a randomized crossover study design. These investigators found that patients randomized to acupuncture treatments had improvement on both McMaster University's OA index and Lequesne's indices at 4 and 8 weeks. The same research team then conducted a large-scale sham-controlled RCT that...

Immunologics For Arthritis Side Effects

A serum sickness-like syndrome has been observed during sulfonamide administration. This diagnosis should be limited to patients with at least three of the symptoms of classical serum sickness, that is fever, rash, allergic arthritis, lymphadenopathy, and possibly leukopenia or neutropenia. Histologically, severe serum sickness-like syndrome seems to correspond to an allergic vasculitis (126,181). Most of the descriptions of serum sicknesslike syndrome with histopathological documentation have been associated with older sulfonamides that are no longer used (182). In some severe forms of serum sickness-like syndrome, the reaction can be complicated by a number of unusual organ manifestations, including plasmacytosis, lymphocytosis, monoclonal gammopathy (183,184), interstitial myocarditis (13,33), allergic pneumonitis, nephropathy, liver damage, and nervous system disorders (126,181).

Symptoms of arthritis

People who suffer from arthritis will be pleased to learn that strength-training research on arthritic subjects has shown that resistance exercise may ease the discomfort of both osteoarthritis and rheumatoid arthritis.10 In one study, the researchers concluded High intensity strength training is feasible and safe in selected patients with well-controlled rheumatoid arthritis and leads to significant improvements in strength, pain, and fatigue without exacerbating disease activity or joint pain.11

Rheumatoid Arthritis

There are several spontaneous and induced animal models of arthritis available. In MRL lpr mice that have a defective Fas gene, arthritis develops spontaneously, but the immune mechanisms underlying joint disease in these mice are not known 135 . T cell-mediated arthritis can be induced in susceptible strains of mice and rats by immunization with type II collagen, the collagen type found in cartilage. This model has long been used to study mechanisms and effects of anti-arthritic drugs, for instance liposome-encapsulated drugs 136 . However, in the human situation there is no evidence for collagen-specific immunity. Arthritis can also be induced using various bacterial antigens. However, in these models the resemblance to human disease is, at best, questionable 137 .

Rheumatoid Arthritis Disease Process

Rheumatoid arthritis (RA) is a disease defined by seven criteria, with four that should be fulfilled to make the diagnosis (Table 1). These criteria have been useful in harmonizing clinical trials and clinical practice. However, they are not based on what is now known about etiology or pathogenesis, and they are not too helpful in selecting treatment for the single patient. Hence, there are needs to redefine the diagnosis for RA and related diseases, first to define entities more related to distinct etiologies and pathogenetic mechanisms, then to use such new entities for stratification and selection of patients in clinical trials and clinical practice. TABLE 1 Classification Criteria for Rheumatoid Arthritis 2. Soft tissue swelling (arthritis) of three or more joint areas observed by a physician 3. Swelling (arthritis) of the proximal interphalangeal, metacarpophalangeal, or wrist joints 4. Symmetric swelling (arthritis) Source Arnett FC, Edworthy SM, Bloch DA, et al. (American...

Osteoarthritis and Rheumatoid Arthritis

In addition to the nonarticular rheumatologic conditions discussed previously, a number of articular disorders warrant the attention of the pain specialist. Among these, osteoarthritis and rheumatoid arthritis are among the most common. In the United States, as many as 40 million persons are affected by arthritis and musculoskeletal conditions. Osteoarthritis (degenerative joint disease) is the most common form of arthritis and is the most prevalent articular disease affecting elderly persons. The condition results from destruction of joint cartilage by chondrocytes and affects multiple joints, including the distal interphalangeal joints, the proximal interphalangeal joints, spine, hip, and knees, but rarely wrist, shoulder, or metacarpal-phalangeal joints. Weight-bearing joints are most apt to be affected. Osteoarthritis may arise from primary joint dysfunction, involving the synovial capsule, or it can arise from secondary processes (e.g., prior injury or joint trauma). Symptoms of...

Table 812 Treatment options for patients with rheumatoid arthritis

The joints may be swollen and tender, and over time there occur significant deformities of the hands, including ulnar deviation and the swan-neck and boutonniere deformities of the fingers. Patients with rheumatoid arthritis experience a number of systemic problems arising from the inflammatory processes of the disease, including subcutaneous nodules, anemia, vasculitic processes, entrapment neuropathy, interstitial nephritis, and effusions (pericardial and pleural). Treatment endeavors directed at patients with rheumatoid arthritis are listed in Table 8-12. Because there is so much loss, disability, and discomfort accompanying arthritic conditions, it is not surprising that significant mood disturbances can accompany the disorder. Depression appears to be the most prevalent psychological disturbance accompanying osteoarthritis and rheumatoid arthritis. Pain severity among patients with arthritis was found to be correlated with the presence of depression...

Helping Rheumatoid Arthritis

Rheumatoid arthritis is a serious and very painful disease that causes inflammation and stiffness of your joints. It's not the same as the ordinary sort of wear-and-tear arthritis some of us get. Some of the pain and swelling of rheumatoid arthritis comes from bad prostaglandins that are made from arachidonic acid which is an omega-6 fatty acid. For some patients, omega-3 oils seem to help counteract the bad prostaglandins and relieve the symptoms. The doses needed are fairly high, in the range of 3 grams of fish oil or flaxseed oil a day. Since rheumatoid arthritis is usually treated with powerful anti-inflammatory drugs that can have nasty side effects, omega-3 oils are certainly worth a

Scaphotrapeziotrapezoid osteoarthritis

Isolated STT arthritis is less common than SLAC patterns of arthritis 43,44 , and the etiology of STT arthritis is not as well understood. In Watson and Ballet's paper 1 , SLAC wrist accounted for 57 of arthritic wrists, whereas 27 of cases occurred between the scaphoid, trapezium, and trapezoid a combination of these two patterns occurred in 15 1 . Previous studies have associated STT arthritis with isolated sca-pholunate ligament disruption 35 . Cope 45 demonstrated in a cadaveric study that abnormal scaphoid rotation, rotatory subluxation of the scaphoid, is prevented if the scaphotrapezial and radiocarpal ligaments are intact, even if the sca-pholunate interosseous ligament is disrupted. With disruption of all of these ligaments, the resulting rotatory subluxation of the scaphoid leads to abnormal pressures on the radioscaphoid articulation and eventual arthritis of the radiocarpal joint 45 . Consistent with this concept of isolated scapholunate ligament injury leading to STT...

Other medical therapies for osteoarthritis of the knee

Intra-articular hyaluronan is an alternative to NSAID therapy in the treatment of osteoarthritis of the knee. Intra-articular hyaluronan for knee osteoarthritis reduces pain similarly to NSAIDs. VI. Surgical therapies. Joint lavage and arthroscopic debridement are options for patients with osteoarthritis of the knee who have not responded to pharmacologic therapy. Carefully selected patients with osteoarthritis of the knee or hip may benefit from an osteotomy. Osteotomies can provide pain relief in patients who are not candidates for total joint arthroplasty.

Blocking Il1 In Patients With Rheumatoid Arthritis With The Il1 Receptor Antagonist

The basic concept of inhibition of ICE to reduce the processing and secretion of IL-ip in disease states received a great deal of support following the publication of clinical trials of IL-1 receptor antagonist (IL-IRa) in patients with rheumatoid arthritis and graft versus host disease. Also, the importance of endogenous IL-IRa in patients with rheumatoid arthritis is supported by a study using the administration of soluble IL-1R type I to these patients. Since the soluble form of IL-1R type I binds IL-IRa with a greater and near irreversible affinity than that of IL-1 a or IL-ip, the use of the soluble IL-1R type in humans worsened disease in these patients (21). Although IL-iRa was used in three trials to reduce 28-day mortality in sepsis, the overall success of any anticytokine-based therapy in this patient population precludes any conclusion whether the anticytokine is effective (22-24). In each of these three trials, there was clear evidence of improved outcome in subgroups...

Introduction What is Osteoarthritis

Osteoarthritis (OA) is defined by the American College of Rheumatology as a heterogeneous group of conditions that lead to joint symptoms and signs which are associated with defective integrity of articular cartilage, in addition to related changes in the underlying bone at the joint margins. Osteoarthritis is usually classified as primary or idiopathic when there is no obvious predisposing cause, and secondary when there is some clearly defined predisposing pathology 6 . Idiopathic OA is the most common form of arthritis and is a debilitating progressive disease that affects 60 of men and 70 of women over the age of 65 79 with enormous socioeconomic costs, rivaling those of ischemic heart disease. As the Baby Boomers reach middle age and obesity is on the increase in the general population, OA will have an even greater impact on society in the future. Primary OA is a frustrating disease for both patient and clinician, because neither cause nor cure is known and, once started, the...

Pivotal Studies in Rheumatoid Arthritis

Rheumatoid arthritis Psoriatic arthritis Juvenile idiopathic arthritis (Lovell et al. 2004) Under investigation (phase III) a Based on approved labeling from the European Agency for Evaluation of Medicinal Products indications in other areas may differ AS ankylosing spondylitis, DMARDs disease-modifying antirheumatic drugs, EMEA European Agency for the Evaluation of Medicinal Products, e.o.w. every other week, FDA Food and Drug Administration, MTX methotrexate, PsA psoriatic arthritis, RA rheumatoid arthritis

Changes in Matrix Components During Osteoarthritis

(IX) collagen develop noninflammatory degenerative joint disease 28 . Mice deficient in both biglycan and fibromodulin develop severe and premature knee OA 7 , even though the cartilage defect may be secondary to tendon defects that cause subluxation of the joints. Genetic defects in the minor matrix components may cause OA in some instances, but not for most OA patients.

Collageninduced Arthritis CIA

Rheumatoid arthritis is the most common chronic inflammatory disease targeting peripheral joints. It causes progressive cartilage destruction and bone erosion around joints (Palmer, 1995). CIA is an experimental mouse model used for the study of human RA and is induced in genetically predisposed mice by immunization with bovine collagen II (bCII) emulsified in CFA as mentioned before. CD4+ T cells play a central role in disease induction in arthritis (Ranges et al., 1985). Both antigen specific helper T cells and antibodies isolated from arthritic animals are capable of transferring disease within susceptible mouse strains (Seki etal., 1988 Taylor etal., 1995). Suggesting both B and T lymphocytes are involved in the pathogenesis of CIA. As previously mentioned, CD137 CD137L interaction blockade showed only mild effect in preventing the development of CIA, however, CD137 agonist was capable to both prevent and treat established CIA. Similar as SLE, CD137 engagement with agonistic...

The Role of Cytokines in Animal Models of Osteoarthritis

Animal models have been developed to explore the roles of cytokines in OA pathogen-esis 18 , (see Chapter 9), and recent studies have examined OA susceptibility in transgenic or knockout mouse models with disrupted cytokine expression or signaling (Table 3.1). In the STR ort mouse that develops spontaneous OA, the catabolic cytokines are expressed in association with lesions 134 . In a number of animal models, delivery of an IL-1 receptor antagonist (IL-1Ra), a naturally occurring antagonist of IL-1, to affected joints by injection or gene transfer, ex vivo or in vivo, inhibits chondrocyte catabolism and cartilage degeneration (for review see 52,58,67,167,223 . In surgically induced models of OA, ex vivo or in vivo gene therapy for an adenoviral vector encoding IL-1Ra resulted in significant inhibition of cartilage degradation 62,245 . Paradoxically, gene deletion of IL-1 or IL-1 -converting enzyme (ICE) seems to accelerate the development of surgically induced knee OA in mice after...

Polyarthritis Table I13

Commonly presents as an afebrile obese boy in early adolescence with knee, thigh, or hip pain without arthritis restricted range of motion, with or without preceding minor trauma. Disseminated gonococcal infection Henoch-Schonlein purpura (HSP) Juvenile rheumatoid arthritis (JRA) Kawasaki disease Lyme disease Painful arthritis, new murmur or congestive heart failure, recent group A streptococcal infection Fever, vesicular or pustular rash, tenosynovitis Purpuric rash below waist Chronic or recurrent fever and rash See discussion under Differential Diagnosis, earlier Polyarthralgia or polyarthritis in early stages, recent tick bite, fever, malaise 5. LCPD. Commonly presents as a boy, aged 4-9 years, who has hip pain without arthritis but with a limp or leg-length discrepancy.

Gold therapy for rheumatoid arthritis

End Stage Lyme Disease Symptoms

Rheumatoid arthritis Patients undergoing Chrysotherapy may suffer from a wide variety of unpleasant and harmful side effects. These may include a metallic taste in the mouth, discolouration of the skin, dermatitis, diarrhoea, nausea, flushing, vomiting, bone marrow damage, etc. Such a range of difficulties begs the question, why use gold-based drugs The answer to this question is quite straightforward there is no cure for RA. Even though there are various classes of drugs available for the treatment of RA, it should be noted that treatment is designed to alleviate the symptoms of the disease, to reduce the swelling and pain, or even halt the progression of the disease, but there is no cure for RA. Amongst the classes of drugs employed in the treatment of RA are (i) Non-steroidal anti-inflammatory drugs (NSAIDS), which function by blocking the production of (bad) prostaglandins that promote inflammation and pain. Examples of NSAIDS include Advil (ibuprofen), Feldene (piroxicam) and...

Juvenile chronic arthritis

Juvenile chronic arthritis is defined as a chronic arthritis persisting for at least 3 months in one or more joints in a child less than 16 years of age. 4 It is rare, affecting only about one in 1000 children, but produces profound medical and psychosocial problems. The commonest types of juvenile chronic arthritis are oligoarthritis affecting four or fewer joints (about 50 ) and polyarthritis affecting five or more joints (about 40 ). Systemic onset arthritis, previously known as Still's disease, accounts for about 10 of cases. It is usually seen in children under the age of 5 but can occur throughout childhood. The children present with a high remittent fever and coppery red rash, plus other features including lymphadenopathy, splenomegaly and pericarditis. Arthritis is not an initial feature but develops ultimately, usually involving the small joints of the hands, wrists, knees, ankles and metatarsophalangeal joints.

Project Title Heart Disease In Rheumatoid Arthritis

Summary (Applicant's Abstract) The hypotheses to be tested in this proposal are built on findings from two intriguing, but rather disparate lines of investigation. The first is the recent data suggesting that the excess mortality experienced by people with rheumatoid arthritis (RA) may result from increased rates of coronary heart disease (CHD) among RA patients compared to the general population. The second is the rapidly growing body of evidence indicating that chronic systemic inflammation (such as that which occurs in RA) plays an important role of chronic inflammation in CHD. We propose 3 specific aims to investigate this subject First, we will use a cohort study to test the hypothesis that the incidence of acute MI (the central manifestation of CHD) is higher in RA subjects compared to controls. Second, we will identify high-risk RA subgroups and, using a novel adaptation of the case-cohort design, investigate interactions between RA and the major CHD risk factors (e.g. smoking,...

Rheumatoid Arthritis and Low Back Pain

A small literature has examined electrophysi-ological activity in the context of rheumatoid arthritis and low back pain. Regarding rheumatoid arthritis, research suggests that patients, in comparison to healthy control participants, show larger amplitude N1 and P2 responses following repetitive, painful stimulation (Hummel et al, 2000). While patients' neural responses to stimuli were significantly different from controls, patients and control participants showed similar responses as measured by a peripheral index of pain sensitivity. This was taken to indicate that central influences may play a primary role in the experience of pain in rheumatoid arthritis patients. Finally, continuous EEG recordings measured in patients with low back pain who received heat therapy showed decreased power in the beta-1 and beta-2 frequency bands in comparison to low back pain patients who received analgesic treatment (Kettenmann et al, 2007).

Osteoarthritis of the ankle joint

This may rarely occur as a primary disorder however, degenerative arthritis of the ankle joint is more commonly secondary to recurrent episodes of trauma from lateral ligament instability or from the sequelae of intra-articular fractures involving the ankle joint. It may also occur as a secondary phenomenon to avascular necrosis of the talar dome secondary to talar neck fractures. The long-term outcome of septic arthritis of the ankle joint which damages the articular cartilage may be degenerative osteoarthrosis.

Biomarkers For Osteoarthritis

Further research in this area to define and identify the role of biomarkers in the evaluation of knee osteoarthritis. Joint Structure, Osteoarthritis, and Aging The normal function of diarthrodial joints such as the knee involves providing a wide range of mobility while sustaining large forces that are multiples of the body's weight. For example, normal function of the knee during stair climbing requires the knee to flex in the range between 0 and 90 degrees while sustaining com-pressive forces on the articular surface that can exceed four times body weight. As previously discussed, the biology of cartilage is influenced by the mechanical environment of the joint. Thus, the intrinsic mechanical environment (force and motion) is an important consideration in the context of understanding the factors that influence the initiation and progression of osteo-arthritis. The intrinsic forces and motions at the joint are dependent on complex interactions between the shape of the articulating...

Functional Kinematics During Walking And Osteoarthritis

As previously discussed, functional joint loading can influence the health of articular cartilage and is ultimately associated with the progression of degenerative changes to cartilage. In addition, joint motion (kinematics) can influence the initiation of osteoarthritis (Andriacchi et al., 2004). For example, the anterior cruciate ligament (ACL) of the knee, one of the four major ligaments of the knee, provides translational and rotational stability to the joint. The ACL frequently is injured during sporting activity and is the most frequently reconstructed soft-tissue structure at the knee. The ACL-deficient knee provides a basis for examining the influence of abnormal kinematics on the initiation of knee osteoarthritis. There are numerous clinical studies (Buckland-Wright et al., 2000 Daniel et al., 1994 Lohmander and Roos, 1994 Roos et al., 1995) that report premature knee osteo-arthritis in chronic ACL-deficient knees and even in knees following reconstruction. Even though ACL...

Rheumatoid Arthritis Ra

Rheumatoid arthritis is a chronic polyarthritis of unknown cause affecting between 1 & and 3 of the population. The term 'arthritis' is to some extent misleading as this disorder is a multisystem disease which can affect a number of other organs e.g. heart, nervous system, eyes, kidneys, lungs. It is a debilitating disorder in which drugs are helpful but not curative and patients often have to learn to cope with chronic or episodic pain, fatigue and psychological distress. Drug treatment both with non-steroidal anti-inflammatory drugs and disease-modifying anti-rheumatic drugs (such as sulphasalazine, methotrexate or gold) carries high side-effect levels, which can hugely affect adherence (Gotzche, 1989). For this and other reasons RA patients are high users of complementary therapies (Astin, 2002).

Summary The Rheumatoid Arthritis

The pharmacokinetics of etanercept is similar across different adult populations, including women and the elderly, and across several inflammatory disease states. In addition, pharmacokinetic parameters in children receiving a weight-based dose are similar to those in adults. Etanercept has shown clinical efficacy in the treatment of rheumatoid arthritis, active polyarticular-course juvenile chronic arthritis, psoriatic arthritis, ankylosing spondylitis, and plaque psoriasis. Moreover, etanercept has demonstrated a similarly favorable safety profile across all indications.

Load Influences Healthy Cartilage And Cartilage With Osteoarthritis Differently

A recent study (Andriacchi et al., 2004) examined the relationship between loading and motion at the knee during walking and the response in healthy cartilage relative to cartilage with osteoarthritis. Healthy cartilage thickness increased on the medial condyle in subjects with a higher adduction moment based on a significant (P < 0.05) positive correlation between the ratio of medial to lateral condyle thickness and adduction moment (see Figure 77.7). In contrast, for osteoarthritic cartilage, the medial to lateral condyle thickness ratio decreased with an increase in the adduction moment. In patients with knee osteoarthritis, it has been shown that individual variations in the mechanics of walking can influence the rate of progression of knee osteoarthritis (Miyazaki et al., 2002) and the outcome of treatment for medial compartment osteoarthritis at the knee (Prodromos et al., 1985 Wang et al., 1990). For example, varus alignment of the knee has been related to the presence and...

Osteoarthritis Prevalence and Risk Factors

It is well known that OA differs in men and women. Men younger than 50 tend to be most affected by OA, whereas, in people over 50, two thirds of the OA patients tend to be women 69 . The reason for this is unclear. Osteoarthritis in younger men is considered to be an occupational disease. In contrast, the high incidence in postmenopausal women suggests that the change in hormonal status may play a role in the OA process. However studies dealing with the protective effect of estrogens show conflicting results (reviewed in 67,95,203 ). A study in cynomolgus monkeys has shown that long-term estrogen replacement therapy significantly reduces the severity of OA lesions 94 . These data conflict with a common notion that, as noted for many years, there is an inverse relationship between OA and osteoporosis 191 . However, considering the prevalence and characteristics of the two diseases, it would not be surprising if they coexisted on occasion 6 . Moreover, some patients present with...

Possible Interaction of Bone and Cartilage in Osteoarthritis

Routes of nutrient entry may coexist. Hence, bone-derived products may indeed drive cartilage metabolism 158,241 . Potential candidates are IGF-1, TGF- , and interleukin-1 and -6 (IL-1 , IL-6). The IGFs are important growth factors that regulate bone formation 103 . Osteoarthritic subchondral osteoblasts produce variable total IGF-1 levels and less IGF binding proteins compared to normal 101,148,150 . This results in higher levels of free IGF-1 that seem to promote bone remodeling 101,147 and increase bone stiffness, a situation that exacerbates cartilage matrix degradation 54 . Both TGF- and IGF-1 are involved in matrix deposition and turnover, with TGF- stimulating matrix synthesis 175 and collagenase activity, whereas IGF-1 inhibits matrix development in bone cells 206 . The increase in growth factors is likely to favor matrix deposition in bone and to limit overall degradation. In this connection it is worth calling attention to a study in murine knee joints that showed that...

The Chondrocyte in Osteoarthritis

Osteoarthritis is defined largely as a disease of cartilage, since the chondrocytes, which constitute the unique cellular component of adult articular cartilage, are able to respond to mechanical injury, joint instability due to genetic factors, and biologic stimuli such as cytokines and growth and differentiation factors (Fig. 3.1). In young individuals without genetic abnormalities, biomechanical factors due to trauma are strongly implicated in initiating the OA lesion 95,114 , and mechanical disruption of the association between chon-drocytes and matrix may lead to changed metabolic responses in the chondrocyte 6,82 . The aberrant behavior of OA chondrocytes is reflected in the appearance of fibrillations, matrix depletion, cell clusters, and changes in quantity, distribution, or composition of matrix proteins 175 . In the early stages of OA, a transient increase in chondrocyte proliferation is associated with increased synthesis of cartilage matrix proteins. This is often...

Psoriatic Arthritis

Proximal Interphalangeal Joint Toe

The association of psoriasis with a specific type of arthritis is well established. Psoriatic arthritis may co-occur with, but is not related to, rheumatoid arthritis, and can be differentiated a symmetrical polyarthritic form may be encountered, strongly mimicking rheumatoid arthritis (Fig. 11.23). Psoriatic arthritis is relatively uncommon with a prevalence of probably no more than 5 (Hellgren 1969). The positiv-ity for HLA-B27 antigen in psoriasis ranges from 46 to 78 , which is relatively low compared to Reiter's syndrome and ankylosing spondyloarthropathy. The clinical onset is insidious in most cases, but in about one-third it may present with acute manifestation. Psoriatic arthritis affects both sexes nearly equally, with the peak incidence occurring between the mid-30s and mid-40s of life. The strong proclivity for the involvement of the distal interphalangeal joints of the hands and feet is an important, but not a sine qua non, finding (Resnick and Niwayama 1988). The...

MTcFdg Petct in Rheumatoid Arthritis

Pet Scan Rheumatoid Arthritis

The fact that 18F-FDG in inflamed joints was first reported by Yasuda et al. (1996) and, most recently, 18F-FDG PET-CT has been used for the diagnosis of early rheumatoid arthritis (Beckers et al. 2004). 18F-FDG PET-CT was systematically applied to the monitoring of disease activity by simultaneous multiarticular assessment. The knees and either the wrists and finger joints or the ankles and first metatarso-phalangeal joints were evaluated individually and globally (Fig. 10.9). Parameters derived from PET-CT and clinical, biological, and so-nographic parameters were correlated. This study has confirmed that metabolic activity is significantly increased in synovitis in active rheumatoid arthritic joints. The diagnostic use of 18F-FDG PET-CT is expected for more effective treatment of early rheumatoid synovitis. Figure 10.51 shows an incidental finding of 18F-FDG uptake in a patient with rheumatoid arthritis who developed diffuse large B-cell lymphoma of the colon as a complication of...

Nuclear Angiography in Rheumatoid Arthritis

Rheumatoid Arthritis Nuclear

Fig. 10.49 Value of whole-body bone scintigraphy in the diagnosis of juvenile rheumatoid arthritis. Anterior whole-body bone scan in an 18-year-old female with polyarthritis clearly shows prominent symmetrical multiarticular tracer uptake (arrows) Nuclear angiography is widely used for a dynamic assessment of vascular alteration in rheumatoid arthritis, especially in the early stage (Hopfner et al. 2002, 2004). As in any inflammatory or infective diseases of the skeleton, nuclear angiography provides unique information on the disease activity of rheumatoid arthritis using visual or quantitative analysis of the blood flow, blood pool, and tracer uptake Fig. 10.50A, B Nuclear angiography in rheumatoid arthritis. A Nuclear arteriogram of the right hand with rheumatoid arthritis shows areas of increased vascularity in the intercarpal and first through third carpometacar-pal joints (arrows). B Static bone scan reveals increased uptake in inflamed focus of rheumatoid arthritis (arrows) Fig....

Degenerative arthritis

The patient with peripheral or axial joint osteoarthritis will usually give a history of gradually increasing pain over months or years, with loss of movement of the joint. Early morning stiffness and pain is usually minimal but when present will usually settle with gentle use of the joint over Fig. S.1 Clinical features of reactive arthritis. Asymmetrical oligoarthritis Psoriatic arthritis Reactive arthritis (including Heifer's syndrome) Septic arthritis

Inflammatory Synovitis Rheumatoid Arthritis

Rheumatoid arthritis is the most common inflammatory arthritis, affecting 1-2 of the population. Onset of the disease is typically in the fourth and fifth decades of life. With current medical management, overall prognosis has improved, but unfortunately after 10-12 years with the disease, more than 80 of patients have evidence of some joint deformity. Juvenile rheumatoid arthritis (JRA), although not as common, involves the hip in approximately one third of children and adolescents, leading to pain, deformity, and lifetime disability.47 The hallmark of the disease in juvenile and adult patients is persistent immune system-mediated inflammatory synovitis of varying degrees. The resulting synovitis, when uncontrolled, can result in articular cartilage destruction, bony erosions, and subsequent deformities. In JRA, the growing proximal femur may become malformed secondary to the increased synovial blood flow associated with inflammation and synovitis, changing the mechanics of the joint...

Arthritis In Bloodvessel To The Brain

Coronal Plane

A clearer understanding of the precise steps of the aging process will emerge as researchers identify the roles of each of our genes. For example, many of the molecular and cellular changes of aging may be controlled by the action of one gene, called p21. Its protein product turns on and off about 90 other genes, whose specific actions promote the signs of older age. The p21 gene intervenes when cells are damaged by radiation or toxins, promoting their death, which prevents them from causing disease. It also stimulates production of proteins that are associated with particular disorders seen in aging, including atherosclerosis, Alzheimer disease, and arthritis.

Juvenile Rheumatoid Arthritis

Arthritis Bone Scan

Juvenile rheumatoid arthritis is one of the most common pediatric rheumatic disorders and a major cause of chronic disability and occasional crippling deformity. The clinical manifestations include synovitis of the peripheral joints with effusion and periarticular soft-tissue swelling. Onset is before 16 years of age, and overall prevalence is estimated tobe 113 100,000 Fig. 10.47A, B Insufficiency fractures and avascular bone necrosis in rheumatoid arthritis treated with corti-costeroids. A Anteroposterior radiograph of the right hip in a 34-year-old woman with rheumatoid arthritis shows peripheral sclerosis and central irregularity, suggesting microfractures and necrosis (arrowheads). Note that the volume of the femoral head is somewhat reduced. B Anterior pinhole scan reveals spotty hot areas in the periphery (arrows) and a cold area in the center of the femoral head, respectively denoting insufficiency fractures and avascular necrosis. Increased tracer uptake is also seen in the...

Arthritis and Artificial Joints

Severe Case Rheumatoid Arthritis

Arthritis26 is a broad term for pain and inflammation of a joint and embraces more than a hundred different diseases of largely obscure or unknown causes. In all of its forms, it is the most common crippling disease in the United States nearly everyone past middle age develops arthritis to some degree. Physicians who treat joint disorders are called rheumatologists. The most common form of arthritis is osteoarthritis (OA), also called wear-and-tear arthritis because it is apparently a normal consequence of years of wear on the joints. As joints age, the articular cartilage softens and degenerates. As the cartilage becomes roughened by wear, joint movement may be accompanied by crunching or crackling sounds called crepitus. OA affects especially the fingers, intervertebral joints, hips, and knees. As the articular cartilage wears away, exposed bone tissue often develops spurs that grow into the joint cavity, restrict movement, and cause pain. OA rarely occurs before age 40, but it...

Arthritis Human Error

In addition to her parents' health problems, Pamela was recently diagnosed with rheumatoid arthritis, a systemic, progressive condition that results in considerable fatigue and requires her to take seven different medications to treat inflammation, pain, and autoimmune activity. Her prognosis is good if she carefully adheres to her medication schedule and does not become overly fatigued however, this regimen is proving more difficult than she anticipated. Pamela recognizes that because of her extremely busy schedule, she has difficulty taking her medications at the right times of day, so although she understands what she needs to do with the medications, Pamela misses many doses. Pamela's medical errors are playing a role in her own debilitated health.

Joint Laxity And Osteoarthritis

The knee, a common site of osteoarthritis, provides a good illustration of the primary components of the joint that maintain joint stability and thus influence joint laxity. The major ligaments stabilizing the knee in translation and rotation are the anterior (ACL) and posterior (PCL) cruciate ligaments. The stiffness and elastic modulus of these ligaments decrease with age (Noyes and Grood, 1976 Woo et al., 1991). The major changes in muscle with age include reduced muscle activation (Stackhouse et al., 2001 Stevens et al., 2003), cross-sectional area (Frontera et al., 2000 Jubrias et al., 1997 Kent-Braun and Alexander, 1999), force per cross-sectional area (Jubrias et al., 1997), and maximum muscle strength (Frontera et al., 2000 Jubrias et al., 1997 Lindle et al., 1997). These age-associated changes in the properties of ligaments and muscle can cause increased joint laxity with age.

Arthroscopic Findings In The Initial Stages Of Hip Osteoarthritis

Osteodistrofia Hipertrofica

In a previous study,8 we reviewed records and radiographs of 234 hip arthro-scopies and compared intraoperative and radiographic findings. Sixty patients (32.2 ) of the 186 with normal preoperative radiographs had evidence of os-teoarthritis at the time of surgery. This evidence makes initial osteoarthritis the most likely cause of hip symptoms in young patients (average age, 36 years) with normal radiographic findings. One more interesting finding was the preponderance of female subjects (71 versus 29 ) in the group with normal radiographic findings. Quantification of the damage was obtained by dividing the acetabulum and the femoral head in quadrants. Hips with normal radiographic findings but arthroscopic osteoarthritis were found to have less chondral damage (1.9 quadrants) compared with those with radiographically evident osteoarthritis (4.2) quadrants. Hips with normal Hip osteoarthritis appears to begin on one of the two sides of the joint and not as...

Arthralgia arthritis and Reiters syndrome

Arthralgia is a common nonspecific symptom that can occur in any chronic illness, but some patients with HiV develop attacks of acute severe joint pain without any swelling. These attacks of acute arthral-gia often subside spontaneously over a few days. Several types of arthritis may occur. The most common is a type of arthritis that overlaps with reactive arthritis and Reiter's syndrome. Asymmetrical swelling of large joints such as knees and ankles and inflammation of tendons such as the Achilles tendon and of sites where tendons join bone (enthesi- tis) may occur. These are sometimes accompanied by other symptoms of Reiter's syndrome such as urethritis and conjunctivitis. Experts disagree whether the incidence of this type of arthritis is really increased by HIV infection. Some believe that HiV infection is often a marker for high-risk sexual behavior, and therefore the incidence of Reiter's syndrome would be expected to be higher because of this and not because of the HiV...

IL1Ra in Patients with Rheumatoid Arthritis

IL-1Ra was initially tested in a trial in 25 patients with rheumatoid arthritis. In the group receiving a single subcutaneous dose of 6 mg kg, there was a fall in the mean number of tender joints (P < .05) (25). In patients receiving 4 mg kg per day for 7 days, there was a reduction in the number of tender joints from 24 to 10, the erythrocyte sedimentation rate fell from 48 to 31, and C-reactive protein decreased from 2.9 to 1.9 g mL. In this group, the mean plasma concentration of IL-1Ra was 660 240 ng mL. A large double-blind, placebo-controlled multicenter trial of IL-1Ra in 472 patients with rheumatoid arthritis (RA) has been reported (27). The study comprised patients who had discontinued the use of disease-modifying agents such as gold and methotrexate 6 weeks prior to entry. Patients had active and severe RA (disease duration 8 years) and were recruited into a 24-week course of therapy into placebo or one of three IL-1Ra groups. Patients had stable disease of 2 or more...

Streptococcal Cell Wall Arthritis

Streptococcal cell wall (SCW) arthritis in rats is an experimentally-induced inflammatory model with many features that resemble rheumatoid arthritis (RA) in humans. The model is used widely in studies of genetics, pathogenesis, and therapy of acute and chronic inflammation. Arthritis is induced in an appropriately susceptible inbred rat strain (Table 15.10.1) by an intraperitoneal injection of peptidoglycan-polysaccharide polymers (PG-PS), which are isolated from the sonicated cell walls of Streptococcus pyogenes, Group A, D58 strain. In addition to arthritis, intraperitoneal injection of Group A SCW PG-PS may also induce hepatic, splenic, and peritoneal granulomas. SCW PG-PS-induced responses are considered representative of several naturally occurring inflammatory disorders. In this unit, Lewis rats, a highly susceptible inbred rat strain, are injected with an aqueous suspension of Group A SCW PG-PS and observed daily for the development of arthritis for the first 6 days and then...

Sleep and Cytokines in Rheumatoid Arthritis

The prevalence of sleep disturbance can be quite high in autoimmune disorders for example, 50 of multiple sclerosis patients report clinically relevant sleep complaints (Fleming and Pollak 2005) as do 61 of systemic lupus patients (Tench, McCurdie, White, and D'Cruz 2000). Perhaps the highest prevalence is in rheumatoid arthritis (RA) patients, between 50 and 75 of patients complain of difficulties initiating or maintaining sleep (Drewes 1999). Fatigue is a debilitating symptom in each of these conditions, and studies show that poor sleep is significant predictor of fatigue, often more so than other disease-specific variables (Nicassio, Moxham, Schuman, and Gevirtz 2002). Although the underlying causes of sleep difficulties can include medication effects as well as chronic pain, studies with RA patients are indicating that inflammatory cytokines might be important promoters of sleep dysregulation.

Approach To Osteoarthritis

Patients with OA often experience joint stiffness, which occurs with activity or after inactivity (gel phenomena) and lasts less than 15-30 minutes. This is in contrast to the morning stiffness of patients with an inflammatory arthritis (e.g., rheumatoid arthritis, which often lasts for 1-2 hours and often requires warming, such as soaking in a hot tub, to improve. Early in the disease, there are no obvious findings. There may be some crepitus (creaking sound) in the joint, and. unlike inflammatory arthritis, there is often no or minimal tissue swelling (except in the most advanced disease). Bony prominences, especially in the DIP PIP joints, can occur later. Figure 22-1 shows a typical joint involvement in OA versus rheumatoid arthritis. Pain seen in OA typically can be reproduced with passive motion of the joint. Table 56-1 lists the patterns of typical joint involvement.

Melatonin as a Circadian Immunoregulatory Signal in Adjuvant Arthritis

Our studies on melatonin role in arthritis have been mainly addressed to examine the participation of melatonin in regulation of circadian rhythmicity of immune parameters in rats (Castrillon et al. 2001). Pretreatment for 11 days with a pharmacological dose of melatonin (100 g) affected some aspects of the early phase of the immune response elicited by FCA injection, at the preclinical phase of disease. Cell proliferation in rat submaxillary lymph nodes and spleen during the immune reaction (as assessed by ODC activity) exhibited a pineal-dependent diurnal rhythmicity, as it was reduced by pinealectomy or pineal sympathetic denervation (Cardinali, Cutrera, Castrillon, and Esquifino 1996b Cardinali, Cutrera, Garcia Bonacho, and Esquifino 1997a). This effect was counteracted by a pharmacological melatonin dose (100 g day). Exogenous melatonin also restored the reduced amplitude in diurnal rhythms of lymph node or splenic tyrosine hydroxylase (TH) activity and lymph node acetylcholine...

The Role of Cytokines in Osteoarthritis

Osteoarthritis Cytokines

Inflammation and accompanying dysregulated cytokine catabolic activities play key roles in OA pathogenesis in addition to the effects of age and excessive mechanical loading (for review, see 70,74,121 (Fig. 3.2). Osteoarthritis is not considered a classical inflammatory arthropathy, because of the absence of neutrophils in the synovial fluid and the lack of systemic manifestations of inflammation. Nevertheless, synovial inflammation is common in both early and late stages of OA 19 . The expression of proinflammatory cytokines is observed in patients with early OA, and synovitis is common in advanced OA, where it involves infiltration of activated B cells and T lymphocytes 156 . There appears to exist a relationship between the levels in OA synovial fluids and joint tissues of catabolic enzymes and inflammatory mediators such as prostaglandins and nitric oxide and the levels of interleukin-1 Figure 3.2. The loss of balance between cartilage matrix degradation and synthesis in...

Septic arthritis See infective arthritis

Septic bursitis Bursas, or small sacs lined with synovial cells close to joints and tendons, can become inflamed as part of most types of inflammatory arthritis but can also become infected with bacteria. Usually bacteria gain access to the bursa through superficial skin abrasions that can occur as part of usual day-to-day activities. The olec ranon (over the elbow) and the prepatellar (in front of the kneecap) bursas become infected most frequently. Rotator cuff syndrome rotator cuff syndrome is the most common disorder seen, especially in those of middle age or the elderly. While most commonly seen as an isolated condition, it not infrequently complicates other forms of arthritis, especially rheumatoid arthritis. It is discussed elsewhere. Glenohumeral arthritis Arthritis of the gleno-humeral joint occurs in a various conditions. Longstanding rheumatoid arthritis very frequently causes some secondary osteoarthritis here. gout occasionally occurs, and hydroxyapatite-related arthritis...

Scw Pg-ps 10s Rat Arthritis Model

Gender differences, however, are less apparent when relatively high doses of cell walls are injected. Normal euthymic and athymic Lewis rats have also been studied extensively (Case et al., 1989 Sano et al., 1990, 1992, 1993 Wilder et al., 1987). Compared to euthymic Lewis rats, athymic Lewis rats develop severe, acute transient arthritis, but chronic disease is markedly blunted, indicating that acute disease is thy-mus-independent, whereas chronic disease is highly influenced by thymus-dependent mechanisms. These differences in host susceptibility have been evaluated in the context of numerous cytokines and other inflammatory mediators (Allen et al., 1983 Bristol et al., 1993 Case et al., 1989 Crofford et al., 1992 Lafyatis et al., 1989 Sano et al., 1990, 1992, 1993 Sternberg et al., 1989a Wilder et al., 1987). Although chronic SCW arthritis is clearly generated by immunopathogenic mechanisms, a major unresolved issue is the identity of an-tigenic targets of the...

Rheumatoid Arthritis309

Rheumatoid arthritis is a chronic autoimmune disease in which the immune system attacks the synovial tissue, the membrane that lines the joints. It is the second most common form of arthritis and usually appears between ages 20 and 40. Although the cause of rheumatoid arthritis is unknown, there is a genetic component if a close relative is affected, you are more likely to develop the disease. There is no known cure. In rheumatoid arthritis, the fluid that lubricates the joints contains irritating chemicals that attack and damage the surfaces of the joints. The inflamed membrane swells and thickens, causing a wearing away of the joint cartilage, which leads to erosion of the bone and weakening of supporting tendons, ligaments, and muscles. The small joints in the hands, wrists, feet, ankles, and neck are most frequently affected, but the hips and the knees also can be affected. In most cases, more than one joint is affected and usually the same joints are affected on both sides, such...

Stills disease See juvenile arthritis

The most common cause of abnormal bones giving rise to stress fractures is osteoporosis. Patients with rheumatoid arthritis and osteoporosis seem to be at particular risk of stress fractures. This may relate to the deformities many rheumatoid patients develop, leading to abnormal stresses being put on bones as well as the high use of corticosteroids. Other bone diseases such as osteomalacia, paget's disease, and alcohol abuse are well-recognized causes. Some patients with hypermobility syndrome have bony fragility and develop stress fractures. When a typical site is affected in an athlete the diagnosis is usually suspected immediately, often by the athlete. However, in a patient with active arthritis the lack of obvious trauma and presence of painful joints may lead to a stress fracture being overlooked initially. When it affects a long bone a very tender

Rheumatoid Arthritis Attacks Joints

Rheumatoid arthritis is a common autoimmune disorder, most often affecting women from 40 to 60 years old. The major symptom is chronic inflammation of the joints, although the hematologic, cardiovascular, and respiratory systems are also frequently affected. Many individuals with rheumatoid arthritis produce a group of auto-antibodies called rheumatoid factors that are reactive with determinants in the Fc region of IgG. The classic rheumatoid factor is an IgM antibody with that reactivity. Such auto-antibodies bind to normal circulating IgG, forming IgM-IgG complexes that are deposited in the joints. These immune complexes can activate the complement cascade, resulting in a type III hypersensitive reaction, which leads to chronic inflammation of the joints.

Assessment Of Arthritis In The Mouse And

The presence or absence of arthritis in both the mouse and rat model is relatively easy to ascertain. In both rodent models, any or all of the four paws can be affected. The inflammation at its peak extends from the ankle all the way through the digits and is characterized by extreme swelling and erythema. Once arthritis appears, each paw is examined two to three times a week. It is not uncommon to see a normal-looking limb one day, yet find it greatly swollen the next. Although the arthritis is monophasic, severe arthritis may result in ankylosing of the joint. The biggest difficulty in characterizing the arthritis is evaluating the severity of the inflammation. The most widely used system is a simple visual scoring of 0 to 4 (Table 15.5.3) where a score of 1 indicates minimal inflammation and 4 represents extensive Table 15.5.3 Visual Scoring System for Evaluating Arthritis Severity in Cia Rodent Models Table 15.5.3 Visual Scoring System for Evaluating Arthritis Severity in Cia...

Osteoarthritis and the ACL Deficient Knee

There are three clinical presentations with combined ACL laxity and medial compartment osteoarthritis. The first is the patient with primarily ACL laxity symptoms that is, recurrent giving way and mild activity related pain. This is best treated with an ACL reconstruction alone. The second is the patient with more severe osteoarthritis and ACL laxity. The symptoms are pain and giving way associated with a varus knee and medial compartment narrowing on the standing X-rays. This patient should be managed with a combined ACL reconstruction and tibial osteotomy done at the same sitting. It is acceptable to stage the osteotomy as the initial procedure, followed by the ligament reconstruction six months later. The third scenario is the patient with advanced medial compartment osteoarthritis and residual ACL laxity. The injury usually is long standing the knee is in varus, but lacks extension. The patient at this point has pain, but not giving way. The best treatment is a tibial osteotomy....

Other Common Sites of Osteoarthritis

Osteoarthritis commonly affects the symphysis pubis, the interphalangeal joints of the hands and feet, and the sesamoidometatarsal joint of the great toe with hallux valgus (Resnick 2002) as well as the type II accessory bone of the navicular bone (Lawson et al. 1984). As elsewhere, common radiographic features include bone erosions, eburnation, articular narrowing, and cystic formation. Scintigraphy shows increased uptake and articular narrowing. Not infrequently, the scintigraphic changes appear more prominent and impressive than the radiographic changes, especially in the early stage.

Syndrome of Pyogenic Arthritis Pyoderma Gangrenosum and Acne

Patients with certain mutations in the coiled-coil domain of PSTPIP1 have a condition called the syndrome of pyogenic arthritis, pyoderma gangrenosum, and acne (PAPA), an autosomal dominant disease associated with deforming, sterile arthropathy, severe cutaneous ulcers with pathergic reactions at sites of minor trauma (pyoderma gangrenosum), and cystic acne (Wise et al. 2002). PAPA mutations in PSTPIP1 attenuate its association with protein tyrosine phosphatase with a PEST (proline, glutamate, serine, threonine) domain (PTP-PEST) (Spencer et al. 1997 Wise et al. 2002 Badour et al. 2004), resulting in hyperphosphorylation of PSTPIP1 (Cote et al. 2002). Hyperphos-phorylation in turn increases the strength of the interaction between pyrin and PSTPIP1 (Shoham et al. 2003), perhaps preventing pyrin from exerting negative regulatory effects on the innate immune response.

Rheumatoid Arthritis Hydrogen Peroxide

A continuous and long-term deficiency in antioxidants is believed to be responsible for the etiology of many diseases,1-3 including the neurodegenerative disorders Alzheimer's disease, Parkinson's disease, amyotrophic lateral sclerosis, Huntington's chorea, as well as a variety of inflammatory diseases such as atherosclerosis, diabetes, arthritis, and the aging process itself. Even diseases such as cancer and certain viral infections are exacerbated by a deficiency in antioxidants. Human papilloma virus (HPV) can cause genital warts, various types of cancer, and is a major risk factor in squamous cell carcinoma. The multiplication and possibly the transformation of HPV is inhibited by high levels of antioxidants, both in vitro and in vivo. , These diseases are linked to oxidative stress, a term coined by Seis,6 which is an imbalance in the ratio of oxidants to antioxidants, where oxidants predominate in the body. Raising the level of different antioxidants can provide some protection...

Infection Septic Arthritis

Hip joint infection and septic arthritis, although most common in growing children, is becoming more prevalent in the adult population due to the growing number of elderly, disabled, and immunosuppressed patients, and those with chronic systemic illnesses. The ramifications of sepsis in this major weightbearing joint can result in lifelong disability for a child, and can be responsible for the loss of independence and or demise of an adult if not recognized and treated early. Evrard has reported a 13 incidence of mortality from hip joint infection in the adult.104 This seemingly high mortality rate in adults may be secondary to concurrent medical issues or underlying hip disease that make diagnosis difficult and often impede appropriate, early aggressive surgical treatment. Although the rate of pediatric hip infections is not likely to increase, society's growing elderly, debilitated, and immuno-

Arthritis Relief Now

Arthritis Relief Now

When you hear the word arthritis, images of painful hands and joints comes into play. Few people fully understand arthritis and this guide is dedicated to anyone suffering with this chronic condition and wants relief now.

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