Arthritis

Updated 21 December 2015

Rheumatic diseases - from Natural Standard

Rheumatic diseases are illnesses that cause long-term inflammation and loss of function of one or more structures that help support the body.

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BACKGROUND

Examples of supportive structures include connective tissues, tendons, ligaments, and the cartilage and bones that make up joints.

There are more than 100 types of rheumatic diseases. Examples of common rheumatic diseases include bursitis, fibromyalgia, juvenile rheumatoid arthritis, osteoarthritis, rheumatoid arthritis, spondyloarthropathies, and systemic lupus erythematosus (SLE). Although each disease is unique, common symptoms include pain, stiffness, and swelling. These symptoms affect different body parts, depending on the specific disease. Some rheumatic diseases may affect internal organs.

There are currently no cures for fibromyalgia, osteoarthritis, rheumatoid arthritis, spondyloarthropathies, or systemic lupus erythematosus (SLE). However, many treatments are available to manage symptoms. Treatment primarily focuses on reducing inflammation and relieving pain. Patients with bursitis usually recover completely after a few weeks of treatment to reduce swelling. Juvenile rheumatoid arthritis (JRA) usually goes away on its own after several months or years. Patients may take medications to reduce symptoms until the condition resolves on its own.

COMMON TYPES AND CAUSES OF RHEUMATIC DISEASES

Bursitis: Bursitis occurs when the fluid-filled sacs (bursae) that lubricate and cushion the joints become inflamed. As a result, bursitis causes pain, especially when the patient tries to move the affected joint.

Bursitis usually affects the shoulders, elbows, or hips, but it may affect many other joints throughout the body.

Bursitis may be caused by arthritis in the joint, injury, or infection of the bursae.

Fibromyalgia: Fibromyalgia, formerly called chronic muscle pain syndrome, psychogenic rheumatism, and tension myalgias, causes pain and fatigue in the muscles, ligaments, and tendons.

It remains unknown what causes fibromyalgia. Researchers believe that several factors, including sleep disturbances, injury, abnormalities in the nervous system, and changes in the muscle metabolism, may lead to the development of fibromyalgia.

Osteoarthritis: Osteoarthritis, also called degenerative joint disease, occurs when the cartilage in the joints breaks down. The cartilage serves as a cushion between bones, allowing the joint to move without pain. Therefore, patients with osteoarthritis experience pain and reduced mobility in their joints. Osteoarthritis may affect any joint in the body. Osteoarthritis occurs most often in individuals older than 45 years, but it may develop at any age.

The exact cause of osteoarthritis remains unknown. Most researchers believe that several factors, including obesity, age, joint injury or stress, genetics, and muscle weakness, may contribute to the development of osteoarthritis.

Rheumatoid arthritis: Rheumatoid arthritis is an autoimmune disorder that occurs when the body's immune system, which normally fights against disease and infection, attacks itself. Unlike osteoarthritis, which only affects the bones and cartilage, rheumatoid arthritis may also cause swelling in other areas of the body, including the tear ducts, salivary glands, the lining of the heart, the lungs, and occasionally, blood vessels

Women are two to three times more likely to develop rheumatoid arthritis than men. Most cases of rheumatoid arthritis occur in individuals who are 20-50 years old.

Some researchers believe that this autoimmune process is triggered by an infection with a virus or bacterium. Genetics may also play a role in the development of rheumatoid arthritis.

Juvenile rheumatoid arthritis (JRA): Juvenile rheumatoid arthritis (JRA) is a type of rheumatoid arthritis that develops in children between the ages of six months and 12 years of age. Unlike rheumatoid arthritis that develops in adults, JRA is usually a temporary condition that subsides after several months or years.

There are three major types of juvenile rheumatoid arthritis: pauciarticular JRA, polyarticular JRA, and systemic JRA. Pauciarticular JRA affects four or fewer joints, especially the knees or wrists. Polyarticular JRA causes swelling and pain in five or more joints, especially the hands, feet, knees, hips, feet, ankles, and neck. Systemic JRA affects the entire body. Multiple joints are swollen, painful, and stiff.

Researchers believe that JRA, like rheumatoid arthritis, is a type of autoimmune disorder. It remains unknown what triggers this autoimmune reaction in patients. It has been suggested that an infection or heredity may be involved in the development of JRA.

Spondyloarthropathies: Spondyloarthropathies are a group of rheumatic diseases that primarily affect the spine. Some of the most common spondyloarthropathies include ankylosing spondylitis, Reiter's syndrome, and psoriatic arthritis. These disorders cause the joints and bones to become inflamed, causing pain and stiffness.

Researchers have not discovered what causes spondyloarthropathies. However, certain genetic mutations have been linked to the disorders. This suggests that some spondyloarthropathies may be passed down within families (inherited).

Systemic lupus erythematosus (SLE): Systemic lupus erythematosus (SLE) is an autoimmune disease that causes chronic inflammation. When only the skin is involved, the condition is called discoid lupus. When internal organs are involved, the condition is called systemic lupus erythematosus (SLE). One or more organs may be involved with SLE. Some cases of discoid lupus may progress to SLE. Researchers estimate that about 10% of discoid lupus patients eventually develop SLE.

The exact cause of lupus remains unknown. Researchers believe that genetics may be involved because individuals who have family histories of lupus are more likely to develop the disease than those who do not. Also, it is more common in African Americans and individuals of Japanese or Chinese descent.

The use of certain medications, including hydralazine, guanidine, procainamide, phenytoin, isoniazide, and d-penicillamine, has also been associated with SLE. Drug-induced lupus resolves once the offending medication is discontinued.

Hormones may also play a role since females are more likely to develop SLE than males.

SIGNS AND SYMPTOMS

Bursitis: Patients with bursitis generally experience a dull ache or pain of the affected joint that worsens during movement. The affected joint may feel swollen or warm to the touch. The joint may also be red in color.

Fibromyalgia: Symptoms of fibromyalgia may vary, depending on the weather, time of day, physical activity, and stress levels. Patients generally experience pain and stiffness throughout their bodies. Common symptoms include fatigue, sleep disturbances, irritable bowel syndrome (IBS), headaches, facial pain, and increased sensitivity. Other symptoms may include depression, difficulty concentrating, chest pain, numbness or tingling sensations in the hands or feet (paresthesia), anxiety, painful menstrual periods, dizziness, as well as dry eyes, skin, or mouth.

Osteoarthritis: Because osteoarthritis develops slowly, many patients do not experience symptoms right away. Once symptoms develop, they are generally the worst during the first year of the disease. Common symptoms include joint pain (arthraglia), swelling and/or stiffness in a joint (especially after use), joint discomfort before or during a change in the weather, bony lumps on the fingers, and loss of joint flexibility. The joints that are most often affected by osteoarthritis include the fingers, spine, and weight-bearing joints, such as the hips, ankles, feet, and knees.

If patients overuse the affected joints and do not receive treatment, the cartilage in the joints may wear down completely. When this happens, the bone may rub against bone, causing severe pain.

Rheumatoid arthritis: Rheumatoid arthritis often affects many joints at the same time. The severity of symptoms varies among patients. Symptoms, which may come and go, typically include pain and swelling in the joints (especially in the hands and feet), generalized aching or stiffness of the joints and muscles (especially after periods of rest), loss of motion of the affected joints, weakness in the muscles near the affected joints, low-grade fever, and general feeling of discomfort. In general, both sides of the body are affected equally. For instance, if arthritis is in the hands, both hands will be equally affected. Early in the disease, the joints in the hands, wrists, feet, and knees are most frequently affected. Over time, arthritis may develop in the shoulders, elbows, jaw, hips, and neck.

Eventually, the joints may become deformed. Small lumps, called rheumatoid nodules, may develop under the skin at pressure points. These lumps, which range from the size of a pea to a quarter, may be visible near the elbows, hands, feet, Achilles tendons, back of the scalp, knee, or lungs. Rheumatoid nodules are not painful. However, bone deformities or swelling may reduce the flexibility of the joints.

In addition to the joints, other areas of the body may also be affected. Rheumatoid arthritis may cause swelling in the tear ducts, salivary glands, the lining of the heart, the lungs, and occasionally, blood vessels.

Juvenile rheumatoid arthritis (JRA): In general, patients with juvenile rheumatoid arthritis (JRA) experience swelling, pain, and stiffness in the affected joints.

Pauciarticular JRA affects four or fewer joints. Additional symptoms may include inflammation of the colored part of the eye (iris).

Polyarticular JRA affects five or more joints at one time. Additional symptoms may include low-grade fever and bumps or nodules on affected joints.

Systemic JRA affects the entire body. Patients may develop high fevers that develop suddenly during the evening and then drop to normal. During a fever, patients may have a pale complexion, feel ill, or develop a rash. The spleen and lymph nodes may also become enlarged.

Spondyloarthropathies: Spondyloarthropathies primarily affect the spine. These disorders cause the bones and joints to become inflamed. As a result, patients typically suffer from pain and joint stiffness. The pain may be the worst during the morning and it may improve during the day and after exercise. Many patients also experience fatigue.

Systemic lupus erythematosus (SLE): Symptoms of systemic lupus erythematosus (SLE) vary, depending on the affected parts of the body. More than 90% of lupus patients experience symptoms that affect the skin. The classic lupus rash, which is characterized by reddened cheeks and nose (butterfly rash), is usually triggered by sun exposure. Patients may develop red and scaly patches of skin on the face and scalp that can lead to scarring and temporary hair loss.

Some lupus patients may experience joint pain (especially of the hand, knees, and wrists), muscle weakness, and muscle pain.

High blood pressure or blood in the urine may develop if the kidneys are affected.

Patients may develop inflammation of the sac that surrounds the heart (pericarditis), which may cause chest pain. Abnormal tissue growth can form on the heart valves. Hardening of the arteries can lead to chest pain and heart attacks. Some patients may not receive enough blood supply to their hands when they are exposed to cold temperatures. This condition, called Raynaud's phenomenon, causes whiteness and blueness in the fingers.

Some SLE patients experience brain and nerve problems, which may cause seizures, nerve paralysis, severe depression, psychosis (loss of contact with reality), and stroke. In rare cases, patients may experience spinal cord inflammation, which can lead to paralysis.

If the lungs are affected, the most common problem is inflammation of the lining of the lung (pleurisy), which may cause chest pain and shortness of breath. Pleural effusions, which are collections of water between the lung and chest wall, may also occur.

About half of lupus patients are anemic (low red blood cell counts), and up to half have thrombocytopenia (low platelet counts) and leukopenia (low white blood cell count). Common symptoms of thrombocytopenia include bleeding, bruising, and blood clots.

Many SLE patients develop painless ulcers in the mouth and nose. When lupus involves the intestines, patients often experience abdominal pain.

COMPLICATIONS

Cosmetic concerns: Arthritis may cause small bumps, called nodules, to form on bones. These bumps can occur on any joint, but they are most common in the hands. These nodules may be disfiguring.

Depression: Some patients with rheumatic diseases may suffer from depression. This may happen if the arthritis interferes significantly with the patient's lifestyle. Patients should consult their healthcare providers if they experience feelings of sadness, low self-esteem, loss of pleasure, or apathy. Sometimes patients will have difficulty functioning for two weeks or longer, with no known underlying cause. These may be signs of depression.

Joint damage: In some cases, arthritis may lead to severe joint damage. In these cases, surgery, such as a joint replacement, may be necessary. Patients should regularly visit their healthcare providers to monitor their conditions.

Limited mobility: Patients with arthritis may have limited mobility in their joints. Joint mobility decreases as the joint becomes more damaged. If arthritis is not properly managed with medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs), arthritis may interfere with a patient's daily life.

Pain: Rheumatic diseases may cause severe and/or long-term pain. Patients should stay in close contact with their healthcare providers to ensure that their medications are properly managing the pain. In some cases, the medication or dosage may need to be changed over time.

Tendonitis: Tendonitis describes inflammation or irritation of a tendon or ligament. Although the most common cause of tendonitis is overuse of tendons or ligaments, it may also result as a complication of rheumatic diseases, such as rheumatoid arthritis.

DIAGNOSIS

General: Once patients are diagnosed with rheumatic diseases, they should visit their healthcare providers regularly, at least once a year. Patients should stay in close contact with their physicians to prevent complications and ensure that their symptoms are properly managed.

Bursitis: Bursitis is diagnosed after a physical examination. If the bursae are tender and swollen, and there is pain in the nearby muscles and tendons when the joint is used, a positive diagnosis is made.

Fibromyalgia: Fibromyalgia is a difficult condition to diagnose. Healthcare providers will typically perform many tests, including X-rays and computerized tomography (CT) scans to rule out other conditions. The American College of Rheumatology has established guidelines for diagnosing fibromyalgia. According to these guidelines, patients must have aching pain throughout the body for at least three months. Patients must also have at least 11 parts of the body that are unusually sensitive when mild, firm pressure is applied. However, some healthcare providers consider the guidelines to be too strict, and they may diagnose the condition even if the patient does not meet all of the criteria.

Osteoarthritis: X-rays are often the first test performed if a patient has symptoms of osteoarthritis. If the patient has osteoarthritis, the X-ray images will often show loss of cartilage in the affected joints, narrowing of the space between bones, and bumps called nodules.

A procedure called arthrocentesis may also be performed at a healthcare provider's office. During the procedure, a needle is inserted into the affected joint and a small sample of fluid is removed. The fluid is then analyzed to rule out other conditions, such as gout or infection. This test may also temporarily relieve some pain and inflammation in the joint.

A surgical procedure called arthroscopy may also be performed. During the surgery, a small incision is made into the affected joint. Then a tube called an arthroscope is inserted into the joint. This tube has a small light and camera that allows the healthcare provider to see the inside of the joint. If abnormalities, including cartilage or ligament damage, are seen, the patient is diagnosed with osteoarthritis.

Rheumatoid arthritis and juvenile rheumatoid arthritis (JRA): A blood test may be performed to determine if an antibody called the rheumatoid factor is present. Most patients with rheumatoid arthritis eventually have this abnormal protein in their blood. However, it may not present when symptoms first develop. If rheumatoid factor is present, a positive diagnosis is made. If patients test negative, but rheumatoid arthritis is suspected, a healthcare provider may recommend treatment to reduce symptoms. Another test may be performed in the future to confirm a diagnosis.

Spondyloarthropathies: There are no specific diagnostic tests for spondyloarthropathies. A diagnosis is typically made after a detailed medical history and physical examination.

Systemic lupus erythematosus (SLE): The American College of Rheumatology has developed 11 criteria for the diagnosis of lupus. Individuals are diagnosed if they meet four of the 11 criteria.

1) A malar rash is a butterfly-shaped, red rash on the cheek and nose.

2) A discoid rash is characterized by red and scaly patches of skin on the face and scalp that can lead to scarring and temporary hair loss.

3) Sensitivity to light (photosensitivity) occurs when the patient experiences a skin rash in response to ultraviolet light or sun exposure.

4) Painless ulcers may be present in the mouth or nose.

5) Patients may have swollen or tender joints.

6) If serositis, or inflammation of the membranes that cover the lung, heart and abdomen, is observed, lupus may be indicated.

7) High blood pressure, loss of protein in the urine, or a microscopic analysis of the urine demonstrates inflammation of the kidneys.

8) Neurologic disorders, which may cause seizures, nerve paralysis, severe depression, psychosis (loss of contact with reality), and strokes, may occur in lupus patients.

9) A complete blood count may be conducted to determine if the patient has low blood counts. Lupus patients may have low red blood cell counts (anemia), low platelet counts (thrombocytopenia), and/or low white blood cell counts (leukopenia).

10) Patients are tested to determine whether they have antibodies to DNA, a nuclear protein, or phospholipids. The presence of these antibodies indicates an autoimmune disease.

11) The fluorescent antinuclear antibody test (FANA) is a blood test that may be performed to determine if the patient has autoantibodies. Autoantibodies mistakenly attack body cells because they are identified as harmful invaders. Patients with autoantibodies have autoimmune disorders. Up to 98% of people with lupus have positive FANA test results.

MONITORING INFLAMMATION

General: In order to prevent complications, patients should regularly visit their healthcare providers. C-reactive protein (CRP) tests and erythrocyte sedimentation rate (ESR) tests are commonly used to monitor inflammation associated with rheumatic diseases.

C-reactive protein (CRP) test: The C-reactive protein (CRP) test can be used to monitor inflammation that is associated with rheumatic diseases. A high or increasing amount of CRP in the blood suggests that the patient has an acute infection or inflammation. In a healthy person, CRP is usually less than 10 milligrams per liter of blood. Most infections and inflammations result in CRP levels higher than 100 milligrams per liter of blood.

While the test is not specific enough to diagnose a particular disease, it can suggest an autoimmune disorder, and it can be used to help physicians monitor inflammation and determine if current treatments are effective.

Erythrocyte sedimentation rate (ESR): An erythrocyte sedimentation rate (ESR) test may be conducted to measure and monitor inflammation associated with rheumatic diseases. This blood test measures the rate at which red blood cells settle in unclotted blood.

During an inflammatory response, the high proportion of fibrinogen in the blood causes red blood cells to stick together. The red blood cells form stacks called rouleaux, which settle faster than normal. Elevated levels usually occur in patients who have rheumatic diseases.

A normal value for men younger than 50 years old is 15 millimeters per hour, and a normal value for men older than 50 is less than 20 millimeters per hour. The normal value for women who are less than 50 years old is less than 20 millimeters per hour, and the normal value for women older than 50 is less than 30 millimeters per hour.

Like the C-reactive protein test, an ESR test does not suggest a specific diagnosis. However, it is useful in detecting and monitoring rheumatic diseases and inflammation.

TREATMENT

General: There are currently no cures for fibromyalgia, osteoarthritis, rheumatoid arthritis, spondyloarthropathies, or systemic lupus erythematosus (SLE). However, many treatments are available to manage symptoms of pain and inflammation.

Patients with bursitis usually recover completely after a few weeks of treatment.

Juvenile rheumatoid arthritis (JRA) usually goes away on its own after several months or years. Patients may take medications to reduce symptoms until the condition resolves on its own.

Non-selective nonsteroidal anti-inflammatory drugs (NSAIDs): Nonsteroidal anti-inflammatory drugs (NSAIDs) have been used to relieve pain and inflammation caused by rheumatic diseases. Commonly used over-the-counter NSAIDs include ibuprofen (Advil© or Motrin©) and naproxen sodium (Aleve©). Higher doses of these drugs are also available by prescription. Commonly prescribed NSAIDs include diclofenac (Cataflam© or Voltaren©), nabumetone (Relafen©), and ketoprofen (Orudis©). NSAIDs may be taken by mouth, injected into a vein, or applied to the skin. These medications are generally taken long term to manage symptoms.

The frequency and severity of side effects vary depending on the specific NSAID used. The most common side effects include nausea, vomiting, diarrhea, constipation, decreased appetite, rash, dizziness, headache, and drowsiness. The most serious side effects include kidney failure, liver failure, ulcers, heart-related problems, and prolonged bleeding after an injury or surgery. About 15% of patients who receive long-term NSAID treatment develop ulcers in the stomach or duodenum.

Selective COX-2 inhibitors: Celecoxib (Celebrex©) has been taken by mouth to reduce pain and inflammation caused by rheumatic diseases, especially osteoarthritis or rheumatoid arthritis. Celecoxib is currently the only COX-2 inhibitor that is approved by the U.S. Food and Drug Administration (FDA). These drugs block the cyclooxygenase-2 (COX-2) enzyme, which stimulates inflammation. Celecoxib is generally taken long term to manage symptoms.

Like non-selective NSAIDs, COX-2 inhibitors have been linked to an increased risk of serious heart-related side effects, including heart attack and stroke. Selective COX-2 inhibitors have also been shown to increase the risk of stomach bleeding, fluid retention, kidney problems, and liver damage. Less serious side effects may include headache, indigestion, upper respiratory tract infection, diarrhea, sinus inflammation, stomach pain, and nausea

Pain relievers: Prescription pain relievers, including tramadol (Ultram©), have been used to reduce pain caused by osteoarthritis or rheumatoid arthritis. Although this drug, which is available by prescription, does not reduce swelling, it has been shown to reduce pain and it has fewer side effects than NSAIDs. Tramadol is generally taken as a short-term treatment to reduce symptoms of flare-ups (sudden onset of symptoms).

Narcotic pain relievers, such as acetaminophen/codeine (Tylenol with Codeine©), hydrocodone/acetaminophen (Lorcet©, Lortab©, or Vicodi©), or oxycodone (OxyContin© or Roxicodone©), may be prescribed to treat severe arthritis pain. These drugs reduce certain chemicals in the brain that allow patients to feel pain. Although these drugs can effectively alleviate pain, they do not reduce swelling. Narcotic pain relievers are only used short-term to treat flare-ups. Common side effects include constipation, drowsiness, dry mouth, and difficulty urinating. Narcotic pain relievers should be used cautiously because patients may become addicted to them.

Topical pain relievers: Topical pain relievers are creams, ointments, gels, and sprays that are applied to the skin. These medications are absorbed through the skin. Many over-the-counter pain relievers may temporarily help reduce the pain caused by osteoarthritis. Products, such as Aspercreme©, Sportscreme©, Icy Hot©, and Ben-Gay©, may help reduce arthritis pain. Capsaicin cream, which is made from the seeds of hot peppers, may reduce pain in joints that are close to the skin surface, such as the fingers, knees, and elbows. Capsaicin-containing products may take several weeks to take effect.

Corticosteroids: Corticosteroids, such as prednisone (e.g. Deltasone©) and methylprednisolone (Medrol©), have been used to reduce inflammation and pain caused by rheumatic diseases, especially rheumatoid arthritis, and SLE. Corticosteroids reduce the body's immune response, which subsequently alleviates symptoms. These drugs are generally very effective when used short-term. However, if corticosteroids are used for many months to years, they may become less effective and serious side effects may develop. Side effects may include easy bruising, thinning of bones, cataracts, weight gain, a round face, and diabetes.

Occasionally, corticosteroids are used to treat patients with severe osteoarthritis. The medication is injected into the affected joints to reduce pain and inflammation.

Patients with bursitis may receive corticosteroid injections into affected joints to reduce pain and inflammation. This provides quick relief of symptoms. Most patients only require one injection to effectively treat bursitis.

Corticosteroids are usually prescribed for a certain amount of time, and then the patient is gradually tapered off the medication. Patients should not stop taking corticosteroids suddenly or change their dosages without first consulting their healthcare providers.

Immunosuppressants: Patients with rheumatic diseases, such as rheumatoid arthritis or SLE, may take prescription drugs called immunosuppressants. These medications weaken the body's immune system, which limits the amount of joint or tissue damage. Commonly prescribed immunosuppressants include leflunomide (Arava©), azathioprine (Imuran©), cyclosporine (Neoral© or Sandimmune©), and cyclophosphamide (Cytoxan©).

These medications may have serious side effects, including increased risk of infections, kidney problems, high blood pressure, and decreased levels of red blood cells. Other side effects may include increased hair growth, loss of appetite, vomiting, and upset stomach.

Disease-modifying antirheumatic drugs (DMARDs): During the early stages of rheumatoid arthritis, patients typically receive disease-modifying antirheumatic drugs (DMARDs) to limit the amount of permanent joint damage. They are called "disease-modifying" drugs because they slow the progression of rheumatoid arthritis. These drugs may take weeks to months before they begin to take effect. Therefore, they are often used in combination with NSAIDs or corticosteroids. Commonly prescribed DMARDs include the gold compound auranofin (Ridaura©), hydroxychloroquine (Plaquenil©), minocycline (Dynacin© or Minocin©), sulfasalazine (Azulfidine©), and methotrexate (Rheumatrex©).

Abatacept (Orencia©): Abatacept (Orencia©) is a type of drug called a costimulation modulator. Abatacept reduces inflammation and joint damaged caused by rheumatoid arthritis. The drug prevents white blood cells, called T-cells, from attacking the joints. Patients receive a monthly injection through a vein in the arms.

Side effects may include headache, nausea, and mild infections, such as upper respiratory tract infections. Serious infections, such as pneumonia, may develop.

Rituximab (Rituxan©): A medication called rituximab (Rituxan©) has been used to treat patients with rheumatoid arthritis. This medication, which is injected into the patient's vein, reduces the number of B-cells in the body. This medication helps reduce swelling because the B-cells are involved in inflammation.

Side effects may include flu-like symptoms, such as fever, chills, and nausea. Some people experience extreme reactions to the infusion, such as difficulty breathing and heart problems.

Antidepressants: Some patients with rheumatic diseases, especially arthritis, may also suffer from depression. Commonly prescribed anti-depressants for patients with rheumatic diseases include amitriptyline, nortriptyline (Aventyl© or Pamelor©), and trazodone (Desyrel©).

Joint replacement surgery: In some cases, patients with osteoarthritis or rheumatoid arthritis suffer from permanent joint damage. In such instances, joint replacement surgery may be necessary. During the procedure, the damaged joint is surgically removed and it is replaced with a plastic or metal device called a prosthesis. The most commonly replaced joints are the hip and knee, but other joints, including the elbow, shoulder, finger, or ankle joints, may also be replaced.

Joint replacement surgeries are generally most successful for large joints, such as the hip or knee. Researchers estimate that hip or knee replacements last at least 20 years in 80% of patients. After a successful surgery and several months of rehabilitation, patients are able to use their new joints without pain.

As with any major surgery, there are risks associated with joint replacements. Patients should discuss the potential health risks and benefits of surgery with their healthcare providers.

Muscle relaxants: Muscle relaxants, such as cyclobenzaprine (Flexeril©), may help reduce muscle pain and spasms associated with fibromyalgia. Patients usually take these medications by mouth before sleep. Muscle relaxants should only be taken short-term. The most common side effect of muscle relaxants is sedation. Patients should not drive or operate machinery while taking muscle relaxants.

Pregabalin (Lyrica©): Patients with fibromyalgia may take an anti-seizure medication, called pregabalin (Lyrica©). Although this medication is primarily used to prevent seizures, the U.S. Food and Drug Administration (FDA) has also approved the medication as a treatment for fibromyalgia. Pregabalin has been shown to reduce pain caused by fibromyalgia.

Side effects may include dizziness, sleepiness, difficulty concentrating, blurred vision, weight gain, dry mouth, and swelling in the hands and feet.

Cool compress or ice pack: Applying a cool compress or ice pack to the affected joint during a flare-up may help reduce swelling and pain caused by a rheumatic disease.

Heat: Applying a hot pack to affected joints may help reduce pain, relax muscles, and increase blood flow to the joint. It may also be an effective treatment before exercise. Alternatively, patients may take a hot shower or bath before exercise to help reduce pain.

Lifestyle: Many lifestyle changes, including regular exercise, weight management, and a healthy diet, may help reduce symptoms of osteoarthritis. A healthcare provider may recommend a physical therapist or nutritionist to help a patient determine the best treatment plan for him/her.

Individuals with osteoarthritis or rheumatoid arthritis should wear comfortable footwear that properly supports their weight. This may reduce the amount of strain put on the joints during walking.

Patients with rheumatic diseases may require canes, walkers, or other devices to help improve their mobility. If the hands are severely affected, braces may be beneficial. Patients should talk to their healthcare providers about assistive devices that are available.

Individuals with osteoarthritis or rheumatoid arthritis should maintain good posture. This allows the body's weight to be evenly distributed among joints.

PREVENTION

There is currently no known method of prevention for fibromyalgia, rheumatoid arthritis, juvenile rheumatoid arthritis (JRA), or systemic lupus erythematosus (SLE). Patients should take their medications exactly as prescribed and visit their healthcare providers regularly to help prevent complications and ensure that symptoms are properly managed.

Individuals who maintain a healthy body weight have a decreased risk of developing osteoarthritis. Being overweight or obese increases the amount of stress put on the joints and may contribute to the development of osteoarthritis or may worsen symptoms of the disease.

Eating a healthy and well-balanced diet may help individuals control their weight. The U.S. government issued a revised food pyramid in 2005 in an effort to help Americans live healthier. The new pyramid provides 12 different models, which are based on daily calorie needs, ranging from the 1,000-calorie diets for toddlers to 3,200-calorie diets for teenage boys.

Regular exercise may also help patients control their weight. There are many ways for people to exercise including, gardening, walking, sports activities, and dancing. Patients who are beginning an exercise program should choose activities that fit their levels of strength and endurance. The type of exercise is not as important as a consistent exercise schedule. Most experts today agree that burning calories should not be the goal of exercise. Exercise that causes extreme pain or discomfort is considered by many experts as harmful, and it may even cause permanent damage to the body.

Patients can reduce their risks of developing bursitis and prevent flare-ups by stretching the muscles before physical activity. Strengthening the muscles around the joints also helps protect against bursitis. Patients should also avoid resting the joints on hard surfaces.

Copyright © 2011 Natural Standard (www.naturalstandard.com)

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Professor Asgar Ali Kalla completed his MBChB (Bachelor of Medicine and Bachelor of Surgery) degree in 1975 at the University of Cape Town and his FRCP in 2003 in London. Professor Ali Kalla is the Isaac Albow Chair of Rheumatology at the University of Cape Town and also the Head of Division of Rheumatology at Groote Schuur Hospital. He has participated in a number of clinical trials for rheumatology and is active in community outreach. Prof Ali Kalla is an expert in Arthritis for Health24.

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