Sherry's Dr. appt

[Guest guest]

Hi Newbie Sherry,

First, make out a piece of paper with all your

complaints over the years down to today. He will want to look and feel

you up. (not that kind of feel you up) He

will want blood tests done. He may want X-rays. If you have arthritis be careful of

a chiropractor. Here is some info.

In the United States

alone, arthritis affects more than 42 million people, disabling 1 out of every

6 sufferers. In fact, arthritis is the leading cause of disability in that

country. The economic impact of this disease is “roughly equivalent to a

moderate recession,” states the National Centers for Disease Control and

Prevention, as it costs Americans over 64 billion dollars each year in medical

expenses and lost productivity. According to the World Health Organization,

surveys involving developing countries, such as Brazil,

Chile, China, India,

Indonesia, Malaysia, Mexico,

Pakistan, the Philippines, and Thailand, showed that the burden of

arthritis and other rheumatic diseases in such lands is almost “equal to

that in the industrialized world.”

It

is a myth that arthritis is only a disease of the elderly. True, people are

more seriously affected by it as they grow older. But one of the most common

forms, rheumatoid arthritis, commonly affects those between the ages of 25 and

50. In the United States,

nearly 3 out of every 5 people with arthritis are younger than 65 years of age.

Similarly, in Great Britain,

out of 8 million sufferers, 1.2 million are under age 45. More than

14,500 are children.

Each

year, the number of arthritis sufferers increases rapidly. In Canada, within

the next decade, the number of people with arthritis will increase by one

million. While the prevalence of arthritis is greater in Europe than in Africa

and Asia, the incidence of this disease is on

the rise in those latter continents too. The rising tide of arthritic disease

has thus prompted the World Health Organization to declare 2000-2010 the Bone

and Joint Decade. During this time doctors and health-care professionals around

the world will collaborate in an effort to improve the quality of life for

those who suffer from musculoskeletal diseases like arthritis.

What

is known about this painful disorder? Who are at risk for developing it? How

can those who suffer from arthritis cope with its crippling effects? Will the

future bring a cure? Our following articles will discuss these issues.

Understanding Arthritis

“AT

NIGHT, I LOOK AT MY DEFORMED FEET AND HANDS AND I CRY.”—MIDORI, JAPAN.

ARTHRITIS

has plagued humans for centuries. Egyptian mummies give evidence that the

disease existed centuries ago. Explorer Columbus evidently suffered

from it. And millions today are afflicted. Just what is this crippling disease?

The

word “arthritis” is taken from Greek words meaning “inflamed

joints” and is associated with a group of well over 100 rheumatic

diseases and conditions. These diseases may affect not only the joints but also

the muscles, bones, tendons, and ligaments that support them. Some forms of

arthritis can damage your skin, internal organs, and even your eyes. Let us

focus on two diseases commonly associated with arthritis—rheumatoid

arthritis (RA) and osteoarthritis (OA).

Joint Architecture

A

joint is where two bones meet. A synovial joint is surrounded by a tough

capsule that protects and supports it. (See illustration on page 4.) The joint

capsule is lined with a synovial membrane. This membrane produces a slippery

fluid. Within the joint capsule, the ends of the two bones are covered with a

smooth elastic tissue known as cartilage. This prevents your bones from rubbing

and grinding against each other. Cartilage acts as a shock absorber as well,

cushioning the ends of your bones and distributing stress evenly across your

bones.

For

example, when you walk, run, or jump, the pressure exerted on your hips and

knees can be four to eight times your body weight! While most of the impact is

absorbed by the surrounding muscles and tendons, the cartilage helps your bones

to tolerate this load by compressing like a sponge.

Rheumatoid Arthritis

In

the case of rheumatoid arthritis (RA), the body’s immune system launches

an all-out attack on its joints. For some unknown reason, a large volume of

blood cells—including T cells, which are key players in the body’s

immune system—rushes into joint cavities. This triggers a cascade of chemical

events that result in the joint becoming inflamed. The synovial cells may begin

to proliferate uncontrollably, forming a tumorlike mass of tissue called a

pannus. The pannus, in turn, produces destructive enzymes that destroy the

cartilage. Bone surfaces may now stick together, causing restricted

motion—and excruciating pain. This destructive process also weakens the

ligaments, the tendons, and the muscles, causing the joint to become unstable

and partially dislocated, oftentimes leaving a deformed appearance. Usually RA

affects joints in a symmetrical pattern, afflicting the wrists, knees, and

feet. Upwards of 50 percent of individuals diagnosed with RA also develop

nodules or bumps under the skin. Some develop anemia and dry, painful eyes and

throat. Fatigue and flulike symptoms, including fever and aching muscles,

accompany RA.

RA

is highly variable in effect, onset, and duration. In one person the pain and

stiffness may come on slowly over a period of weeks and even years. For

another, the onset may be quite sudden. For some people, RA lasts for a few

months and then leaves without noticeable damage. Others may experience periods

of worsening symptoms called flares, followed by periods of remission during

which they feel better. And in some patients the disease continues active for

many years, relentlessly disabling them.

Who

are at risk for RA? “It’s most common in women in their middle

years,” notes Dr. Schiff. However, Schiff further states

that “it can affect anyone at any age including children, as well as men.”

For those with relatives who have rheumatoid arthritis, the risk increases.

Several studies further suggest that smoking, obesity, and a history of blood

transfusion are all significant risk factors.

Osteoarthritis

“Osteoarthritis,”

states the Western Journal of

Medicine, “is in many ways

like the weather—ubiquitous, often unnoticed, sometimes dramatic in its

effects.” Unlike RA, osteoarthritis (OA) rarely spreads to other body

parts but concentrates its erosive influence in one or just a few joints. As

cartilage is slowly eroded, bone begins grinding against bone. This is

accompanied by bony outgrowths called osteophytes. Cysts may form, and the

underlying bone thickens and becomes deformed. Other symptoms include knobby

knuckles, grating and grinding sounds that emanate from arthritic joints, and

muscle spasms, along with pain, stiffness, and loss of mobility.

In

times past, OA was thought to be just another consequence of old age. However,

experts have abandoned that long-held belief. The

American Journal of

Medicine states: “There is

no evidence that a normal joint, subject to common stresses, will break down

over the life of a person.” Then what causes osteoarthritis? Efforts to

understand its exact cause are “plagued by controversy,” according

to the British magazine The Lancet. Some investigators propose that

damage to a bone, such as microfractures, may occur first. This, in turn, may

trigger bony outgrowths and cartilage deterioration. Others think that OA

starts in the cartilage itself. As it degenerates and frays, they reason,

stress increases on the underlying bone. Pathological

changes occur as the body attempts to repair the damaged cartilage.

Who

are at risk for OA? While age alone does not cause OA, the loss of joint

cartilage is experienced more frequently with increasing age. Others at risk

may include those who have some abnormality in the way their joint surfaces fit

together or who have weak leg and thigh muscles, legs of unequal length, or a misalignment

of the spine. Trauma to a joint caused either by an accident or by an

occupation in which repetitive motions overuse a joint can also set the stage

for osteoarthritis. Once deterioration begins, being overweight can exacerbate

OA.

Dr. Tim

Spector states: “Osteoarthritis is a complex disease that has definite

environmental risk factors but there is also a strong genetic component.”

Particularly susceptible to OA are middle-aged and older women with a family

history of the disease. Unlike the disease osteoporosis, high rather than low

bone density precedes the occurrence of OA. Some researchers also cite damage

from free oxygen radicals and a deficiency of vitamins C and D as factors.

Treatment

Treatment

for arthritis usually involves a combination of medication, exercise, and

life-style modification. A physical therapist may initiate a therapeutic

exercise program. It may incorporate range-of-motion, isometric, aerobic, and

isotonic or weight-bearing exercises. These have been shown to improve a

multitude of symptoms including joint pain and swelling, fatigue, malaise, and

depression. The benefits of exercise are seen even in the very elderly.

Exercise can also limit bone-density loss. Some claim that a measure of pain

relief has also been achieved through various forms of heat and cold therapy

and acupuncture.

Because

weight loss can significantly reduce joint pain, diet can be a major component

of arthritis management. Some have also claimed that a diet that includes

calcium-rich foods such as dark, leafy green vegetables, fresh fruits, and

cold-water fish rich in omega-3 fatty acids—and that cuts down on

processed foods and saturated fats—can not only help achieve weight loss

but also reduce pain. How? Some say that such a diet inhibits the inflammatory

process. There are also claims that diets that eliminate meat, milk products,

wheat, and vegetables belonging to the nightshade family, such as tomatoes,

potatoes, peppers, and eggplant, have also been effective for some.

In

some cases a surgical procedure called arthroscopy is recommended. This

involves inserting an instrument right into a joint, allowing a surgeon to

remove the synovial tissue producing the destructive enzymes. This procedure

has limited effectiveness, however, as inflammation often recurs. Even more

drastic a procedure is joint arthroplasty, in which the entire joint (usually a

hip or a knee) is replaced with an artificial one. This surgery has a longevity

of 10 to 15 years and is often highly effective in eliminating pain.

More

recently, doctors have tried less invasive treatments, such as

viscosupplementation, where hyaluronic fluid is injected directly into a joint.

This is most commonly performed on the knees. Injecting substances that

stimulate cartilage repair (chondroprotective agents) has also had a measure of

success, according to some European studies.

While

no drug has been found to cure arthritis, many drugs reduce pain and

inflammation, and some have shown promise in slowing the progression of the

disease. Analgesics, or painkillers, as well as corticosteroid therapy,

nonsteroid anti-inflammatory drugs (NSAIDs), disease-modifying antirheumatic

drugs (DMARDs), immunosuppressants, biologic response modifiers, and drugs

genetically engineered to interfere with the immune response are all part of

the arsenal being used to provide relief from the debilitating symptoms of

arthritis. However, relief may come at a high price, as all of these types of

drugs can cause serious side effects. Weighing the potential benefits and risks

presents a challenge for both the patient and the doctor.

How

have some who have suffered the ravages of arthritis been able to cope with

this painful disease?

[Footnotes]

Among

these are osteoarthritis, rheumatoid arthritis, systemic lupus erythematosus,

juvenile rheumatoid arthritis, gout, bursitis, rheumatic fever, Lyme disease,

carpal tunnel syndrome, fibromyalgia, Reiter’s syndrome, and ankylosing

spondylitis.

ALTERNATIVE THERAPIES

Some therapeutic agents are thought to be safer, with

fewer side effects, than traditional treatments. Among these are oral

type II collagen, which some researchers claim has had success in reducing

swollen joints and pain in rheumatoid arthritis (RA). How? By inhibiting

proinflammatory and destructive cytokines, namely interleukin-1 and tumor

necrosis factor á. A few

natural nutrients have also reportedly shown some ability to inhibit these same

destructive elements. They include vitamin E, vitamin C, niacinamide, fish

oils that are high in eicosapentaenoic acid and gammalinolenic acid, borage

seed oil, and oil of evening primrose. In China, Tripterygium wilfordii

Hook F, an herbal remedy, has been used for years. Reportedly, it has had a

measure of success in reducing the effects of RA.

From: sherrysue616

Sent: Friday, April 09, 2004 12:07

PM

To: LUPIES

Subject: Newbie with

Questions

I'm still waiting for my appt. with the Rhuematologist later this

month. Meanwhile, I have some questions

about lupus arthritis

symptoms. I was suffering with terrible knee

pain for a couple of

months. Suddenly, my knees are much better

and my pain has centered

on my neck,shoulders,and upper back. Is it

common for the pain to

shift to different areas? I went to the

chiropractor today for the

2nd time this week looking for some relief.

Does anyone else see a

chiropractor? Any information on lupus

arthritis symptoms would be

appreciated. Also, I'm wondering what to

expect on my first visit

to the Rheumatologist. Do they try to give

you an educated guess on

what is wrong with you or hold off for more

tests? It seems like

the closer the appt. gets, the more nervous I get!

Thanks for your help!

Sherry