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Arthritis

Arthritis Arthritis As we grow older our bodies begin to degenerate, and stop working. There are many different kinds of diseases that we are subject to as we age, cancers, heart disease, Alzheimers disease, arthritis, and many others. All have a negative affect on our lives, making it difficult to function. Arthritis is the second leading chronic disease in the United States. Arthritis occurs when the body incorrectly identifies its own tissue as foreign matter and attacks it. Arthritis includes a set of more than eighty autoimmune diseases. Arthritis attacks connective tissues and joints.

It causes stiffness, pain, inflammation, and swelling of the joints. Some kinds are crippling, but rarely leads to death. There are many different kinds of arthritis, the main ones being Osteoarthritis and Rheumatoid arthritis; others include gout and ankylosing spodylitis. Almost everyone develops osteoarthrits as they age, some get it while in their fifties and in others it does not appear until their eighties. Osteoarthritis is the most common form that affects older people; this form of the disease wears down the cartilage mostly through overuse and injury but there are other causes.

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This specific form of the disease causes the cartilage to break down and the bones to rub against each other. Deformity and swelling occurs because knobs of hardened bits of cartilage develop in the joint. It forms especially if a joint has been injured many times. Arthritis affects the hips, knees, spine, hands, lower back, neck, and knuckles. Osteoarthritis spreads throughout the body damaging organs and connective tissue.

Osteoarthritis cannot be cured. Physicians seek only to relieve the pain and prevent the patient from becoming disabled. A surgeon may repair a severely damaged joint or replace it with a joint made of metal or plastic. About five percent of the people that have arthritis have Rheumatoid arthritis. Rheumatoid arthritis affects the joints in the wrists and knuckles, though it may occur in any joint.

It spreads throughout the body and damages connective tissues and organs. It will eventually, if unchecked, stiffen the joints in deformed positions. In this disease inflamed tissues erode the bones and cartilage. Rheumatoid arthritis generally occurs in a symmetrical pattern, meaning that if it occurs in one hand or knee it will also happen on the other one. The disability that comes with the crippling aspect of Rheumatoid arthritis is preventable by exercise programs, and aspirin or other drugs.

A joint may be repaired or replaced, and in extreme cases a gold compound injection can be used. Rheumatiod arthritis affects three times more women than men. It strikes people of all ages, though generally those of middle- age or older. Rheumatoid arthritis is an inconsistent disease. In some people, it leaves after a few months or years without leaving any noticeable damage. In other people, the symptoms persist and cause the person to be unable to function.

Gout is a hereditary disorder that occurs more frequently in men, than women. An excess of uric acid in the blood and tissues causes it. The pain is caused by crystals of acid formed under the skin and in the joints. Gout occurs when there is too little uric acid excreted or too much for the kidneys to excrete. An attack begins suddenly with severe pain and swelling in a joint and the overlaying skin becomes red and shiny. If it is untreated it can last up to seven days and further attacks are likely even after the symptoms disappear. The causes of gout are not known, but drugs and some minor injuries can bring on an attack.

Gout is treated by resting the joint and the drugs sulindac, ibuprofen, naproxenm and indomethacin are prescribed for older people who suffer from this form of arthritis. If it is not treated early the condition may become chronic. Ankylosing spondyliits is a condition in which the bones of the spine fuse together, causing stiffness and the back can become bowed. It occurs more frequently in men than women. It usually begins early in adult life.

Early symptoms include backaches and stiffness in the morning. The patients eyes may become inflamed and the joints swollen and tender. Causes are not known as yet, though the physicians are working on it. Exercise is important, in order to keep the spine mobile and straight. Anti-inflammatory drugs are prescribed, and radiotherapy may be used in severe cases of pain and stiffness. An important aspect of treatment is Physiotherapy, breathing exercises. Although treatments differ according to the specific type of arthritis, there are some that are utilized for all types.

The first is Nonsteroidal anti-flammatory drugs (NSAIDs) which help in two ways. They relieve pain and fight inflammations. These drugs range from over-the-counter drugs like aspirin and ibuprofen, to more potent types available by prescription. These have high risks of side effects ranging from mild ringing in the ears to serious gastric ulcers, kidney damage, and heart failure. The second set of drugs is COX-2 inhibitors, which also help with pain and inflammation, but without the side effects. Some of these do not control inflammation, but only help with the pain.

These include acetaminophen and Tramadol. An excess of these drugs can cause liver damage and nausea and constipation, respectively. Other things that can help are keeping positive attitude, controlling weight, exercising regularly, and relaxation. By having a good attitude, studies show that patients experience less pain and have less difficulty functioning. By controlling weight, less stress is put on places where arthritis is commonly felt; hips, knees, back, and other places.

Also, excess weight can make joint surgery more risky and difficult. Through exercise, weight gain is kept down and can increase strength in weakened muscles and joints. Through relaxation techniques, the patient feels less stress, which reduces feelings of helplessness and frustration. By keeping control of the arthritis, instead of letting it control them, the patient has an easier time functioning and living a normal life. In my family, we have many different kinds of arthritis: rheumatoid is the main one, which causes crippling in the joints, and other forms of it.

My grandmother on my fathers side has this disease, among other types and forms of arthritis. The joints in her fingers and toes are beginning to cripple. My aunt, also on my fathers side, is having the same problem occur in her shoulder. Both of these women are handling the arthritis instead of letting it handle them. They keep active and exercise. Although it is becoming more difficult for my grandmother to do the things she loves such as gardening and crocheting, she does as much as she can.

My aunt also keeps busy and keeps a positive attitude. Both take mostly aspirins, but they also take the mineral supplement that my father invented, which helps with both the pain and inflammation. . My father is a chemist and he has recently invented a mineral supplement that helps immensely with the arthritis pain and inflammation. People, who have taken it, including my aunt and grandmother, experience little or no pain or inflammation while taking the pill.

They say it is better than anything they have tried so far is. It is a proprietary formula that includes both minerals and herbs, and it helps with much more than just arthritis. Because the women in my family have arthritis, it is possible that I, too, may get it. I have hope, however, because of my fathers pills. It is likely that because of the mineral pills I may not experience the pain my aunt, grandmother, and many others have experienced. It seems reasonable that as he perfects his new arthritis supplement, it may cure even those who may have had it for years. He currently sells it through a company called Skin Secrets.

It has helped numerous people so far. The technology we have makes me glad I am alive now, when there are cures for diseases that people died from not many years ago. With all of the new medicines, many of the diseases that plague our nation now may be cured within a few decades. Medicine.

Arthritis

Arthritis is a general term for approximately 100 diseases that produce either INFLAMMATION of connective tissues, particularly in joints, or noninflammatory degeneration of these tissues. The word means “joint inflammation,” but because other structures are also affected, the diseases are often called connective tissue diseases. The terms rheumatism and rheumatic diseases are also used. Besides conditions so named, the diseases include gout, lupus erythematosus, ankylosing spondylitis, degenerative joint disease, and many others, among them the more recently identified LYME DISEASE. Causes of these disorders include immune-system reactions and the wear and tear of aging, while research indicates that the nervous system may often be equally involved. About one out of seven Americans exhibit some form of arthritis. INFLAMMATORY CONNECTIVE TISSUE DISEASES This varied group of diseases produces inflammation in the connective tissues, particularly in the joints. The signs of inflammation–warmth, redness, swelling, and pain–may be apparent. Microscopic examination of the lesions reveals prominent blood vessels, abnormal accumulations of white blood cells, and varying degrees of wound healing with scarring. In some diseases, the inflammation is clearly an immune reaction, the body’s defense against invading microorganisms. In others, the cause is different or unknown. Infectious Arthritis This disease is most common in young adults. Infection in a joint is usually caused by bacteria or other microorganisms that invade the joint from its blood vessels. Within hours or a few days the joint, usually the knee or elbow, becomes inflamed. There is an abnormal accumulation of synovial, or joint, fluid, which may be cloudy and contain large numbers of white blood cells. Gonococcal arthritis, a complication of gonorrhea, is the most common form of infectious arthritis. Treatment with antibiotics and aspiration of synovial fluid is usually promptly effective, and only minor residual damage is done to the joint. Occasionally the infection is prolonged and produces joint destruction and requires surgery. Rheumatic Fever This is a form of infectious arthritis caused by hemolytic streptococcus, a bacterium. Unlike typical infectious arthritis, however, the disease is most common in children aged 5 to 15 years, begins weeks after the onset of the streptococcal infection, and streptococci cannot be isolated from the joint fluid. The inflammatory process may involve the heart and produce rheumatic heart disease. The symptoms of RHEUMATIC FEVER usually occur 2 to 3 weeks after the onset of a severe streptococcal sore throat. Acute pain and swelling “migrate” from joint to joint over a period of several days. The inflammation, which persists for less than three months, can usually be controlled by aspirin and rest, and it produces no residual deformity. Less than 1 percent of children with streptococcal sore throats develop rheumatic fever, and a small number of these will develop rheumatic heart disease. Rheumatic fever only rarely occurs if the streptococcal sore throat is treated early with an antibiotic such as penicillin. The inflammation of the joints and the heart in rheumatic fever apparently occurs because the body’s immune response to the streptococcus damages tissues. For this reason, rheumatic fever has been termed an autoimmune disease. Gout and Pseudogout The inflammatory process in these diseases is unrelated to infection. Rather, inflammation is incited by the deposition in the joint of uric acid present in the bloodstream. An attack of acute gouty arthritis is caused by the formation of needlelike crystals of the deposited uric acid. When these crystals are ingested by white blood cells, the cells release enzymes that evoke inflammations. Uric acid is a normal breakdown product of urine metabolism. Abnormally elevated blood levels of uric acid, which are associated with gouty arthritis, arise through either excessive production of uric acid or decreased excretion of uric acid by the kidneys. Some cases of hyperuricemia and gout are caused by known specific enzymatic defects. Many are associated with metabolic alterations that occur in obesity. When extreme, the gouty process results in large deposits of uric acid, or tophi, around joints. Acute attacks subside when the patient receives anti-inflammatory drugs. Further attacks may be prevented by colchicine, a drug that inhibits the ingestion of crystals by white blood cells. Serum uric acid levels decline and tophi resolve when the excess uric acid production is controlled by weight reduction and by drugs such as allopurinol, a purine analog that inhibits both formation of purines and their breakdown to uric acid. The disease usually affects men over age 40. The symptoms of pseudogout may mimic GOUT, but the inflammation is initiated by crystals of calcium pyrophosphate. They can be distinguished from uric acid crystals by polarization microscopy. The disease is treated with anti-inflammatory drugs. Rheumatoid Arthritis The symptoms of rheumatoid arthritis are attributable to inflammation of the connective tissues, but the cause is unknown. The major disability produced by rheumatoid arthritis has prompted a worldwide program of research devoted to finding its cause and cure. In rheumatoid arthritis, the synovial membranes, or inner linings of the joint capsules, are chronically inflamed. The synovial mass proliferates and thereby destroys cartilage, bone, and adjacent structures. The widespread inflammatory process also involves other tissue such as blood vessels, skin, nerves, muscles, heart, and lungs. The result is painful joints, loss of mobility, and generalized soreness and depression. Rheumatoid arthritis is predominantly a disease of women between the ages of 20 and 60. Probably many individuals have such a mild form of the disease that they never seek medical care. The typical patient with newly diagnosed rheumatoid arthritis is a 35-year-old woman who has been complaining for months of generalized aches and stiffness, particularly in her hands and fingers, for an hour after arising; swelling and pain in fingers, hands, wrists, and elbows; distressing fatigue in the early afternoon; and difficulty in sleeping. The affected joints are tender. The fingers have a sausage-like appearance because of swelling at the proximal interphalangeal joints. The wrists, too, are swollen by overgrowth of synovium, and there are rheumatoid nodules at the elbows. Laboratory studies of the blood may reveal the presence of rheumatoid factors, proteins produced by the immune system in response to the rheumatic process. Although rheumatoid arthritis may prove to be infectious, it is not a conventional contagious disease. The minor tendency for familial occurrence is probably attributable to genetic factors. Immunology, including autoimmunity, is clearly important. Rheumatoid factors (anti-antibodies) form immune complexes that incite inflammation, and lymphocyte accumulations in the body cause swelling of tissues, including synovia. Systemic LUPUS ERYTHEMATOSUS is about one-tenth as common as rheumatoid arthritis. It has an even stronger predilection for women, especially those in the child-bearing ages. It is characterized by inflammation of blood vessels and potential involvement of several tissues and organs, particularly the skin, joints, kidneys, lungs, heart, nervous system, and blood cells. Some patients are acutely affected with a febrile disease that is life threatening because of renal disease, nervous system disease, or accompanying infections. Most have a more indolent disease that produces moderate disability from nondeforming arthritis, skin eruptions, and fatigue. As in rheumatoid arthritis, the body seems to react against itself rather than against an invading microorganism. Anti-self antibodies react with intact blood cells, nuclear components, and blood-vessel walls. The complexes that form in the patient’s blood precipitate in basement membranes of skin, kidneys, and nervous system and thus cause inflammation. Juvenile rheumatoid arthritis usually begins by age 5 or in the early teens. In most cases, tests for rheumatoid factors are negative and the disease becomes inactive by age 15. Ankylosing SPONDYLITIS occurs more commonly in men than women; it affects the spine and sacroiliac joints in particular, with resultant fusion of vertebrae and immobility. Tests for rheumatoid factors are negative, and tests for the tissue antigen HLA B27 are usually positive. NONINFLAMMATORY CONNECTIVE TISSUE DISEASES The joints and other connective tissues can be involved by trauma, endocrine disorders, metabolic abnormalities, congenital deformities, and other disease processes. The most important one is degenerative joint disease (OSTEOARTHRITIS). Degenerative Joint Disease. This is the most common form of arthritis and affects virtually all older adults to one degree or another. Most have few, if any associated symptoms, and the disease is diagnosed only because X rays of the vertebrae show characteristic spurs or because the fingers are knobbed by bony proliferations (Heberden’s nodes) at the distal interphalangeal joints. In some the spurs encroach on nerves as they emerge from the spinal canal and produce nerve-root syndromes. In others, the malpositioned joints are a source of ligamentous strain and abnormal muscular tension. The result is pain that becomes worse as the day goes on. Occasionally a severe form of the disease affects the hips. The destructive process results in restricted mobility of the hip joints and disabling pain, and major surgery may be required. The destroyed tissue is removed and replaced by a new joint made of plastic, an operation that is usually dramatically effective. Degenerative processes affect the ligaments and intervertebral disks of the spine. If a disk slips out, the syndrome of herniated disk may ensue. This is common in middle-aged men and usually affects the lumbar vertebrae, producing nerve-root irritation and ligamentous strain with resultant low-back pain and neurological deficits. Unless the symptoms remit with rest and analgesics, the disk may need to be surgically removed. These degenerative processes are in part caused by wear and tear. They affect primarily weight-bearing joints and joints subject to trauma or to malpositioned anatomy. Joints damaged by other forms of arthritis are prone to later degenerative joint disease. Heberden’s nodes are more prominent in the right hand of right-handed individuals and in the fingers of typists. Traumas produce microfractures in the cartilage that lines the articulating surfaces exposing raw underlying bone. The bone cells then release enzymes that destroy the protein and polysaccharide components of bone. Frayed pieces of cartilage may be taken up by white blood cells and thus add an element of inflammation. TREATMENT OF ARTHRITIS Accurate diagnosis and proper treatment usually follow naturally from the history, physical exam, and laboratory tests and from consideration of the pathophysiologic mechanisms. Infectious arthritis usually responds dramatically to appropriate antibiotics. The noninfectious inflammatory diseases are treated with drugs that suppress inflammation. Many of these drugs, for example, aspirin, indomethacin, and ibuprofen, appear to work by inhibiting synthesis of prostaglandins that mediate inflammation. Although certain adrenal cortical steroids are powerful inhibitors of inflammation, toxic side effects limit their usefulness. Similarly, drugs that inhibit proliferation of cells in the inflammatory masses have potentially severe side effects. Drugs that inhibit undesirable inflammation may also inhibit desired inflammatory responses. A result is a high frequency of secondary infections. More specific therapy, for example, allopurinol and colchicine in gout, is dependent on knowledge of the precise biochemical mechanisms of disease pathogenesis. Researchers are also studying the use of drugs that act on the nervous system. Despite the wear-and-tear origin of degenerative joint disease, it, too, may respond well to so-called anti-inflammatory drugs. Perhaps they are primarily acting as analgesics (pain-killers), or they may act by decreasing the secondary inflammation that follows joint trauma. Franklin Mullinax Bibliography: Arthritis Foundation, Understanding Arthritis (1986); Kelley, William N., et al., eds., Textbook of Rheumatology, 2d ed., (1985); McCarty, Daniel F., ed., Arthritis and Allied Conditions, 11th ed. (1988); Moll, J. M. H., Rheumatology in Clinical Practice (1987).


Category: Science

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