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Patellofemoral Joint Pain

Hoke,2 a physical therapist, provided a good analysis of the mechanical causes of patellofemoral joint pain The knee extensor mechanism attenuates the shock, accepting body weight when the foot contacts the ground in running. This shock attenuation is accomplished through a smoothly controlled eccentric contraction of the knee extensors. The patel-lofemoral joint is a finely balanced system within the extensor mechanism, and multiple factors affect its alignment and function. The runner frequently experiences pain in the patellar region when this system lacks the necessary balance of power between medial and lateral forces. Excessive pronation of the foot also has been cited by multiple authors3,4 as a contributory factor in the development of anterior knee pain. The early peak in knee flexion after foot contact coincides with the peak in rear-foot pronation, and if the pronation of the rear foot becomes excessive, there will be adverse stress on the knee in the sagittal plane...

Enthesitis Related Arthritis

This subset was previously referred to as either juvenile ankylosing spon-dylitis or type II pauciarticular arthritis. It is a spondyloarthropathy usually manifesting as a predominantly lower limb arthritis and enthesitis (inflammation of the insertions of tendon, ligament, or joint capsule into bone). It is the only form of JIA to show a male preponderance (19), usually occurring in the early teens. If enthesitis is absent, then the diagnosis can still be made if arthritis and two other spondyloarthropathy-related features are present as described by the ILAR criteria for enthesitis-related arthritis (Table 3) (8). As seen in adults with spondyloarthropathies, acute painful anterior uveitis is a prominent extra-articular feature, usually occurring as an acute unilateral anterior uveitis with a high frequency of recurrence, sometimes in the contralateral eye. Anterior uveitis in these cases is likely to be extremely painful and therefore not liable to go undetected, in contrast to the...

Arthritis osteoarthritis

This is a joint disease characterised by the breakdown of articular cartilage, growth of bony spikes, swelling of the surrounding synovial membrane and stiffness and tenderness of the joint. It is also known as degenerative arthritis. It is common in the elderly and takes a progressive course. This condition involves varying degrees of joint pain, stiffness, limitation of movement, joint instability and deformity. It commonly affects the weight bearing joints - the hips, knees, lumbar and cervical vertebrae.

Treatment for Pauciarticular Onset Arthritis

Treatment for pauciarticular-onset arthritis usually consists of nonsteroidal anti-inflammatory drugs (NSAIDs). These drugs are discussed in detail in Chapter 20. I often use diclofenac for children with pauciarticular-onset disease that does not respond adequately to other NSAIDs. Naproxen, celecoxib, nabumetone, and diclofenac have the advantage of being given less frequently than ibuprofen. For children who have true pauciarticular arthritis, it is rare for additional medications to be necessary. Occasionally, there are children who have persistent swelling of one or two joints despite an adequate trial of NSAIDs. This is the point at which it is reasonable to consider injection of corticosteroids directly into the joint (intra-articular injection). These rarely have side effects and often provide rapid and dramatic relief for months. Most children can be talked through injection of one joint without undue distress, but anesthesia may be necessary if more than one joint must be...

Mechanical Complications of Obesity Arthritis

Obesity is frequently complicated by degenerative arthritis (DJD). Increased body weight leads to trauma of the weight-bearing joints and speeds the development of osteoarthritis in obesity. Knee and hip joints are particularly affected. However, obese patients have increased DJD of the hands, perhaps due to cytokines produced by adipose tissue, which may damage the cartilage in joints. Flattening of the arc of the planter surface of the feet (flat feet) occurs more frequently in obese people, presumably due to the stress of carrying excess body weight. Flat feet may lead to unsteady gait and aches and pains after walking. Increased fat deposition, particularly in the abdominal region, can change the natural curvature of the spine, causing lordosis and resulting in backache in obese people.

Enthesitisassociated Arthritis

Heel Insertion

The term spondyloarthropathy does not refer to a specific disease. Meaning arthritis involving the back, it describes a pattern of inflammation that may occur in children with a variety of underlying conditions. For many years, children with spondyloarthropathies were considered to have JA, but now these children are described as having enthesitis-associated arthritis. Although enthes-itis-associated arthritis is considered a subtype of juvenile arthritis, it is important to recognize that this is a very different disease from, for example, pauciarticular-onset arthritis. Remember, juvenile arthritis is being used as an umbrella term encompassing a large number of different conditions. In contrast to other types of arthritis, the spondyloarthropathies have a different pattern of joint involvement, a different prognosis, a different best medication, and a different cause. The first widely recognized group of children with spondyloarthropathies were teenage boys with swollen knees and...

Organizations Dedicated Primarily to Arthritic Conditions Juvenile Rheumatoid Arthritis Spondyloarthropathy Ankylosing

Box 7669 Atlanta, GA 30357-0669 (800) 283-7800 http The American Juvenile Arthritis Organization (AJAO, is now part of the Arthritis Foundation and may be accessed via its contact numbers. Arthritis Society of Canada 393 University Avenue, Suite 1700 Toronto, Ontario M5G 1E6, Canada (416) 979-7228 http Arthritis Insight http This is a Web-based, question-and-answer site with information for children and adults.The children's info is at http This is a site for children, teenagers, and young adults to share ideas, complaints, and the knowledge that they aren't the only ones in the world with arthritis.

The Center for Alternative Medicine Evaluation and Research in Arthritis CAMERA

Focuses on the investigation of the effectiveness of complementary therapies for the alleviation of conditions accompanied by acute and chronic pain, such as arthritis. CAM areas of interest include herbal medicine, homeopathy, and acupuncture. In 1999, the National Center for Complementary and Alternative Medicine (NCCAM) awarded a 7.8 million grant to the University of Maryland to establish a center for alternative medicine research in arthritis and related disorders. The Center for Alternative Medicine Evaluation and Research in Arthritis (CAMERA) is housed within the Complementary Medicine Program (CMP). Though the focus is currently on investigating the use of acupuncture, future projects involve studies with botanicals, including traditional Chinese herbal formulas.

Cytokine Targeting in Psoriasis and Psoriatic Arthritis Beyond TNFa

2.4 IL-15 in Psoriasis and Psoriatic Arthritis 37 Abstract. Targeting TNFa provided proof of concept for the role of proinflammatory cytokines in promoting cutaneous inflammation, particularly psoriasis. Recent studies have elucidated the presence of numerous cytokine and chemokine activities in psoriatic skin and synovium. There is considerable interest in the potential of such activities as novel therapeutic targets. IL-15 is an innate response cytokine that activates leukocyte subsets via binding to its unique IL-15Ra and shared P and y chain receptors. IL-15 promotes T cell memory and sustains local T cell activation, in part via prevention of apoptosis and mediates activation of monocytes, neutrophils and NK cells. IL-15 is up-regulated in psoriatic skin and psoriatic arthritis synovium. IL-15 blockade in a murine model of psoriasis led to marked suppression of typical psoriatic skin features. Clinical intervention in other chronic inflammatory disease states is now ongoing with...

Rheumatoid Factor Positive Polyarthritis JIA

This is classified as an arthritis involving five or more joints during the first six months of disease associated with a rheumatoid factor positive test on at least two occasions at least three months apart. This subtype is generally considered to be the juvenile form of erosive adult rheumatoid arthritis (RA) although erosions are often late due to the greater amount of cartilage the younger the patient. The peak age of onset is in mid to late adolescence although it can develop in much younger children. As in adult RA, there is a female predominance. Rheumatoid nodules and classical vasculitis are seen only in this group, in which all extra-articular manifestations found in adult RA may occur, including ocular, cardiac and pulmonary involvement. There are no major differences known between juvenile- and adult-onset arthritis pathological processes. There are however differences in outcome related to effects of joint inflammation occurring in a growing skeleton and the psychosocial...

Systemic Onset Juvenile Idiopathic Arthritis

Adult and pediatric disease are characterized by a daily spiking fever and an evanescent, non-fixed, macular erythematous rash that is most pronounced at the height of fever and arthritis. If arthritis is not present (as may be the case in early disease), the diagnosis may still be made in the presence of organ involvement, such as serositis (pericarditis or pleurisy), generalized lymphadenopathy, splenomegaly, or hepatomegaly. These features, coupled with a neutrophilia (greater than 13 x 109 L in 75 or more of patients) and elevated acute-phase reactants, may suggest infection, particularly if the arthropathy is not evident at disease onset with systemic features. Specific diseases in addition also require consideration and exclusion (Table 2). to adult-onset Still's disease where only 25 to 5 of patients achieve remission in their disease course (14,15). In some patients the systemic features, including the fever and malaise, respond well to nonsteroidal antiinflammatory drugs. In...

Rheumatoid Factor Negative Polyarthritis JIA

Extra-articular manifestations than in rheumatoid factor positive JIA and prognosis is less severe. There is an association to chronic asymptomatic anterior uveitis, but with a lower incidence than in the oligo-arthritis JIA subset, but there is a similar association with ANA positivity. In adults with rheumatoid arthritis, there is a subgroup of 25 of patients who are rheumatoid factor negative. In this adult seronegative subgroup, erosive joint damage and extra-articular manifestations are less common than in rheumatoid factor positive disease. The occult anterior uveitis and ANA positivity associations seen in juveniles are not, however, seen in adult disease.

Oligo Arthritis and Extended Oligo Arthritis JIA

Oligoarticular JIA is the most common subtype of JIA, representing 50 of all JIA (1). Oligo-arthritis affects young girls at least six times more frequently than boys, with a peak incidence below 3 years of age. The prevalence is between 20 and 30 per 100,000, and most ethnic groups are affected (9). Children with this form of JIA have four or fewer joints affected within the first six months of disease, although as many as one-third may subsequently progress to polyarticular involvement (10). Those that subsequently have a cumulative involvement of five or more joints are reclas-sified into the extended oligo-arthritis subtype. Specific exclusions include a positive family history of psoriasis or spondyloarthropathy and a positive rheumatoid factor. Children who remain oligoarticular for five years are unlikely to progress to extended oligo-arthritis. This group of patients are classically associated with antinuclear antibody (ANA 40-75 ), usually in low titre (less than 1 in 640)...

Post Streptococcal Reactive Arthritis and Rheumatic Fever

Post-streptococcal reactive arthritis is another form of infection-associated arthritis. It differs in that we know this form of infection-associated arthritis is initiated by a group A streptococcal infection. Poststreptococcal reactive arthritis behaves just like the other forms of infection-associated arthritis. Sometimes the arthritis is in a single large joint such as the hip, and at other times it can affect multiple joints. There is a lot of confusion regarding the relationship of post-streptococcal reactive arthritis to acute rheumatic fever. Since acute rheumatic fever is associated with possible damage to the heart and requires penicillin prophylaxis, this is an area of great concern. Acute rheumatic fever is defined according to the Jones criteria (see box). Children who develop a nonmigratory (not moving from joint to joint) arthritis after a streptococcal infection do not fulfill these criteria. As a result, many physicians do not treat these children with penicillin...

Treatment of Arthritis Associated with Gastrointestinal Complaints

Adalimumab has recently been approved as therapy for inflammatory bowel disease. This agent is extremely effective for the arthritis of IBD as well as for the disease itself. Use of adalimumab is increasing, as there is growing hesitation on the part of gastroenterologists to use NSAIDs in children with inflammatory bowel disease because of the medications' propensity to cause gastrointestinal side effects.

Complications of Psoriatic Arthritis

The primary complications of psoriatic arthritis are related to recurrent arthritis. Some children develop significant joint damage over the course of their disease. Serious eye involvement can occur in young children, and children with ANA-positive psoriatic arthritis must be monitored just as carefully as children with ANA-positive pauciarticular-onset JA. Fortunately, eye involvement is less common in teenagers but still possible. Persistent wrist and finger involvement is often prominent. In some children this seems to be the only evidence of disease. However, children may begin with only wrist involvement but years later develop problems in other joints. Elbow, neck, and jaw involvement is more common in children with this form of arthritis and must be looked for. However, hips, knees, ankles, and toes may also be involved. Because the arthritis can become widespread, it is important to do everything possible to bring it under control quickly and, if possible, to prevent it from...

Treatment of Reactive Arthritis

The most important step in the treatment for children with any kind of infection-associated arthritis involves making sure the infection is properly treated. Once it is clear that the infection associated with the arthritis is no longer active, these children should be treated just like other children with spondyloarthropathies. Most respond well to NSAIDs. In most cases, the arthritis resolves completely over a period of a few months. TNF inhibitors are sometimes required, while other children benefit from the addition of sulfasalazine. Intra-articular injection of corticosteroids may be useful if only one joint remains troublesome after the infection has been fully treated, but oral corticosteroids are rarely necessary. Physical therapy to maintain strength and range of motion is often necessary during the acute phase of the disease. Surgery should not be necessary for a child with infection-associated arthritis unless it is required to treat the infection.

Complications of Reactive Arthritis

Since, by definition, infection-associated arthritis resolves within a year of onset, long-term complications are infrequent. There may be complications related to the initial infection, but most children recover fully and do well. Reiter's syndrome, as noted previously, is a special case of reactive arthritis. It is distinguished from other cases of reactive arthritis by the occurrence of arthritis, urethritis (irritation of the urinary tract), and conjunctivitis. Children with Reiter's syndrome sometimes have rashes, particularly on their hands and feet. They may also have severe, painful acute anterior uveitis. When evaluating a child for the diagnosis of Reiter's syndrome, it is important to remember that the arthritis, urethritis, and conjunctivitis do not all have to be present on the same day. They may occur one after the other without ever overlapping in time. Although Reiter's syndrome with all of the findings is common in adults, it is rare in childhood.

Eye Complications of Juvenile Arthritis and Related Conditions

In juvenile arthritis and related conditions, the eyes may be involved even when there is no evidence of active joint disease. Ocular complications may take several forms. Children with pauciarticular-onset, polyarticular-onset, and psoriatic arthritis are all at risk of developing eye inflammation (chronic anterior uveitis). In this condition, inflamed cells accumulate in the eye and the resultant irritation may cause damage to the colored part of the eye (iris), the lens, and other structures (see Fig. 5-1 in Chapter 5). The most worrisome aspect of this inflammation is that often it does not produce pain or redness, and so it may cause serious eye damage before it is detected. Frequency of Routine Screening Ophthalmologic Examinations for Children with Juvenile Arthritis If you look carefully at the joint of a child with arthritis, the inflammation is centered in the synovium. This is the lining tissue, the normal function of which is to keep the joint clean of debris. Examination...

Stateoftheart Care For Children With Juvenile Arthritis

State-of-the-art care for children with pauciarticular-onset, polyarticular-onset, and systemic-onset juvenile arthritis requires that physicians and families make sure the inflammation is promptly brought under control and not allowed to cause continuing joint damage. In the past physicians believed that children who had evidence of low-grade active disease but seemed to be doing okay should not be treated aggressively. We now know this is wrong, as the earliest damage is to the rapidly growing cartilage, and this kind of damage does not show up on X-rays until years later, when it has become permanent bone damage. Failing to treat properly means continuing bone and joint damage and a continuing risk of further disease flares. Children whose disease comes under good control within six months of starting therapy will generally do well. Children with any type of juvenile arthritis whose disease is not under good control within six months of starting appropriate therapy are at increased...

Rheumatoid Arthritis

Rheumatoid arthritis (RA), the most common inflammatory joint disease, is a chronic autoimmune disorder that affects approximately 1 of the population and causes significant disability. The etiology of RA is largely unknown, although current evidence suggests contributions from both environmental and genetic components (271). The chronic inflammation in the arthritic joint is characterized by recruitment of immune cells, including lymphocytes, macrophages, and plasma cells, leading to massive thickening of the synovium accompanied by release of inflammatory mediators, ultimately leading to invasion and destruction of articular cartilage and bone. At the molecular level, chronic inflammatory arthritis is characterized by diminution of T cell factors and an abundance of cytokines and growth factors, such as in-terleukin-6, tumor necrosis factor a (TNF-a), and interleukin-1p (IL-1p), which are produced by macrophages and synovial fibroblasts and play a major role in the progression of...

Systemiconset Juvenile Arthritis

Systemic-onset juvenile arthritis refers to the onset of arthritis with fever and a characteristic rash. Systemic-onset juvenile arthritis has no relationship to adult-onset rheumatoid arthritis and most likely no relationship to the other forms of juvenile arthritis, either. It is best considered an entirely separate disease. Although all children with systemic-onset arthritis share key characteristics, the outcome of systemic-onset disease is so varied that it is difficult to believe it is in fact a single disease. There are several key points when making the diagnosis of systemic-onset arthritis. First, the fever must fall back to normal at least once each day. Second, the rash should have the characteristic salmon pink appearance it should never look like a bruise. It is occasionally itchy. Occasionally, there are children who develop fever and rash before the arthritis becomes evident. These children should always be followed carefully for the possibility of another diagnosis,...

Juvenile Rheumatoid Arthritis

The classification system for juvenile inflammatory arthritis (JRA) divides this form of childhood arthritis into three categories systemic, pauciarticular (four or fewer affected joints), and polyarticular. Among children with JRA, the most important ocular disease is chronic, nongranulomatous anterior uveitis. It occurs in about 20 of children with pauciarticular JRA, 5 to 10 of children with polyarticular JRA, and rarely, if ever, in those with the systemic type. Young girls with the pauciarticular subtype of JRA and a positive test for serum antinuclear antibodies are at the highest risk for developing chronic anterior uveitis. Onset is usually insidious and the children are frequently asymptomatic this type of uveitis is termed white eye because of its benign appearance to the causal observer. The uveitis may precede the arthritis by up to five years. In JRA, chronic anterior uveitis is bilateral in two-thirds of patients. Slit-lamp examination reveals cells and proteinaceous...

Is Glucosamine Really The Arthritis Cure

If you are among the millions who suffer from osteoarthritis I do not have to tell you about pain. Nagging, persistent and at times unbearable, pain is a way of life for you. For most of you, the search for relief from this grinding pain is a chore in and of itself. While exact numbers differ widely, according to Newsweek, there are 22 million with Osteoarthritis in the US. Whether your pain is in your knees, neck, hands, shoulders or any other joint, there have been some important advances made in treating these conditions. I'm going to discuss these advances with you and explain in detail how this information can help you take control of your osteoarthritis.

Role of Diet in the Management and Prevention of Degenerative Arthritis

Much less is known about the role of diet in the treatment of OA and other degenerative arthritides. The above discussion regarding n-3 PUFAs in RA also may pertain to OA, although the strength of the effect has not been studied as thoroughly. However, the same eicosanoid metabolism occurs in OA as in RA, with the exception that the disorder is limited to the joint rather than involving the whole body. Thus, fish oils may well be of benefit in OA. Antioxidant intervention with vitamin E may also be effective in OA, with several studies showing an effect comparable with NSAIDs. Although not strictly nutrients, glucosa-mine and chondroitin sulfate, which are two of the constituents of normal cartilage that decline with arthritis, have been shown to be useful when given as an oral supplement, especially in patients with early OA. suggesting that obesity seems to be a mechanical rather than systemic risk factor. Thus, maintaining body weight within the recommended ranges is probably the...

American Juvenile Arthritis Organization AJAO

A special council of the arthritis foundation that helps to serve the special needs of children, teens, and young adults with childhood rheumatic diseases and their families. Its members are parents, family members, doctors, nurses, occupational and physical therapists, social workers, young adults, and anyone with an interest in arthritis in young people. The AJAO serves as an advocate for and works to improve the quality of life for children with rheumatic diseases and their families by working toward better medical care, stimulating research, and providing education and support. The organization tries to increase awareness of childhood arthritis, promotes access to care by pedi-atric rheumatologists, develops education and support programs, advocates the needs of those affected by childhood arthritis, and encourages research and funding toward prevention, control, and cure. conferences and publishes educational materials ranging from free brochures to inexpensive self-help manuals....

Polyarticularonset Juvenile Arthritis

Polyarticular-onset disease is defined as arthritis involving five or more joints during the first six months of disease, without other explanation. In my opinion, any involvement of small joints indicates polyarticular-type disease even if initially there are fewer than five joints involved. Polyarticular-onset disease may occur in any age group but is found more often in girls than in boys. There are two major peaks in the age at onset of disease in young children between eighteen months and eight years of age and in older children and teenagers after eleven years of age. Some children start with only one or two arthritic joints, with the arthritis slowly spreading to other joints, while other children rapidly develop arthritis of multiple joints. Laboratory findings in children with polyarticular-onset arthritis are highly variable. Some have entirely normal laboratory tests, while others have elevated ESR and low hemoglobin. A small percentage of children with polyarticular-onset...

Pauciarticularonset Juvenile Arthritis

To base the distinction between pauciarticular-onset and polyarticular-onset JA only on the basis of the number of joints involved six months after onset may seem both confusing and of limited utility. After all, it's hard to tell exactly when someone's arthritis began, and the drawing of the line at five joints seems a bit arbitrary. However, the classification persists because it is generally useful. Children who have arthritis of the hands and feet, whether or not the large joints are affected, usually have more joints involved (because of the number of joints in those areas) and thus fall into the category of polyarticular onset. These children have a different prognosis (and probably a different disease) than children with only large joint involvement, who tend to fall into the category of pauci-articular onset because there are not that many large joints in the body. The proper classification should be onset with only large joints versus onset with small joints involved, with or...

Reactive Arthritis Infectionassociated Arthritis And Reiters Syndrome

Reactive or infection-associated arthritis is a type of spondyloarthropathy brought on by infection. Reiter's syndrome is a special case of infection-associated arthritis with a particular set of systems (discussed later). Affected children are often very ill, with fever, rash, and arthritis. Sometimes the arthritis is in only one large joint, but at other times it may be widespread, affecting many joints both large and small. It was originally termed reactive arthritis because the arthritis frequently begins shortly after a significant viral or bacterial infection. The name was changed to infection-associated arthritis to remind physicians that in some cases the infection is still present and may require treatment. The most common infectious agents that cause these forms of arthritis are bacteria (shigella, salmonella, neisseria, and chlamydia) and viruses (especially parvovirus B19). The arthritis associated with Lyme disease is also a form of infection-associated arthritis. Mild...


The product Phytodolor contains alcoholic extracts of Populus tremula, Fraximus excelsior and Solidago virgaurea and is standardised to 0.14 mg mL of isofraxidine, 1 mg mL salicine, and 0.07 mg mL of total flavonoids. As part of this combination, goldenrod has been investigated in patients with RA, osteoarthritis and back pain. Pain was significantly reduced by treatment with Phytodolor in a placebo-controlled study of 47 patients (Weiner & Ernst 2004). Symptom relief was equally effective amongst patients receiving half strength, normal (60 drops three times daily) or double-strength treatment. A shorter placebo-controlled study of 2 weeks duration found that Phytodolor reduced the need for conventional drug doses in subjects with 'at least one rheumatological diagnosis' (Weiner & Ernst 2004). Similarly, Phytodolor reduced requirements of diclofenac compared to placebo in a smaller study of 30 patients (Weiner & Ernst 2004). A 2-week placebo-controlled study of 30 subjects with...

Psoriatic Arthritis

Psoriatic arthritis is another spondyloarthropathy that requires special attention. Pediatric rheumatologists continue to debate exactly who belongs in this group, since a child does not have to have psoriasis to have psoriatic arthritis, and children might have another form of arthritis and coincidentally have psoriasis. It is called psoriatic arthritis because over the course of as much as ten to fifteen years, many children who have this type of arthritis will develop psoriasis. Whether they eventually develop psoriasis or not, what's most important is that in children diagnosed with this condition, their disease behaves like the arthritis associated with psoriasis and responds to the same medications. There are varied criteria for the diagnosis of psoriatic arthritis. They require that the child have arthritis plus dactylitis or changes in the fingernails of a type often seen in children with psoriasis (onycholysis), as well as a close relative with psoriasis. Some physicians...

With Arthritis

Deodhar et al. were the first to report on the antirheumatic activity of curcumin in human subjects (107). They performed a short-term, doubleblind, crossover study in 18 patients with ''definite'' rheumatoid arthritis to compare the antirheumatic activity of curcumin (1200 mg day) with that of phenylbutazone (300 mg day). Subjective and objective assessment in patients who were taking corticosteroids just prior to the study showed Liacini et al. examined the effect of curcumin in articular chondrocytes. Interleukin-1 (IL-1), the main cytokine instigator of cartilage degeneration in arthritis, induces matrix metalloproteinase-3 (MMP-3) and MMP-13 mRNA and protein in chondrocytes through activation of mitogen-activated protein kinase (MAPK), AP-1, and NF-kB transcription factors (108). Curcumin achieved 48-99 suppression of MMP-3 and 45-97 of MMP-13 in human and 8-100 (MMP-3) and 32-100 (MMP-13) in bovine chondrocytes. Inhibition of IL-1 signal transduction by these agents could be...


Arthritis refers to the inflammation of a joint which causes pain and swelling of the joint. Arthropathy refers to non-inflammatory disease of a joint, which may have many different causes. There certainly is a higher incidence of joint problems in adults with Down's syndrome, but whether or not there is an increase in the incidence of auto-immune arthritis (such as juvenile rheumatoid arthritis, or JRA) is still being debated in the medical community. One researcher recommended a new condition be named 'arthropathy of Down's syndrome', since the diagnosis of juvenile rheumatoid arthritis is a diagnosis of exclusion (i.e. when you make sure that no other disease process is causing the arthritis, then JRA is all you have left). Most researchers, however, are willing to diagnose JRA in children and teens with Down's syndrome if the specific criteria are met. The treatment of arthritis in people with Down's syndrome is the same as in people without Down's syndrome. If the joint pains are...


There is strong evidence to suggest that glucosamine is effective in treating the symptoms of OA, as well as being effective in slowing the disease progression. A Cochrane review of 16 RCTs has concluded that 'there is good evidence that glucosamine is both effective and safe in treating osteoarthritis' and that 'glucosamine therapy may indeed represent a significant breakthrough in the pharmacological management of osteoarthritis' (Towheed et al 2003). Although most studies have been of OA of the knee, there is some clinical evidence that it is also active against OA of the spine (Giacovelli 1993) and temporomandibular joint (Shankland 1998). The National Institutes of Health (NIH) recently spent US 14 million on a Glucosamine Chondroitin Arthritis Intervention Trial (GAIT), a 24-week, placebo-controlled, parallel, double-blind, five-arm trial involving 1 583 patients that aimed to answer the question as to the efficacy of glucosamine hydrochloride and chondroitin by comparing...


Individuals who are overweight or obese increase their risk for the development of osteoarthritis. 16-18,91,92 The association between increased weight and the risk for development of knee osteoarthritis is stronger in women than in men. 92 In a study of twin middle-aged women, it was estimated that for every kilogram increase of weight, the risk of developing osteoarthritis increases by 9 to 13 percent. The twins with knee osteoarthritis were generally 3 to 5 kg (6.6 to 11 lb) heavier than the co-twin with no disease. 16 An increase in weight is significantly associated with increased pain in weight-bearing joints. 175 There is no evidence that the development of osteoarthritis leads to the subsequent onset of obesity. 91 A decrease in BMI of 2 units or more during a 10-year period decreased the odds for developing knee osteoarthritis by more than 50 percent weight gain was associated with a slight increase in risk. 93 clinical improvement in patients with osteoarthritis. 176...

Juvenile Arthritis

Arthritis is defined as pain, swelling, or limitation of motion in a joint. According to the criteria of the American College of Rheumatology, juvenile rheumatoid arthritis (JRA) is the proper diagnosis for any child with the onset of arthritis before sixteen years of age if the arthritis lasts at least six weeks in more than one joint or three months in a single joint, without other explanation. Based on this definition, every child with chronic arthritis has JRA. However, it is very clear that not every child with arthritis has the same condition. A five-year-old girl with a swollen knee and inflamed eyes does not have the same disease as a teenage boy with a swollen knee and ankle pain. They have different prognoses (probable outcomes in the future), different responses to medication (the best medicine for the little girl is unlikely to be the best medicine for the boy), and most likely different causes for their disease. Rheumatologists recognize more than fifty causes of chronic...

Fatigue is associated with disability

Although fatigue is sometimes thought of as a trivial symptom, it is associated with considerable disability. Studies that have assessed the levels of disability in CFS sufferers suggest profound deficits. Two prevalence surveys (Buchwald et al. 1995 Wessely et al. 1997) used quality of life questionnaires and found a stepwise increase in disability from healthy subjects to those with chronic fatigue and those with CFS. Role performance (the ability to fulfil occupational or household functioning) was especially impaired. Patients with CFS have disabilities comparable to, or worse than, patients with many common medical illnesses such as heart disease, diabetes, or arthritis (Wells et al. 1989). This applies both to cases seen in clinical settings and those who do not consult. Patients with CFS who also suffer from psychological distress or depression have particularly severe impairments. Wessely et al. (1997) demonstrated a striking gradient of decreasing function in subjects with...

Useful Communication Strategies Importance of the First Question

When seeing a new referral it is very important to clarify the perception (both adolescent and parental) of why the adolescent has been referred to you. Adolescent-parent discrepancies may be readily revealed, even at this early stage in the consultation In several studies, the professional's lack of interest in the wider impact of the condition is reported by young people to impede effective communication (9,10,17). This is readily addressed by always starting the consultation with a non-disease-related question, for example, What have you been up to since we last met rather than How is your arthritis A useful aide-memoire is to draw a text box in the corner of the notes page with a reminder of an important event to ask about at the next visit, e.g., joined new football team, took part in a play, etc. The mere fact that you have remembered will convey the message that the young person has being listened to and that the rest of their life is important. Adolescent health professionals...

Chondroprotective Effect

The overall chondroprotective effect of chondroitin has been demonstrated in animal models, whereby oral or intramuscular chondroitin sulfate has been shown to protect rabbit articular cartilage from experimental chymopapain injury (Uebelhart et al 1998a) and inhibit the destruction of the cartilage extracelluar matrix (Sumino et al 2005). The chondroprotective action of chondroitin has been found to be potentiated by high sulfur mineral water in an animal model of osteoarthritis (Caraglia et al 2005).

Impact Of Loss Of Motion

If any of your joints whether your hips, knees, or shoulders are tight, you may find that the number of positions you can move into independently is limited. This, in turn, may limit the types of activities you can do for yourself. Range-of-motion exercises are the most basic element of an activity program for people with MS. Moving joints through their full range of motion even once a day will help to prevent development of contractures (frozen joints) and of permanently reduced range of motion of a particular joint. Maintaining the flexibility of your joints and of the structures around them will also decrease spasticity of your muscles.

Educational Strategies

Knowledge regarding the disease and its treatment is a prerequisite for good medication adherence. Most treatment centers implement some form of patient and family education in their routine clinical practice. The National Arthritis Advisory Board in the United States has developed standards for arthritis patient education (82) and provided the following definition

Finding Out Whether You Have Fibromyalgia

Part II is about discovering whether you have fibromyalgia, and part of that process is ruling out medical problems that may be impostors for your real problem of fibromyalgia. These conditions include chronic fatigue syndrome, myofascial pain syndrome, thyroid disease, forms of arthritis, and a few other illnesses that may surprise you, such as Lyme disease, lupus, and Raynaud's phenomenon (all discussed in Chapter 6). Then I move into diagnosing fibromyalgia. A good doctor is crucial to diagnosing and treating fibromyalgia, and I discuss the important role that doctors play in Chapter 7. I also offer advice on working with your regular doctor and, if that doesn't work, finding a new doc. Then I cover what actually happens (or should happen) during your physical exam to find out whether you have fibromyalgia.

Small Vessel Vasculitis

Henoch-Schonlein purpura (HSP) is the most common juvenile form of small vessel vasculitis. Although HSP is seen in adolescents, the peak age-of-onset is 4-6 years (18). There is an association with preceding infection in up to half of cases (38). HSP presents with the combination of non-thrombocytopenic palpable purpura over the lower extremities, abdominal pain, arthritis, and glomerulonephritis. Pathologically there is IgA deposition in the glomerular mesangium or the dermal vessels (39). HSP is a self-limiting disorder that carries an excellent prognosis. Although 20 to 50 of cases may be associated with renal involvement only 1 progress to chronic renal insufficiency (40). However, it should be noted that this risk is greater in adolescents (41).

Uncommon Chronic Systemic Inflammatory Disorders Periodic Fever Syndromes

Castleman's disease is a rare atypical lymphoproliferative disorder characterized by enlarged lymph nodes with striking vascular proliferations. It is separated into localized disease, usually observed in young patients, and multicentric disease, more common in older patients. Localized disease has a good prognosis with surgery. Multicentric disease can be associated with other systemic disorders such as HIV, AIDS, malignant lymphoma, and rheumatoid arthritis. Diagnosis depends on biopsy. Treatment options include surgery, chemotherapy, anti-herpetic treatments, antiretroviral therapy and monoclonal antibodies against IL-6 and CD20 (127). Prognosis depends on the underlying disorder.

The makeup of articular cartilage

Proteoglycans are nothing more than molecules composed of sugar and proteins. What they do inside your cartilage matrix is wrap themselves in and around the collagen fibers. So what happens then The proteoglycans add stretching capability and they act to capture water. Remember, we already said that 65 to 80 of your cartilage is made up of water. It is this squeezing in and out activity as your joints are in motion that is facilitated by these proteoglycans. And there is just one

Laboratory Findings In Lyme Disease

Children with Lyme disease almost invariably have a positive Lyme titer and a positive Western blot (see Chapter 22). In addition, they have elevated ESRs and white blood cell counts. While the elevated white blood cell count and ESR are commonly present in children with polyarticular-onset arthritis, they are infrequent in children with pauciarticular-onset disease. Some children with Lyme disease have positive tests for antinuclear antibody (ANA). They should not have rheumatoid factor (RF), antibodies to double-stranded DNA, or complement abnormalities.

Outcomes Disease Activity

Systemic onset JIA is associated with the highest levels of inflammation in the pediatric population and the worst long-term functional outcome. However, in adulthood the levels of clinical inflammation are significantly lower than any other subset (2,3). This suggests that the concept of arthritis burning out may hold true in this specific subtype.

Children With Sle And Joint Problems

Although the family may not be aware of it, arthritis is often present when a child with SLE first comes to the doctor. It is usually very responsive to treatment with steroids or NSAIDs. As a result, arthritis is rarely a significant long-term problem. The exception is an unusual condition termed Jaccoud's arthropathy, a painless swelling, primarily in the fingers and wrists, that develops slowly during the course of SLE. It does not usually cause damage to the bones, but it may be painful and interfere with use of the hands. The explanation for this problem is unclear. Unfortunately, it does not respond well to medication. Unfortunately, the normal course of avascular necrosis is for the bone to crumble slowly under the continued stress of bearing weight. If this happens, it will be necessary for the joint to be replaced (see Chapter 23). In children with SLE, the hip is the joint most commonly affected, but shoulders, elbows, knees, ankles, and other joints all may be involved. The...

Clinical Manifestations

In the head and neck, pharyngeal gonococcal infection is asymptomatic as a rule, although rare cases present with exudative pharyngitis and cervical lymphadenopathy. Symptomatic patients usually present with findings suggestive of tonsillitis. The tonsils are enlarged with a white-yellow exudate arising from the crypts. Patients may show evidence of oropharyngeal trauma, particularly on the soft palate or uvula. Fever (8 ) and lymphadeno-pathy (9 ) are uncommon findings (11). Organisms are found within the cellular debris at the base of crypts. Isolated pharyngeal infection is rare complications occur infrequently, if ever, and most cases resolve spontaneously within a few weeks or in response to therapy for genital or rectal infection. In addition, transmission of pharyngeal infection to other sites is inefficient. Gonococcal oropharyngitis is common among homosexuals and among children who are victims of sexual abuse. Infection follows orogenital contact. For asymptomatic patients,...

Table 78 Exercise Adaptations for Medical Problems

Arthritis To avoid stress on your joints, choose non-weight-bearing cardiovascular exercises, for example cycling and swimming. Taking breaks will help to minimize pain. You can strengthen the muscles around painful joints by doing isometric exercises (exercises that do not involve movement). If you have arthritis in your knees, for example, lie on your back, raise your leg 1 foot off the ground, and hold it for 30 seconds, with or without an ankle weight. This exercise strengthens your quadriceps muscles but places minimal stress on the knee joints.

The Impact Of Adolescent Pain On Quality Of Life

In the Roth-Isigkeit study, 54 of adolescents who reported pain also had problems with sleep and appetite, 49 had long-term absences from school and 47 were unable to meet friends (7). A separate outpatient survey showed that 72 suffered impairment in sports activities, 51 reported absence from school, 40 experienced limitations in social functioning, and 34 had problems with sleeping (77). Sleep disorders with frequent nocturnal arousals or daytime somnolence are common in children suffering juvenile rheumatoid arthritis (76) similar sleep disturbances are seen in adolescents with chronic pain. In the German cohort study, 41 of the young people reported sleep disturbances attributable to pain. This significantly increased with age. Restrictions at school, absenteeism, and problems with school activities are widely reported in this population.

IL15 in Chronic Inflammation

The foregoing description clearly renders IL-15 an intriguing candidate in the context of chronic inflammation. This has now been tested in a number of chronic inflammatory disease states (Table 1). Although expression data pertain to many of these diseases, most functional characterisation has been performed in inflammatory arthritis. We and other groups identified IL-15 and IL-15Ra expression at mRNA and protein levels in inflamed synovium and in peripheral blood from patients with RA (McInnes et al. 1997, 2003). Recently, IL-15 serum expression has been shown to rise progressively with RA disease duration (Gonzalez-Alvaro et al. 2003) . IL-15 levels are also higher in juvenile idiopathic arthritis and correlate with CRP. IL-15 expression is also reported in RA nodule tissues together with a predominantly Th1 cytokine milieu (Hessian et al. 2003). It is clear therefore that IL-15 is expressed at the site of pathology. The functional importance of IL-15 in inflammatory synovitis is...

Treatment Of Dermatomyositis

For children without evidence of vasculitis who are not profoundly weak, a low or moderate dose of corticosteroids is often sufficient. Some children with dermatomyositis have mild arthritis when they first come to a doctor's attention. This usually responds well to treatment with corticosteroids, but a brief course of nonsteroidal anti-inflammatory drugs (NSAIDs) may also be beneficial. Hydroxychloroquine is another drug that is often useful as a steroid-sparing agent in children with mild disease, especially where rash predominates.

Applications Future Challenges

The draft sequence already is having an impact on finding genes associated with disease. Genes have been pinpointed and associated with numerous diseases and disorders including breast cancer, muscle disease, deafness, and blindness. Additionally, finding the DNA sequences underlying such common diseases as cardiovascular disease, diabetes, arthritis, and cancers is being aided by the human SNP maps generated in the HGP in cooperation with the private sector. These genes and SNPs provide focused targets for the development of effective new therapies.

Reviewing more Thought Court cases

Over the years, Connor, a 58-year-old high school teacher, became an avid outdoorsman, spending his summer vacations camping, fishing, and hiking. Although his arthritis has been getting progressively worse, Connor has tried to ignore the pain. In fact, he only consults his doctor when the pain becomes overwhelming. His doctor refers him to an orthopedic specialist who tells Connor he needs a hip replacement. Connor slips into depression at the news. He fills out some Thought Trackers and zeroes in on a malicious thought I'll never be happy again. Life will just be a downhill slide from here. He accuses this thought of increasing his misery and puts it on trial (see Worksheet 6-9). That's unreliable forecasting and magnification. I need to check with the doctor before I come to this conclusion. And there are many ways to manage pain. There are other people with arthritis who manage to have a good quality of life.

Is the pain I have experienced part ofPD

It is said that pain and PD don't go together thus, pain appears to be something else, such as arthritis, bursitis, a bad back, or a frozen shoulder. However, pain is part of PD and has many forms. How common is pain is PD Perhaps 50 of people with PD complain of pain at one time, and in perhaps 50 of them 25 of all people with PD the pain is related to PD and not to something else. The pain may be related to PD if it fits a pattern, if it's worse where PD is worse, if it's relieved by PD drugs, or if there's no other cause.

Marc J Philippon MD Mara L Schenker BS

Femoroacetabular impingement (FAI) has been recently revealed as a significant cause of hip pain in the athlete 1 and as a predictor of early onset hip osteoarthritis 2-4 . The hip is highly reliant on its bony structure for stability and support during substantial loading in weight bearing and sport. As a result, any abnormality in bony morphology may alter the force distribution in the joint, and can potentially cause injury to the capsulolabral structure or articular cartilage. induce cam-type impingement, causing injury to the labium and adjacent articular cartilage 8-10 . Insufficient reduction of femoral neck fractures and decreased anteversion of the femoral neck have also been shown to cause cam impingement 11,12 . Pincer impingement may be caused by general acetabular overcoverage (coxa profunda) or acetabular retroversion 13,14 , and has been shown to be associated with osteoarthritis of the hip 15 . Demographically, cam impingement seems to be more common in young males and...

Approach to Defining Cause of Chronic Enteropathy

There are numerous causes for chronic enteropathy in children and all methods of categorizing have their advantages and deficiencies. The majority of the worldwide burden of chronic enteropathy is due to malnutrition and secondary immune deficiency and should be readily diagnosed if in the associated context most other forms of chronic enteropathy are rare. Regardless, a detailed and careful history is of primary importance in determining the potential causes of chronic enteropathy in the individual child and avoiding unnecessary and costly investigations. Clues to early onset enteropathy may be contained in the prenatal history such as a mother's infectious status including exposure to HIV. In environments where antenatal ultrasonography is routine, fetal fluid-filled dilated loops of intestine and polyhydramnios may be an early indication of congenital enteropathy syndrome such as congenital chloride-losing diarrhea. A careful history of the age and time of onset of symptoms should...

Circadian Rhythms and Diseases

Clinical research has been conducted with varying numbers of study subjects to explore circadian rhythms associated with disease states. Peak time of disease activity is shown in Table 9.1. Several potential oral delivery methods have been described for targeting circadian rhythms, as described below. Such awareness is useful for diagnosis and treatment 16 . Osteoarthritis may be distinguished Allergic rhinitis Arthritis Osteoarthritis

The Analysis Of Quantified Handedness Measures Statistical Considerations

Another methodological issue pertains to the size of the experimental and control groups in handedness studies. Many studies are not powered with enough participants to show significant differences between the experimental and control groups. For example, suppose an investigator hypothesizes that the prevalence of right and left handedness (however measured and defined) are 10 and 30 , respectively, in a control group and an experimental group (e.g., patients with rheumatoid arthritis). In that hypothetical study, a minimum of 71 participants in each group would be necessary to demonstrate statistical significance at the 0.05 level with a power of 0.8 (20 chance of missing the effect) (Fleiss, 1981). Further, if the frequency of left handedness is less than 3-fold higher in the experimental group than the control group, or the frequency of right handedness in the control participants is greater than l0 , then even greater numbers of participants are necessary to demonstrate a...

Anterior Cruciate Ligament

The mechanism of injury is usually noncontact, with the foot planted when a twisting injury occurs at the knee. Athletes usually hear or feel a pop and have immediate pain and swelling within 24 hours. Contact injuries may also damage the ACL. On examination they can usually weight bear but have a large effusion. They have a positive Lachman test suggesting that the ACL is torn (Fig. 7). Radiographs are usually normal although a Segund Fracture is pathognomonic for an ACL tear (Fig. 8). An MRI may be useful in equivocal cases or in those with a soft endpoint on Lachman testing. Athletes with a torn ACL need surgical repair if they wish to return to cutting and pivoting sports as without an ACL, cutting and pivoting will damage the meniscus and may lead to early arthritis. Adolescents may also sustain a tibial spine fracture with the same mechanism that tears the ACL. Mechanisms that injure the ACL can also cause damage to the MCL or meniscus.

Inflammatory Conditions

Olive leaf extract is used to promote symptomatic relief in various inflammatory conditions, such as osteoarthritis and asthma, and as a gargle in tonsillitis and pharyngitis. The anti-inflammatory effects demonstrated by several major components in olive leaf provide a theoretical basis for its use however, clinical trials are not yet available to determine whether effects are significant and efficacy remains speculative. Alternately, olive oil supplementation has been tested in some clinical studies. Rheumatoid arthritis In some studies of RA in which fish oil supplements have been investigated, olive oil has been used as a placebo because it was generally regarded as containing neutral fatty acids however, in some instances olive oil produced significant improvements in disease activity, prompting further research. More recently, a study of 43 patients investigated the effects of placebo (soy oil), fish oil (3 g day), and a combination of fish oil (3 g day) and 9.6 mL day of olive...

What if the Medicine Is Not Working

If your child is taking the drug your physician recommended and it is not working, you might be expecting results too quickly. Some arthritis medicines do not make a big difference until they have been taken for several weeks. Other medicines may be very important, but instead of making the child feel better, they prevent him or her from getting worse. Be sure you talk to your doctor about your concerns. If you are not comfortable talking with your doctor or the office staff, you need to find a doctor you can be comfortable talking with.

Data From Existing Clinical Studies

The work described here has identified dryness and fatigue as the key patient-reported outcomes in PSS (with joint pain and Raynaud's also being frequent). In expert panel discussions, fatigue was felt to be a particularly important outcome domain in its own right, in relation to patients' disease experience.60,61 We have also shown that fatigue can improve following systemic therapy20 and there is increasing interest in fatigue as a secondary outcome measure in rheumatoid arthritis.25,40 Nevertheless, because fatigue has psychosocial as well as biological causes, there is reasonable hesitation to rely on it exclusively as a single primary outcome measure, particularly where biological therapy is being considered. Other approaches are to use fatigue as part of a composite symptomatic outcome measure (eg, with pain and dryness symptoms)32 or to incorporate fatigue into, or alongside, a systemic activity

Metabolic Implications And Health Benefits Of Dha Epa And u3 Fatty Acids

Dietary EPA and DHA are packaged and transported through chylomicrons produced in the intestinal epithelial cells. The most relevant tissues that contain u-3 PUFA are hepatic, lung, kidney, spleen, plasma, heart, retina, and the vascular endothelium. EPA concentrates in the hepatic, renal, and blood cells, whereas DHA concentrates in the heart, retina, and brain. These PUFAs have three major roles cell membrane structure, precursors of eicosanoids, and effectors of protein activity (enzymes, receptors, and ionic channels). EPA is preferably incorporated associated with phosphatidyl choline (67 ) and ethanolamine (13 ) in platelets, whereas DHA accumulates with phosphatidyl ethanolamine (45 ) and choline (37 ). DHA is also incorporated into cardiolipin, a phospholipid only found associated with the cardiac muscle. Eicosanoides are hormones synthesized from 20-carbon FA, mainly araquidonic and EPA, and the enzymes cyclooxygenases and lipooxygenases (Figure 29.2). EPA is precursor of...

Chondral Injuries Of The

Chondral injuries of the hip may be seen in conjunction with a variety of hip disorders, and may result from an atraumatic or traumatic etiology. These disorders include labral tears, loose bodies, hip instability or dislocation, osteo-necrosis of the femoral head, slipped capital femoral epiphysis, hip dysplasia, and degenerative joint disease 12-17 . Chondral injuries can be acute, chronic, or degenerative, and may be partial thickness or full thickness lesions. As the experience with hip arthroscopy expands, so, too, will the ability to recognize the various injury patterns to the chondral surfaces of the hip. As our understanding of the pathologic processes contributing to chondral injury of the hip joint improves, perhaps we will be able to intervene preventing the progression to osteoarthritis.

Applications To Health Promotion And Disease Prevention

Include multiple sclerosis, rheumatoid arthritis, asthma, arteriosclerosis, etc. Those pathologies indicate a critical role for tissue infiltration by leukocytes in inflammatory disease pathogenesis. For immigration of circulating leukocytes into tissues, transmigration through the vascular endothelial layer involves two independently regulated events binding to vessel endothelium, followed by diapedesis. For this purpose, cell arrest is mediated by activation of adhesion receptors on the moving cell, followed by attachment to counter-receptors on other cells or endothelial cells, leading to an immobilized cell. Furthermore, the inflammatory response is mediated by a broad spectrum of mediators able to promote vascular events, edema, and, finally, the recruitment of inflammatory cells (Friedl & Weigelin 2008).

Adverse Effects And Reactions Allergies And Toxicity

The aqueous and oil extracts of the seeds have been shown to possess antioxidant, antiinflammatory, anticancer, analgesic, and antimicrobial activities. TQ has been shown to be the active principle responsible for many of the seed's beneficial effects. The toxicity of the fixed oil of N. sativa (L.) seeds in mice has been examined changes in key hepatic enzymes levels were not observed in rats, suggesting the safety of therapeutic doses of N. sativa (L.) fixed oil (Zaoui et al., 2002). Several findings have provided clear evidence that TQ possesses reproducible antioxidant effects through enhancing the oxidant scavenger system. The oil and TQ have shown potent anti-inflammatory effects on several inflammation-based models, including experimental encephalomyelitis, colitis, peritonitis, edema, and arthritis, through suppression of the inflammatory mediator prostaglandins and leukotrienes. The oil and certain active ingredients showed beneficial immunomodulatory properties, augmenting...

Moving Yourself to a Better Frame of Mind

Both extremes are unreasonable positions to take. For example, although people who don't have fibromyalgia really can't feel your pain, they may have arthritis or another chronic-pain problem and, thus, can understand what chronic pain feels like, even if it's not your specific type of chronic pain. On some level, they should be able to grasp your problem. On the other hand, people shouldn't be expected to automatically sympathize with poor you even when those people are your own loving family members. You're setting yourself up for disappointment if you take either of these polar positions.

Mycophenolate Mofetil

Mycophenolate mofetil (marketed as Cellcept) is a newer immunosuppressive drug that inhibits DNA synthesis. It is primarily used for the treatment of organ transplant recipients but has been increasingly used for the treatment of children with SLE and other vasculitic diseases. It has also been used in children with uveitis and in adults with psoriatic arthritis. At present, the role of mycophenolate mofetil in the treatment of children with arthritis has not yet been defined. It has been reported to be as effective as cyclophosphamide in high dosages, but most physicians have found the necessary dosage of mycophenolate mofetil to cause a significant incidence of stomach complaints, which force people to stop taking the medication. Too, practical clinical experience has not matched the success of the carefully selected patients in the published studies. More studies combining mycophenolate mofetil with other medications are under way.

Signposting Resources for Parents

Chat 2 Parents booklet specifically for parents of adolescents with arthritis The website of the American Juvenile Arthritis Organization - a council of the U.S.-based Arthritis Foundation - offers generic information for parents of adolescents U.K.-based Children with Chronic Arthritis Association U.K.-based charity for families with children with arthritis

Disease of the joints

The most common diseases are inflammatory and degenerative arthritis, but there are many others that cause primary changes in the joints and secondary changes to the surrounding soft tissues. Massage must not be given in the acute stages of joint disease, when the joint may be red, hot, swollen and very painful.

Laughter Gods Heart Medicine

The heart of the physical man in a busy life receives enormous stress from diet and lifestyle choices. Do you take time to laugh Laughter is God's medicine for the heart. Laughter relaxes blood vessels boosting blood flow. Life is in the blood. It carries essential nutrients and oxygen to tissue cells. Mental stress causes blood vessels to constrict or get smaller reducing blood flow. When you laugh, reactions in the body are prompted by a release of nitric oxide, which relaxes blood vessels much like endorphins released during exercise. When you laugh, you also have less wear on your joints.

Essential Fatty Acids Omega3 Omega6

Research has shown that many adults with rheumatoid arthritis who take omega-3s show significant improvement after six to eight weeks of taking the supplement. However, by twelve weeks the body readjusts itself and begins to make increased amounts of the inflammatory mediators again, so there seem to be no long-term benefits. The major side effects of omega-3 fatty acids are increased bruising and prolonged bleeding. It's also very expensive if you take the amount necessary to show a short-term effect. Flaxseed oil is another source of essential fatty acids that is frequently recommended for the treatment of arthritis. There is no long list of negative side effects, but there is no convincing evidence it helps, either.

Dont want steroids Are other treatments available for MS attacks

Traditionally, the management of MS centered on the use of extended periods of physical (and mental) rest, as it did for patients with tuberculosis or rheumatoid arthritis. Today, relapse management in MS seems to revolve around the use of steroids. ACTH was approved for the treatment of attacks of MS by the FDA in 1978 and remains the only drug approved for treatment of MS attacks. The IV form of ACTH is in very short supply, but the intramuscular form (ACTHAR Gel) is again in production and can be obtained with a prescription. Rheumatoid arthritis a common inflammatory joint disease caused by an autoimmune response.

Common conditions that affect joints

Two common conditions that affect the structure and function of joints are rheumatoid arthritis and osteoarthritis. Although differing in pathology, they both result in damage to the hyaline cartilage that lines the bones, inflammation of the synovial membrane and an increase in synovial fluid entering the joint space. These factors produce heat, swelling and pain around the joint, which limit movement.

Total Hip Replacement

Total hip replacement (THR) surgery is one of the most significant advances in the care of children with severe arthritis. Prior to the widespread availability of THR for children, any child with severe arthritis in the hip was simply placed in a wheelchair when the pain became too great. Few were ever able to resume walking. Now we are able to replace the hips of children with severe pain, and wheelchairs have become far less common. The appropriate time for surgery is as soon as the child's arthritis begins significantly to limit his or her ability to walk around outside the house. If your child's hip pain is such that you are considering asking for a wheelchair, it is time to be asking for THR surgery instead. As soon as the child begins to use a wheelchair, he or she begins to lose strength in the legs and begins to develop flexion contractures in the knees. Both of these complications make it much more difficult to recover the ability to walk after surgery. The best outcome is...

Nutritional Status at the Time of Diagnosis

The relationship between concurrent TB and malnutrition is complex. Even though malnutrition is an important risk factor for TB, TB in turn results in cachexia, anorexia, and asthenia. As in other infectious diseases, resting energy expenditure is increased and intake is decreased. Weight loss and muscle wasting may in part be related to tumor necrosis factor-a (TNF-a) and other proinflammatory cytokines that participate in the immune response against TB. On the one hand, TNF-a plays a critical protective role against Mycobacterium tuberculosis. On the other hand, TNF-a results in wasting and anorexia. One of the first research teams to identify TNF called it 'cachectin' because the team identified it as the chemical mediator of weight loss in cancer and chronic inflammatory diseases. In experimental mycobacterial infections, TNF-a is required for the control of bacil-lary growth and the protective granulomatous response. Patients receiving anti-TNF-a monoclonal antibodies for the...

Importance for developing effective intervention strategies

Understanding the impact of fatigue on daily living activities is central to providing effective interventions, including both remediation and compensatory strategies (see Chapter 12). Research suggests that remediation strategies such as engagement in planned exercise (Mock et al. 1997) and activities such as gardening and walking (Winningham et al. 1986 Cimprich 1993) may relieve fatigue. Compensatory strategies, such as energy conservation techniques, have been used successfully with patients with diagnoses of chronic fatigue syndrome, chronic obstructive airway disease, and arthritis (Furst et al. 1987 Hubsky and Sears 1992 Welham 1995 Rashbaum and Whyte 1996 Brus et al. 1998). Whilst this approach is being advocated as a technique for managing cancer-related fatigue there is little systematic evaluation of its effectiveness. As patients live longer with cancer and experience ongoing fatigue, efficacious interventions that assist patients in lifestyle changes will become...

Pain Is Pain Its All the Same

If your cousin has pain from arthritis or a bad back, he may think that his pain is about the same as your pain from fibromyalgia. (Or he may think that his pain is far worse than yours ) But studies indicate that the pain from fibromyalgia can be far more intense than other forms of muscle or joint pain, and it often lasts longer as well. Some studies have demonstrated that people with fibromyalgia feel pain more intensely and for a longer period than others.

Diseases Epidemiological Evidence

Among the most common neurologic diseases are neurodegenerative disorders such as Alzheimer's and Parkinson's disease, which may be caused by oxida-tive stress and mitochondrial dysfunction leading to progressive neural death. An increasing number of studies show that antioxidants (vitamin E and polyphenols) can block neuronal death in vitro. In a 2-year, double-blind, placebo-controlled, randomised trial of patients with moderately severe impairment from Alzheimer's disease, treatment with 1340 mg day-1 a-TE significantly slowed the progression of the disease. Clinical treatment of Alzheimer's patients with large doses of vitamin E (670 mg a-TE twice daily) is one of the key therapeutic guidelines of the American Academy of Neurology. In a multicentre, double-blind trial, vitamin E (1340 mg a-TE day-1) was not beneficial in slowing functional decline or ameliorating the clinical features of Parkinson's disease. Administration of vitamin E significantly relieved symptoms in patients...

Piper nigrum L Piperaceae Pepper Lada

Piper Nigrum

Traditional Medicinal Uses The plant is used in many Asian countries as a stimulant, for the treatment of colic, rheumatism, headache, diarrhoea, dysentery, cholera, menstrual pains, removing excessive gas and increasing the flow of urine. 11 It is also used in folk medicine for stomach disorders and digestive problems, neuralgia and scabies. In Ayurveda, it is used for arthritis, asthma, fever, cough, catarrh, dysentery, dyspepsia, flatulence, haemorrhoids, urethral discharge and skin damage. In Chinese medicine, it is used for

Images Of Zingiber Officinale Used As Antiulcer

Altman RD, Marcussen KC. Effects of a ginger extract on knee pain in patients with osteoarthritis. Arthritis Bliddal H et al. A randomized, placebo-controlled, cross-over study of ginger extracts and Ibuprofen in osteoarthritis. Osteoarthritis Cartilage 8.1 (2000) 9-12. Haghighi M et al. Comparing the effects of ginger (Zingiber officinale) extract and ibuprofen on patients with osteoarthritis. Arch Iranian Med 8.4 (2005) 267-71. Wigler I et al. The effects of Zintona EC (a ginger extract) on symptomatic gonarthritis. Osteoarthritis Cartilage 11.11 (2003) 783-9.

Morinda citrifolia L Rubiaceae Mengkudu Indian Mulberry Noni

Pairs Rambutans

Traditional Medicinal Uses The whole plant is used to treat aching bones and arthritis. In Malaysia, the heated leaves are applied to the chest and abdomen to treat coughs, nausea, colic and enlarged spleen. In Japanese and Chinese medicine, M. citrifolia is used to treat fever and as a tonic whereas in Indochina, the fruit is prescribed for lumbago, asthma and dysentery. 1 A decoction of the leaves taken orally is effective for the treatment of fever,

A HSV Gene Transfer for Neuropathy and Pain

Gastrocnemius Muscle Transfer

The treatment of pain uses the same approach, subcutaneous inoculation to transduce DRG neurons, to achieve local expression of peptides in sensory neurons. Wilson first constructed a replication-competent HSV-based vector to express proenkephalin (117). Subcutaneous injection of that vector into the dorsum of the foot in mice produced an antihyperalge-sic effect that could be demonstrated by an increased latency to withdraw the foot from noxious heat after sensitization of C fibers by application of capsaicin, or sensitization of A8 fibers by application of dimethyl sulfoxide (117). Although no antinociceptive effect was demonstrated in the absence of prior sensitization using the experimental paradigms reported, substantial expression of methionine-enkephalin could be demonstrated by immunocytochemistry (117). A replication-competent HSV-based vector expressing proenkephalin reduced pain in a rodent model of arthritis (166).

Static Biochemical Tests

Iron status is assessed in relation to three stages of development of iron-deficiency anemia. In the first stage, to evaluate the size of body iron stores, serum or plasma ferritin can be measured by radiometric methods or using ELISA. Commercial kits are available. Confounding effects of infection, liver and malignant diseases, acute leukemia, Hodgkin's disease, rheumatoid arthritis, thalasse-mia major, alcohol consumption, age, and sex are reported. In the second stage, to determine the adequacy of iron supply to the erythroid marrow, serum iron (measured by the colorimetric method, available as commercial kits AAS is not recommended because it gives higher values), plasma or serum total iron binding capacity (TIBC by colo-rimetric or radioactive methods available as commercial kits), erythrocyte protoporphyrin (by specific hematofluorometer), and serum transferrin receptor (by ELISA using developed monoclonal antibodies) are measured. The percentage of trans-ferrin saturation is...

Reaction Forces Inside the Joints

Lever Shoulder Joint

Joint Rj 50 kg + 150 kg 200 kg (440 lb). If low back pain occurs, the lower back muscles have to use much more force to support the posture, and the reaction force inside the lumbar joint is much higher. It is not surprising that an overloaded joint is more likely to be subsequently subject to wear and tear, resulting in osteoarthritis or other joint and muscle injuries. Therefore frequent de-stress treatment with dry needling technique introduced in this book is of great importance to maintain optimal physical performance and a career in sports. Figure 4-5 During abduction, the shoulder joint function as a typical class III lever. Figure 4-5 During abduction, the shoulder joint function as a typical class III lever.

Nuclear Factorkappa B and Activator Protein1

As stated above, NF-kB activity plays a central role in inflammation. Indeed, it may be one of the key regulators of inflammation. Not surprisingly then, a variety of anti-inflammatory drugs, such as aspirin, produce their effects in part by inhibiting NF-kB activity. This can occur in at least two ways. First, NF-kB can be stimulated by redox signals, and some anti-inflammatory drugs may act through attenuation of these signals. For example, gold thiolate, an anti-inflammatory drug used in treating arthritis, may inhibit NF-kB partly through its antioxidant capabilities.

Carpal Tunnel Syndrome

This injury results from the compression of the median nerve in the carpal tunnel. As discussed previously, the carpal tunnel is a narrow, rigid structure composed of a transverse ligament and carpal bones at the base of the hand. The tunnel surrounds the median nerve, which enters the hand between the carpal bones and innervates the palm side of the thumb and fingers. Carpal tunnel syndrome is caused by excessive wrist movements such as repetitive flexion and extension of the wrist (as in cycling, throwing, racket sports, and gymnastics), which result in squeezing or compression of the median nerve in the tunnel at the wrist. Trauma or injury, including fracture or sprain, wrist swelling, arthritis, or hypertrophy of the bone, can also produce carpal tunnel syndrome.

Drugs Used to Treat Infectious Diseases

Cefotaxime sodium (Trade name Claforan) A cephalosporin antibiotic used to treat lower respiratory tract, genitourinary, gynecologic, intra-abdominal, skin, bone, and joint infections and septicemia. Intravenous route only. Side Effects Joint pain, fever, and rash. At high doses, the drug may cause toxic effects on the liver. Adverse Effects Rash, fever, nausea, vomiting, diarrhea, headache, dizziness, muscle or joint pain, or crystals in the urine.

Pathophysiologic Factors That Convert Latent Acureflex Points To Passive Points

Cervicis, the suboccipital muscles at the base of the skull, and the trapezius and levator scapulae muscles). This posture is often associated with posterior displacement of the mandible and temporomandibular joint pain. Myalgic syndromes of the posterior cervical muscle and shoulder muscle are thus frequently associated with head pain and headache. Myalgic headache is often the result of postural or ergonomic stress on the shoulder and neck muscles.6 Infectious diseases produce passive acu-reflex points. Lyme disease is perhaps the most prevalent of the infectious diseases associated with myofascial pain. In some patients, intractable widespread muscle pain and chronic fatigue have been positively associated with Lyme disease (in which elevated immunoglobulin G titers and normal immuno-globulin M titers are indicative of past, not recent, exposure). Some affected patients develop joint pain. Post-Lyme disease syndrome is characterized by diffuse joint and muscle pain, fatigue, and

RLS and other neurologic disorders

227 Charcot-Marie Tooth disease patients compared to 234 controls with a 5.6 prevalence. RLS severity was correlated with worse sleep quality and reduced health-related quality of life measures. Variation in prevalence was not observed between subtypes of Charcot-Marie Tooth disease, but women were more severely affected by RLS than male patients (Boentert M, et al 2010). A series of 28 patients with Friedreich's Ataxia were surveyed for prevalence of RLS with 32 meeting diagnostic criteria (Synofzik M et al, 2011). In a population of 28 chronic inflammatory demyelinating polyneuropathy (CIDP), a prevalence of 39.3 for RLS was found, compared to 7.1 prevalence in age and gender matched control patients. Isolated case reports of RLS symptomatology following development of hyperparathyroidism (Agarwal P et al, 2008), administration of interferon therapy (LaRochelle JS, et al, 2004), development of multifocal motor neuropathy (Lo Coco D, et al, 2009), and Guillain-Barre syndrome have...

Traumatic Hip Instability

Traumatic Brain Injury Mri

The radiologic workup after a presumed traumatic hip injury begins with plain radiographs including an AP view of the pelvis and AP and frog-lateral views of the affected hip. In many cases, this will provide a relatively definitive diagnosis such as an acute traumatic fracture, avulsion fractures, dislocation, subluxation, osteitis pubis, or degenerative joint disease. Additional views that are typically required include a crosstable lateral radiograph and Judet oblique films to further assess acetabular fractures that are noted on the AP pelvis. Once the diagnosis of a hip dislocation is made, a careful evaluation of the femoral neck must be performed to rule out the presence of a femoral neck fracture before any manipulative procedures are performed.

Nutrition and Sutoxins

Reckeweg found the deposition of mucous substances in tendons, ligaments and cartilage particularly dangerous. It could lead to rheumatism, arthritis and arthrosis as well as invertebral disc degeneration, as the coarse connective tissue substances became mucous and soft and therefore less resistant. Reckeweg explicitly referred to August Bier who had injected test animals with sulphur.806 This had led to a mobilisation and elimination of the tissue sulphur which had made the cartilage firmer and poorer in sulphur. Reckeweg explained the effect of sulphur baths in the same way cartilage, he said, was firmer and more resistant the less sulphur it contained.

Chronic Recurrent Multifocal Osteomyelitis and Synovitis Acne Pustulosis Hyperostosis and Osteitis Syndromes

Pattern of arthritis Gonococcal arthritis (Neisseria gonorrhoea) Bacterial arthritis and osteomyelitis (Staphylococcus, Streptococcus, Pseudomonas aeroginosa, gram-negative infections) Reactive arthritis (Salmonella, Shigella, Yersinia) 40 mono-arthritis 30 oligo-arthritis 30 polyarticular Asymptomatic tenosynovitis in 2 3, especially dorsum of hands and wrists Mono-arthritis, usually lower limb Frequent cause of acute septic arthritis in adolescence. Arthritis occurs as part of the disseminated phase of the disease in 1-3 of patients with symptomatic infection and in up to 0.3 of asymptomatic carriers. Initial presentation is with systemic features, dermatitis, tenosynovitis, and migratory polyarthralgia or polyarthritis (bacteraemic phase). This is followed by a progressive localization of joint symptoms and effusions in one or more joints (septic joint phase). Septic arthritis usually occurs in a single joint, most commonly the hip, knee, or ankle. Osteomyelitis should be suspected...

Think I am a good candidate for gastric bypass surgery What do I need to do to obtain insurance coverage for this

Ship with your primary care doctor, he or she will know about your weight loss attempts and will be treating you for any of your obesity-related illnesses or conditions (elevated cholesterol and triglycerides, gallstones, pancreatitis, abdominal hernia, fatty liver, diabetes or prediabetes, polycystic ovary syndrome, high blood pressure, heart disease, pulmonary hypertension, stroke, blood clots in the legs and lungs, sleep apnea, arthritis, gout, lower back pain, infertility, urinary incontinence, or cataracts).

The Tryptophan Load Test

Tryptophan Degradation Test

In patients suffering from a wide variety of unrelated diseases, including Hodgkins' lymphoma, rheumatoid arthritis, schizophrenia, porphyria, renal tuberculosis and aplastic anemia, there is abnormal excretion of kynurenine metabolites after a test dose of tryptophan (Altman and Greengard, 1966 Coon and Nagler, 1969). It is unlikely that such disparate conditions would all be associated with vitamin B6 deficiency. Liver biopsy shows elevated tryptophan

Blood Coagulation System And Immune Complement System

Needling is used effectively for acute inflammation of soft tissues caused by injury from accidents, sports, and all kinds of pathologic conditions (e.g., tonsillitis inflammation of the parotid gland, lymphatic vessels, and nodes appendicitis pancreatitis postoperational infections bacterial dysentery hepatitis B nephritis and other hypoimmune reactions). ISDN is also used for improving hyperimmune response in cases of chronic inflammation such as hyperthyroidism, Hashimoto thyroiditis, sinusitis, asthma, allergy, urticaria, gastritis, rheumatoid arthritis, diabetes, and low leukocyte count during chemotherapy. ISDN is a safe and beneficial adjunct therapy for all these conditions.

Atraumatic Instability

Septic arthritis Rheumatoid arthritis Psoriatic arthritis Another category of atraumatic instability exists and consists of patients with anatomic deficiencies. When deviation occurs from normal bony anatomy, the hip must rely more on the soft tissue structures including the capsule and labrum for stability. Tonnis et al 2 evaluated the radiographs and CT scans of 356 hips in 181 patients and calculated the McKibbin instability index. They demonstrated that patients with a normal McKibbin instability index had the lowest rates of pain and osteoarthritis and had balanced ranges of rotation of the hip. As the McKibbin instability index approached the upper and lower extremes, patients had significantly more pain, osteoarthritis and altered degrees of hip rotation. They concluded that a McKibbin instability index of less than 20 is a major cause of osteoarthritis, pain and altered rotation of the hip. Due to a small sample size, patients with an increased McKibbin instability index had a...

Thuja Occidentalis And Rosacea Aggravations

Artemisia cina (Cina) 38, 246-47, 288 Artemisia maritima 'Linn' see Artemisia cina Artemisia vulgaris (Artemisia) 127, 280 arteries 184 arthritis osteoarthritis 196 rheumatoid arthritis 197 see also joint pain Arum atrorubens see Arisaema triphyllum Arum maculatum (Arum mac.) 127, 280 Arum triph. Arum triphyllum 280

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