Archive for July, 2009
Monday, July 27th, 2009
No causes of polymyalgia rheumatica (PMR) have yet been identified. The inflammation associated with PMR is known to be caused by the white blood cells attacking the synovium (lining of the joints), but why they do this is unknown.
There are certain factors that seem to increase the risk of developing PMR. These include:
* Genetics, race and sex. White women are affected more often than any other demographic. People of Northern European descent seem to be particularly at risk. This suggests that there may be a genetic susceptibility in certain individuals to PMR, but no research has been able to identify a particular genetic link.
* Age. Incidences of PMR in individuals under the age of 50 are extremely rare. Many researchers have suggested that PMR may be connected to the aging process. How it might be connected and to what degree remains controversial.
* Immune system abnormalities. The attack on the synovium by the white blood cells appears to be due to abnormalities in the immune system. The cause is not known.
* Climate. PMR is more prevalent in cooler climates. It is not known whether this is due to an environmental effect on PMR susceptibility or to the genetic background of the people who live in these environments.
* Viruses. Some research has indicated a possible link between PMR and certain viruses, such as adenovirus (any of a group of viruses that cause upper respiratory tract infections and conjunctivitis) and fifth disease (a viral disease that is usually mild and typically occurs in childhood).
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Friday, July 24th, 2009
Polymyalgia rheumatica (PMR) is a rheumatic disease characterized by muscle pain and stiffness in and around the neck, shoulders and hips. Mild inflammation in the joints and surrounding tissues produces this pain, even though there is usually no sign of arthritis. The term “polymyalgia” means “pain in many muscles.”
PMR may develop as rapidly as overnight or more gradually over a period of weeks. It may occur in individuals who are in otherwise excellent health. PMR is generally a benign (not life-threatening) condition that usually goes away without treatment in several months to years, but it can be resolved more quickly with treatment.
The inflammation that characterizes PMR is the result of white blood cells attacking the synovium (lining of the joints), although it is not known why this occurs. The precise location of the inflammation is disputed, but many researchers and physicians believe it may be in or near the large joints, such as the shoulders and hips. However, other joints, such as those of the hands and feet, are also affected in some patients. This inflammation is not as severe as that caused by inflammatory types of arthritis and is usually not noticeable upon physical examination. Detection is made more difficult because large muscles cover the joints of the shoulders and hips.
PMR does not directly cause any muscle weakness or damage, but the muscles may atrophy (deteriorate) from disuse due to pain. Further, PMR is not itself life–threatening, but dangerous complications may arise because of medications and coexisting conditions.
PMR occurs almost exclusively in individuals over the age of 50, with an average age at onset of 70 years. It is twice as common in women as in men. Although it can occur in any race or ethnic group, the vast majority of cases occur in whites. PMR affects about 700 per 100,000 Americans (less than 1 percent) over age 50, according to the National Institutes of Health.
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Thursday, July 16th, 2009
Polymyalgia rheumatica (PMR) is an essentially benign (not life-threatening) inflammatory disease characterized by pain and stiffness in the muscles in and around the neck, shoulders and hips. It may develop rapidly but usually goes away over several years, even without treatment. With treatment, symptoms typically disappear in less than a week.
PMR may occur along with temporal arteritis, a condition that causes arteries, particularly those in the head, to swell. It is not known how or why PMR and temporal arteritis are connected, but temporal arteritis can potentially be life-threatening and is typically tested for along with PMR.
The cause of PMR has not been identified, but white women over the age of 50 are most commonly affected. Theories on the possible causes of PMR include links to genetics, aging, climate and viral infections.
Muscle pain and morning stiffness are the characteristic symptoms of PMR. Other symptoms include arthritis, joint swelling, edema (swollen tissue) and flu-like symptoms (e.g., general weakness, feeling of being unwell, loss of appetite).
PMR is a clinical diagnosis, mainly a diagnosis of exclusion, meaning other conditions should be ruled out. The only blood test found positive is the sedimentation rate (sed rate). Most physicians agree that the following criteria must be met for diagnosis of PMR:
* Patient over age 50.
* Aching and stiffness on both sides of the body that lasts at least 30 minutes and persists for at least one month.
* Sed rate over 40 millimeters per hour. This blood test detects inflammation by measuring the rate at which red blood cells fall in blood plasma.
Some physicians add another requirement – that symptoms respond quickly to corticosteroids. Also, other conditions that may cause the necessary criteria (e.g., rheumatoid arthritis, fibromyalgia, polymyositis) must be ruled out.
PMR is typically treated with low-dose corticosteroids, which eliminate symptoms quickly. Once symptoms disappear, the dose is reduced to the lowest effective dose and treatment with this drug is eventually ended. However, if the dosage is reduced too quickly or treatment is ended too soon, a relapse may occur.
PMR affects less than 1 percent of the U.S. population over the age of 50, according to the National Institutes of Health.
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Tuesday, July 14th, 2009
Q: Are there any foods that have arthritis- or inflammation-fighting properties? I am 51 with severe joint pain in my hands and do not want to take cortisone shots. I have been using glucosamine chondroitin for 60 days along with acetaminophen, which seems to work better than ibuprofen for me.
I take a supplement that has betacarotene, bilerry, vitamin E, ascorbic acid, pine bark, ginkgo biloba, green tea, turmeric, zinc, yeast-free selenium, garlic, echinacea and goldenseal. This has controlled my severe sinus for the first time in my life.
Any foods that would add healthful anti-inflammatory benefits would be helpful.
A: Because you are suffering from inflammation, I am assuming that you have rheumatoid arthritis (RA). Osteoarthritis, the more common form, is not characterized by inflammation around the joints as RA is, but rather is due to wear and tear on the joints due to degeneration or injury.
Although evidence is not strong enough for many doctors to support the use of nutrition in the treatment of arthritis, there are some studies that show foods may help, or irritate it.
In some folks, RA may actually be an allergic reaction to certain foods. This form of arthritis may in fact be a different disease altogether than RA and is referred to as “allergic arthritis.” Perhaps you may want to eliminate to possibility of a food allergy being the cause of your problem.
Some foods may be worth giving up, even without an allergy. Meat contains a type of fat that stimulates the production of inflammatory agents in your body. Adopting a vegetarian diet may help. Patients with RA put on a vegetarian diet showed improvement within a month. A vegan diet may be the most helpful. For some people, giving up dairy products was helpful.
The exception to the vegan/vegetarian route, is to include oily fish, particularly salmon, sardines, mackerel or other fish rich in omeg-3 fatty acids. According to Jean Carper in Food: Your Miracle Medicine, marine oils act directly on the immune system, suppressing 40 to 55 percent of the release of compounds called cytokines that help destroy joints. Fish oil capsules may also help. However, eating fish purchased from a trustworthy market will better guarantee the purity of the oil you are getting.
Simultaneously, keep your intake of omega-6 fatty acids low since they may counter the effects of the fish oils. Do this by avoiding polyunsaturated fats such as safflower and sunflower oils and margarines made from them. Stick to olive oil and other monounsaturates.
Ginger is an anti-inflammatory agent. Try including fresh ginger in vegetable stir-fries, eating food containing ground ginger or dissolving ground ginger in your herb tea.
In summary, eliminate the possibility of a food allergy, avoid meat (better yet, go vegetarian/vegan), get plenty of fish oils and include ginger in your diet. Hopefully these suggestions will give you some relief.
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Friday, July 10th, 2009
Being told that you have osteoarthritis (OA) can be troubling. After all, no one wants to deal with arthritis pain. The pain and stiffness caused by the condition prohibit many people from engaging in physical activities if they do not manage their condition properly. Fortunately, there are ways to manage your pain and stay active.
Remember that having OA, though at times inconvenient and painful, does not mean that you can’t live a productive and fulfilling life. Here are some tips that may help you deal more effectively with osteoarthritis.
1. Learn about your condition
Many people suffer unnecessarily from the pain of OA because they are uninformed. Learn everything you can about OA from reliable sources of information. It’s a good idea to write down questions questions as you think of them and ask your doctor later. Remember not to be shy about asking them; doctors are professionals trained to deal with all sorts of conditions and diseases that many people are embarrassed to talk about. Get a second opinion if you think you could benefit from one.
Because OA is characterized by continual “wear and tear” of the cartilage in your joints, you should be aware that your pain and stiffness might worsen over time if left untreated. Being informed about how your particular case of OA is progressing will help you to better manage your condition, as well as prepare for what difficulties you may have to face in the future .
2. Identify your risk factors and take steps to minimize them
Factors such as age, heredity, weight, prior joint injury and certain medical conditions can increase your chance of getting OA. Be sure to identify what puts you at the most risk for the condition and act accordingly to minimize those risks you can control.
If you are starting to approach middle age and you don’t feel as limber as you once did, it may simply be a sign of age. However, an unusual amount of pain or stiffness that occurs more frequently or lasts longer than you are accustomed to may be an indicator of osteoarthritic damage to your joints. The same goes for if an old injury to your joints bothers you more than it used to, or if your joints feel more stressed than they when you weighed less.
Talk to your doctor about activities that cause you joint pain and what you can do to minimize the discomfort you feel.
3. Modify your exercise routine
Though it may be disheartening to realize that OA may keep you from engaging in certain activities that never previously gave you any trouble, modifying your exercise/activity routine in light of OA can keep you fit and healthy while reducing joint pain and damage. For example, those weekend basketball games may be more trouble than they’re worth if your knee is stiff and in pain for several days afterward.
If you have a routine of exercise or physical activity that is difficult to maintain because of OA, you might want to consider seeking out new activities that place less stress on the affected joints. You may want to try walking or riding a bike instead of jogging. Sure, it may take you a while to adjust to the difference in routine. But your joints will thank you for it later by not being as inflamed.
Swimming is known to be one of the most beneficial of all exercises for a number of reasons. Chief among these for people with OA is that there is no impact on the joints. Swimming and pool training have long been practiced by people looking for a challenging workout without negatively impacting their joints. Specially designed aquatic fitness programs benefit many people with arthritis. Just don’t forget the sunscreen if your pool is outdoors!
4. Know which treatments work best for you and utilize them
Knowing which treatments work best for treating your OA is critical to minimizing the pain and inflammation caused by the condition. Obviously, you wouldn’t consider surgery for your OA if your condition isn’t that serious. Likewise, a treatment such as a hot or cold pack may offer some relief but is not going to resolve severely debilitating pain.
Many patients, particularly elderly individuals, underreport pain for a variety of reasons. Some patients fear complaints will not be taken seriously. Others believe that adequate pain remedies are simply not available or worry about becoming hooked on painkillers. Though it is true that some physicians do not treat pain sufficiently because they fear that patients will become addicted to pain medications, this shouldn’t hold you back from talking to your doctor about what treatments are most appropriate for you and your situation. Injection into the joint with a corticosteroid can also help to reduce pain and improve mobility.
Taking such steps will help you learn what to expect from your condition, the limitations that may result, and what you can do to ease your OA. It may also help to remember that OA won’t be as likely to keep you inactive and away from doing what you love if you treat symptoms of OA in the most effective manner possible .
5. Involve family and friends
Many people are unaware that they may be at risk for developing OA as they age. You may choose to involve your spouse in your new routine to minimize OA. Having a companion will also make those walks or bike rides more meaningful and enjoyable than they would be otherwise. Plus you’ll both be doing something to help yourselves look and feel better.
6. Don’t get frustrated
If the pain and inconvenience of OA has gotten you down, don’t blame yourself. There are many disorders over which the individual has little or no control. Consider yourself lucky that OA is not one of them. Though OA can be a pain at times, most individuals with the condition are able to live full, healthy lives with little or no compromise. By working with your doctor, sticking with treatments that work best for you and keeping a positive attitude, you should be able to overcome the obstacles OA throws your way.
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Monday, July 6th, 2009
A disease as common as arthritis is bound to spawn some myths. Here, a look at the reality behind some commonly held beliefs:
Myth 1: Arthritis happens only to old people.
The truth: Some forms of arthritis do mainly affect elderly people, including the most common, osteoarthritis. Yet many types can affect younger people, and joint injuries at any age can lead to osteoarthritis. Currently more than half of the population with arthritis is under 65. Juvenile arthritis can begin in children as young as infants and toddlers and affects an estimated 294,000 Americans under age 18. Other forms of arthritis, mainly autoimmune conditions including rheumatoid arthritis, Reiter’s syndrome and ankylosing spondylitis, usually strike in middle or early adulthood.
Myth 2: It’s an inevitable part of aging.
The truth: Thirty percent of people older than age 70 have no x-ray evidence of osteoarthritis, the common “wear and tear” form of the disease, according to the American College of Rheumatology. For the 70 percent of people who do show the joint deterioration of osteoarthritis in x-rays, half of them never develop symptoms.
Myth 3: Weather affects symptoms.
The truth: Many people with arthritis believe that cold and dampness can set off joint symptoms. Indeed, according to the Arthritis Foundation, nearly half of arthritis patients think they can predict the weather! Yet the studies have been inconclusive. But don’t cancel your Florida vacation plans yet; milder weather may encourage people with arthritis to be more active, and that has been shown to help.
Myth 4: Exercise makes arthritis worse.
The truth: Regular moderate exercise can help prevent and treat arthritis. Exercise promotes function and mobility, controls weight and strengthens the muscles that support the joints. Though you may want to avoid high-impact exercises (like running) if your knees bother you, low-impact exercises such as walking, tai chi or aquatics are all beneficial. Talk to your physician about the best exercise regimen for you. Pool (aqua) therapy has been shown to cause improvement in mobility in arthritic joints.
Myth 5: “Nightshade” vegetables should be avoided.
The truth: Some people claim that vegetables in the “nightshade” family (potatoes, tomatoes, eggplant and peppers) cause arthritis to flare up. However, none about these associations have been proven. If a certain food seems to negatively affect you or your family, try to avoid it and see if that helps. Otherwise, follow the Arthritis Foundation recommendations for a diet rich in vegetables and fruits, including tomatoes.
Myth 6: Diet can’t help or hurt arthritis.
The truth: The Arthritis Foundation recommends a diet low in calories and saturated fats, rich in “good” fats found in fish and olive oil and nuts, and full of vegetables, fruits and whole grains. Some research suggests that carotenoids (found in orange and yellow vegetables and fruits) and cruciferous vegetables (the broccoli and cabbage family) may be particularly effective at protecting joints. Gout, which causes painful arthritis attacks, has multiple dietary triggers, including many types of meat and seafood and alcohol.
Myth 7: Cracking your knuckles causes arthritis.
The truth: Despite this urban legend, several studies over the years have found no association between knuckle cracking and arthritis. Persistent knuckle cracking may eventually affect your grip strength or, at the very least, annoy your coworkers.
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Thursday, July 2nd, 2009
Fibromyalgia pain can be widespread and flare up throughout the day. Even at night, fibromyalgia symptoms won’t quit, robbing you of precious sleep.
Fibromyalgia is known for its chronic widespread pain and the localized pain it causes in certain muscles, joints, ligaments and tendons. Sleep problems and fatigue are also common.
Sleep disorders associated with fibromyalgia include:
* Restless legs syndrome (RLS). Causes nighttime muscle spasms in the legs. Patients describe it as unpleasant creeping, crawling, tingling, pulling or painful sensations.
* Periodic limb movement disorder (PLMD). Causes spasms similar to those of restless legs syndrome, but occurs only during nighttime sleep and often are more violent.
* Sleep apnea. Causes a patient’s breathing to temporarily slow or stop while asleep. Pauses in breath occur up to 30 times an hour, and each may last for 10 to 20 seconds. Left untreated, sleep apnea can be life-threatening.
* Bruxism. Persistent grinding of the teeth. Bruxism may be related to stress or to temporomandibular joint (TMJ) disorder, a condition that is more common in fibromyalgia patients than the general public.
Source or symptoms
Why does fibromyalgia wreak havoc with sleep patterns? For years, scientists were unsure. Only recently did they suspect that sleep disturbances may actually cause some cases of fibromyalgia.
Patients with fibromyalgia may have a condition known as alpha wave interrupted sleep pattern. The condition (also called alpha EEG anomaly) causes the brain to suddenly become active during deep sleep, which prevents the patient from getting a full night’s rest.
The sleep anomaly leaves patients tired. It also deprives them of one way to reduce fibromyalgia pain: high-quality deep sleep.
Available treatments
Fibromyalgia and sleep problems often go hand in hand, but patients should not resign themselves to a life without rest. If you have fibromyalgia, you can take steps to improve the quality of your sleep. These include:
* Go to bed and getting up at the same time every day
* Exercise earlier in the day but not within three hours of bedtime
* Avoid caffeine, sugar and alcohol before bed
* Avoid eating shortly before bedtime
* Practice relaxation exercises while falling to sleep
* Maintain a sleep environment that has a comfortable temperature and is quiet, free from distractions such as television
* Limit daytime napping
National Institutes of Health studies have found that making such lifestyle changes may significantly reduce insomnia in patients with fibromyalgia.
In some cases, sleep medications also may be helpful, particularly when aggravating conditions such as restless legs syndrome also disturb sleep. However, there are risks associated with taking sleeping pills and other medications over long periods. In addition, some patients find that their bodies eventually become resistant to the effects of the sleep medications.
Many other treatments are available for fibromyalgia, ranging from other medications and psychotherapy to exercise and massage therapy. Consult your physician to find the treatment that is right for you.
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