Posts Tagged ‘inflammation’
Monday, November 9th, 2009
In about half of all sarcoidosis cases, the disease is detected by a routine chest x-ray before any symptoms develop. A general physician may refer patients to a specialist dealing in whichever organs are affected by the disease, such as a lung specialist (pulmonologist) for lung involvement.
The physical will review the medical history and perform a physical examination, which sometimes reveals swelling of salivary glands or lymph nodes in the neck. A series of laboratory tests and imaging tests may be ordered. Sarcoidosis is diagnosed only after other diseases with similar symptoms (e.g., rheumatoid arthritis, fungal infection, tuberculosis) have been ruled out.
The American Thoracic Society recommends a comprehensive initial evaluation, including:
* History, including occupational and environmental exposure
* Physical examination
* Chest x-ray
* Pulmonary function tests (breathing tests)
* Blood tests, including complete blood count and calcium and liver enzyme tests
* Urine tests
* Electrocardiogram (EKG)
* Eye examination
* Tuberculin skin test
Most physicians recognize the following criteria for a diagnosis of sarcoidosis:
* Spotting characteristic signs and symptoms of the disease and/or abnormalities in a chest x-ray.
* Ruling out infection, particularly tuberculosis and histoplasmosis (fungal infection usually seen in the lungs).
* Biopsy of granulomas (collections of inflammatory cells) that are not encasing foreign particles. A biopsy may not be performed if other findings are highly suggestive of sarcoidosis.
During a physical examination, a physician looks for symptoms of sarcoidosis and checks for other possible causes of the symptoms found. Laboratory and imaging tests typically follow. These tests include:
* Chest x-ray. Radiation is used to produce images of tissues inside the chest. According to the National Institutes of Health, about 90 percent of people with sarcoidosis will have an abnormal chest x-ray. Granulomas, which appear as distinctive shadowing in the lungs, and enlarged lymph nodes at the place where the lungs meet the heart or to the right of the trachea (windpipe) may be observed. When other characteristics of sarcoidosis, such as erythema nodosum (tender or painful discolored bumps on the shins), also appear, the chest x-ray may be all that is needed for diagnosis. A staging system is used depending upon the extensiveness of the disease on chest x-ray.
* Biopsy. Tissue is removed for laboratory examination. A biopsy of affected tissue reveals granulomas without encased germs or particles, which is very accurate. The sample used for biopsy can come from any affected organ and only one sample is necessary. The most convenient sources for tissue samples are skin lesions, enlarged lymph nodes close to the skin and granulomas on the conjunctiva (membrane over the eye and below the eyelid). Samples may also be taken from the lungs, liver or muscles.
* Pulmonary function tests. A device called a spirometer is used to evaluate lung function. The patient inhales and exhales into a tube, which records certain lung capacities. These tests are safe and easy, and their results are typically compared over time to monitor the disease. Various factors are measured in these tests, including:
- Lung strength. How much and how fast a person can blow air out of the lungs after taking a deep breath. Will be below normal if there is inflammation or scarring in the lung.
- Lung volume. How much air the lungs can hold. In some patients with sarcoidosis, the lungs may shrink and lung volume will be smaller than normal.
- Diffusing capacity. How well a gas moves into the bloodstream from the lungs. Sarcoidosis makes diffusion of oxygen from the lungs into the bloodstream more difficult.
In addition, a painless sensor called a pulse oximeter can be placed on the finger to estimate the level of oxygen in the blood.
* Blood tests. Numerous blood tests may detect different factors involved in sarcoidosis. For example, one test can reveal an elevated level of the gamma globulin antibody, which is common in black Americans with sarcoidosis. Other blood tests performed include:
- Complete blood count. Measures the numbers of red blood cells, white blood cells and platelets. Sarcoidosis often involves an insufficiency of white blood cells (leukopenia) and platelets (thrombocytopenia).
- Sedimentation rate. Detects inflammation in the body, which may be elevated for sarcoidosis.
- Enzyme tests. May test for several elevated enzymes, including angiotensin converting enzyme (ACE), which is produced in the granulomas. This test is positive in 60 percent of patients with sarcoidosis. Enzyme tests may be repeated after treatment to monitor relapse. Some tests indicate the levels of certain enzymes in the liver.
- Calcium test. Hypercalcemia (too much calcium in the blood) plays a larger role in deciding if treatment is needed because concentrations of calcium can build up and cause complications, particularly in the liver and kidneys. Prolonged hypercalcemia can also weaken bones and lead to osteoporosis. Calcium and other minerals can be measured in an electrolyte panel.
- Rheumatoid factor test. May be positive for sarcoidosis patients.
- Blood gases. Blood from an artery may measure levels of oxygen in the blood and help determine the level of lung function. Blood levels of carbon dioxide may also be tested.
* Urine tests. A urine analysis can detect hypercalciuria (too much calcium in the urine).
* Electrocardiogram (EKG). Measures electrical activity of the heart. An EKG may be used to detect arrhythmias (irregularities in heartbeat) that may occur if sarcoidosis affects the heart.
* Eye examinations. General physicians typically refer patients to an ophthalmologist (eye specialist) for eye tests even if there are no symptoms in the eyes. Ophthalmologists look into the eyes for abnormalities and test for color blindness and other vision troubles. Results can help in monitoring sarcoidosis and are likely to be repeated, particularly if certain drugs are being used.
* Tuberculin skin test. A skin test used to determine if tuberculosis is present. If it is, sarcoidosis can be ruled out.
* Bronchoscopy. A long, narrow, flexible tube (bronchoscope) is inserted into an airway of the lung. This allows physicians to examine the lung tissues and makes certain tests possible, including:
- Bronchoscopy biopsy. A sample of lung tissue is removed for laboratory analysis during bronchoscopy. This may assist in diagnosis when pulmonary function tests and chest x-rays are abnormal and characteristic of sarcoidosis, but no more easily accessed organs seem to be affected. It is usually very safe and performed as an outpatient procedure, with the patient mildly sedated.
- Bronchoalveolar lavage (lung wash). During bronchoscopy, saline (salt water) is injected into a region of lung and suction is used to remove it. The fluid contains washed-out cells and other materials from inside the lungs that are examined for signs of inflammation, such as a large number of white blood cells. However, these findings are not unique to sarcoidosis.
* Mediastinoscopy. A physician removes a sample of lymph nodes for biopsy from the mediastinum (space between the lungs) using one or more small incisions. Risks of this include bleeding, temporary hoarseness and an adverse reaction to the anesthetic.
* Other imaging tests. May be performed when a diagnosis is uncertain or an affected organ is difficult to reach with a biopsy. These tests include MRI, CAT scan and radionuclide imaging. An MRI can also detect early stages of cardiac damage caused by sarcoidosis, researchers have found.
MRI is an imaging test used in pain diagnosis, to guide treatment and to monitor for relapse. CAT scan is an imaging test used in pain diagnosis, to guide treatment and to monitor for relapse.
* Kveim-Siltzbach test. A standardized preparation of sarcoidosis-affected tissue is injected into the skin. The test is positive if a lump forms and biopsy of the lump reveals granulomas. However, it is not always positive, even when sarcoidosis is present. This test is not readily available in the United States and is rarely performed.
Physicians will also check for certain other conditions that may cause symptoms similar to sarcoidosis. These conditions include:
* Tuberculosis
* Histoplasmosis
* Lymphoma (lymph cancer)
* Rheumatoid arthritis
* Rheumatic fever
* Exposure to toxic substances, such as the metallic element beryllium
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Thursday, November 5th, 2009
Sarcoidosis is usually a mild condition, and many patients have no symptoms. Most develop minor symptoms that do not get any worse. Serious symptoms are uncommon, but in rare cases sarcoidosis can be fatal. Although onset can occur suddenly with immediate symptoms, sarcoidosis usually develops slowly and produces symptoms only after it has been present for some time.
Symptoms vary greatly depending on the extent of the disease and which organs it affects. Sarcoidosis can occur in any organ and affects more than one.
The organs most commonly affected by sarcoidosis include:
* Lungs. Symptoms may include shortness of breath (dyspnea), lasting cough or chest pain. The lungs are the most commonly affected organ. Chronic production of sputum and blood in sputum are common in advanced stages.
* Lymph nodes. Swelling of lymph nodes in the neck and chest may cause pain.
* Liver. Although the liver is commonly affected by sarcoidosis, the disease may produce no symptoms there or may involve some abdominal pain.
* Eyes. May produce eye pain, redness, dry eyes, light sensitivity, cataracts and seeing black spots. In some cases, sarcoidosis in the eyes may lead to glaucoma, a leading cause of blindness.
* Skin. The main symptom is warm, tender, red bumps or painful, purplish red, slightly raised bumps (erythema nodosum). These may be accompanied by fever, joint pain or skin lesions. Disfiguring skin sores affecting the nose, cheek, ears and fingers can occur.
Sarcoidosis has an active and inactive phase. In the active phase, the granulomas grow. In the inactive phase, inflammation goes down and granulomas shrink in size, but scarring can persist and can cause symptoms to persist also.
Lofgran syndrome is acute sarcoidosis characterized by erythema nodosum, bilateral hilar lymphadenopathy (an infection and inflammation of lymph nodes in the lungs), polyarthritis and, commonly, uveitis (an eye inflammation). It is common among Scandinavians and the Irish, especially women, but occurs in less than 5 percent of the African American population with sarcoidosis.
Several other organ systems are less commonly affected by sarcoidosis. These include:
* Joints and bones
* Skeletal muscle
* Spleen
* Heart
* Nervous system
* Salivary glands (involvement may cause dry mouth)
* Tear glands
* Sinuses
Rarely, sarcoidosis affects the thyroid gland, kidneys, breasts or reproductive organs.
Despite the relative rarity of sarcoidosis in these systems, the disease may cause serious long-term effects there. For example, sarcoidosis in the heart may lead to heart failure, and sarcoidosis in the nervous system (neurosarcoidosis) may lead to paralysis or coma.
Regardless of where the disease occurs, calcium levels in the urine are likely to be elevated. Calcium levels may also be elevated in the blood. The granulomas (collections of inflammatory cells) associated with sarcoidosis produce activated vitamin D, which enhances calcium absorption from the intestine. If prolonged, this may lead to kidney stones and calcium deposits in the kidneys. In rare and severe cases, the kidneys become unable to function because of the high levels of calcium, and kidney failure may result.
Other symptoms of this elevation in calcium include:
* Loss of appetite
* Nausea
* Vomiting
* Thirst
* Excessive production of urine (polyuria)
Other general symptoms that a patient may experience regardless of what organs are affected include:
* Recurring fever
* Fatigue
* Malaise (overall feeling of ill health)
* Night sweats
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Monday, November 2nd, 2009
The cause of sarcoidosis is not known. Several underlying causes may be related to different patterns of the illness, such as the variances between short-term or long-term occurrence or between race and ethnicity.
Abnormalities in the immune system play a part in sarcoidosis. The formation of granulomas (collections of inflammatory cells) is a function of the immune system. Some studies have demonstrated abnormalities in certain cells (e.g., T cells, cytokines) involved in the immune response in some patients.
A genetic predisposition to sarcoidosis seems likely in at least some individuals. The disease has been known to occur in families. Certain genetic factors may also confer a susceptibility or resistance to sarcoidosis.
Racial and ethnic differences may affect the form of the disease and the organs affected. For example, among Japanese people, the heart and eyes are often affected, and in Northern Europeans the skin is commonly affected, although some other organ (e.g., lung) is also affected. Fever and joint pain typically accompany skin involvement.
In the United States, sarcoidosis affects black people slightly more often than white people. Black Americans are more likely to be affected for a short period of time but with more severe symptoms, including neurosarcoidosis (involvement of the central nervous system), and black women are affected much more than black men. White people have a more equal gender distribution of sarcoidosis, and the symptoms are milder. The cause of these differences is not known.
Various infectious agents, particularly bacteria, have been suspected of causing sarcoidosis. Some studies have reported the presence of bacteria in the blood of some sarcoidosis patients. There have been occasions of the transmission of the disease after heart and bone marrow transplants. However, clinical research has not conclusively demonstrated that infections play a role in sarcoidosis development.
Age may be a factor in the development of sarcoidosis. The disease typically affects young adults between the ages of 20 and 40. It rarely affects children and uncommonly occurs in older adults.
A recent multicenter study on the etiology (cause) of sarcoidosis found little evidence for dominant or common environmental or occupational exposures associated with an increased risk of developing sarcoidosis. For unknown reasons, the disease occurs more often in healthcare workers and more commonly in nonsmokers than smokers.
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Friday, October 30th, 2009
Sarcoidosis is an inflammatory disease characterized by the presence of noncaseating granulomas (collections of inflammatory cells that do not issue pus) that form small lumps in multiple organs. Once thought rare, this condition is now known to be common. In fact, it is among the most common chronic scarring lung disorders.
Sarcoidosis can be either chronic (long-term) or acute (short-term). It nearly always affects more than one organ and can affect any organ in the body. The lungs and lymph nodes, especially those in the chest, are affected most often, with a lingering cough or shortness of breath as the most common symptoms. However, in some cases symptoms are not present.
The disease also frequently affects the skin, eyes and liver. Less commonly it affects the joints, bones, tear glands, salivary glands, spleen, heart, or the nerves or brain. When the disease affects the central nervous system, it is known as neurosarcoidosis, a serious complication. More rarely, sarcoidosis can affect the thyroid gland, kidneys, breasts or reproductive organs.
According to the National Institutes of Health, about 75 percent of sarcoidosis patients have the acute form of the disease and the remaining 25 percent have the chronic form. In about half of those with the acute form, the disease leaves no significant problems. Scar tissue is the most common long-lasting problem, particularly in chronic cases.
Although physicians and researchers do not know what causes sarcoidosis or even precisely what is going on in the bodies of these patients, it is believed that it may be caused by overreaction of the immune system in genetically susceptible individuals to an unidentified toxin, drug or pathogen. Some believe that this unknown factor may be a mycobacterium, a bacterium from the family that is linked to tuberculosis. This theory has not been substantiated with clinical research.
In normal circumstances, the immune system forms granulomas around particles, germs or other foreign substances to isolate and eliminate them. In patients with sarcoidosis, granulomas apparently form without a cause. There is no visible particle or germ enclosed by them. Many granulomas may clump together, forming small to large lumps. These lumps show up on x-rays as shadows and may affect organ function and cause symptoms.
Sarcoidosis affects men and women of all ages, races and ethnic groups worldwide. It typically develops between the ages of 20 and 40 years. It is rare in children and uncommon in adults over 50 years. People of African, Asian, German, Irish, Puerto Rican or Scandinavian descent are most commonly affected.
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Wednesday, October 28th, 2009
Sarcoidosis is a disease characterized by inflammatory lumps (granulomas) that form in multiple organs. It can be either short- or long-term and can affect any organ, most often the lungs and lymph nodes. The granulomas seem to form as an overreaction to an unknown threat to the body.
The cause of sarcoidosis is not known, but it appears that some patients have genetic factors that make them susceptible. It may also affect different races, ethnic groups and populations in varying ways. For example, Japanese people are more likely to be affected in the heart and eyes, whereas in Northern Europeans the skin is affected along with another organ, such as the lungs. The disease may be related to infections similar to tuberculosis. Environmental factors, such as exposure to potentially toxic substances, may increase the risk of developing it.
Sarcoidosis usually has minor symptoms or none at all. Symptoms depend greatly on which organs are affected and to what extent. General symptoms include fever, fatigue and an overall unwell feeling. Symptoms of sarcoidosis in the lungs include shortness of breath, cough and chest pain.
Sarcoidosis is often first detected by x-ray. A series of other tests, including a biopsy of affected tissue, confirm diagnosis. The criteria for diagnosis are detection of the characteristic symptoms and abnormalities, particularly on a chest x-ray, ruling out infections and finding sarcoidosis granulomas in biopsy.
Many cases of sarcoidosis do not need treatment, but the disease can be serious and sometimes even fatal when it affects vital organs. When treatment is required, corticosteroids are normally used. Relapse is much more common when the condition is serious enough that medical treatment is required. Tests (e.g., breathing tests) are performed for a few years to monitor the disease whether or not treatment is required.
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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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Sunday, May 31st, 2009
Various treatments can help reduce the pain and stiffness associated with ankylosing spondylitis (AS). For example, exercise and movement help maintain the flexibility of the spine. Swimming is a preferred exercise for AS patients, according to the American Academy of Orthopaedic Surgeons.
The earlier treatment begins, the more effective it is likely to be. It is important that patients seek medical care before AS may cause irreversible damage to the joints.
Treatments used for AS include:
* Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs can help relieve inflammation, pain and stiffness.
* Disease-modifying antirheumatic drugs (DMARDs). These drugs are used to treat inflamed joints and other tissues. Potential side effects include stomach pain and increased risk of infections.
* Corticosteroids. These medications may suppress inflammation and slow joint damage in advanced cases of ankylosing spondylitis. These drugs are usually taken orally but can also be injected. They should be taken for only a short time under close supervision of a physician, as potential side effects of long-term use include osteoporosis, fractures and diabetes.
* Tumor necrosis factor (TNF) inhibitors. Originally used to treat rheumatoid arthritis, these drugs, a subgroup of biologic response modifiers (BRMs), may decrease inflammation, pain and stiffness in people with AS. Potential risks of TNF inhibitors include serious infections.
Patients frequently will also undergo physical therapy and rehabilitation. This can help improve physical strength and increase flexibility, which may lessen the pain associated with AS. Patients may learn range-of-motion and stretching exercises, which can help increase the flexibility of joints. They may also learn breathing exercises to help them sustain lung capacity, which can be damaged by AS.
Therapeutic use of water (hydrotherapy) and heat (thermotherapy) may also help.
Patients may learn proper sleep and walking positions to help them maintain proper posture and ergonomics. Using a proper chair, bed, mattress and pillow also help in maintaining normal ergonomics. Abdominal and back exercises can also help these efforts. When AS progresses, the upper body tends to stoop forward, but these exercises can help prevent that from occurring. Patients who have difficulty performing daily tasks may be referred to occupational therapy.
Hip replacement surgery involves inserting a plastic cup and metal ball into an enlarged hip socket.AS does not usually require surgery. However, an operation may be recommended for patients with severe pain or joint damage. Depending on the area affected, possible options may include spinal osteotomy, vertebral column resection, hip replacement or knee replacement, according to the American Academy of Orthopaedic Surgeons.
Most patients with ankylosing spondylitis remain employable and continue to function well in society. Education about the disease is essential in the treatment of AS.
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Saturday, May 30th, 2009
In diagnosing ankylosing spondylitis (AS), a physician is likely to begin by reviewing the patient’s medical history and performing a physical examination. X-rays may be taken to CAT scan is an imaging test used in pain diagnosis, to guide treatment and to monitor for relapse.see whether or not the sacroiliac joint is inflamed. In severe and longstanding cases of AS, calcification of ligaments in the back occurs. On x-rays, this gives the back a “bamboo-spine” appearance. In some other cases, a bone scan or CAT scan (computed axial tomography) is used to view these internal features.
The physician may take a blood sample to check for the presence of genes such as HLA-B27, which is present in about 90 percent of patients with ankylosing spondylitis. Blood tests may also be used to check for elevated sedimentation rate – a measurement of the speed at which red blood cells settle to the bottom of a tube of blood in one hour – which indicates inflammation.
Blood testing can also reveal the presence of anemia, a condition in which there is a lack of healthy red blood cells to carry adequate oxygen to tissues. The chronic inflammation of AS may cause anemia.
Other tests may be ordered if a patient has symptoms suggesting a disorder related to AS, such as a colonoscopy for inflammatory bowel disease.
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Friday, May 29th, 2009
The most common symptom of ankylosing spondylitis (AS) is low back pain and stiffness due to inflammation. This usually begins around the sacroiliac joints, where the lower spine joins the pelvis. It may take days or weeks to develop.
Inactivity tends to make symptoms worse, and many patients experience back pain in the middle of the night and may feel stiff in the morning. Movement and exercise tend to reduce symptoms.
As the disease progresses, it may cause inflammation in the upper spine, chest and neck. As the inflammation associated with AS persists, new bone forms during the healing process, causing the vertebrae to grow together. This results in the formation of bony outgrowths (syndesmophytes) that cause the spine to become stiff and inflexible. This process can also occur in the rib cage, restricting lung capacity and function.
Other joints that may become inflamed include the hips, shoulder, knees or ankles. In some cases, the heels are affected and the patient may find it uncomfortable to stand or walk on hard surfaces. In other cases, inflammation can reach the heart, increasing the risk of heart problems. The severity of symptoms and level of disability triggered by AS vary from person to person.
Symptoms associated with more advanced cases of AS include:
* Restricted expansion of the chest and chest pain
* Chronic stooping
* Stiff, inflexible spine
* Loss of lateral flexion (bending sideways)
* Tenderness over the sacroiliac joint
* Fatigue
* Loss of appetite
* Unexplained weight loss
* Bowel inflammation
* Inflammation of the iris (iritis) and eye pain
Patients may have other symptoms if the heart or lungs are involved.
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