A recent study has demonstrated that rheumatoidarthritis (RA) patients who use tumor necrosis factor (TNF) blockers are up to four times more likely to develop a serious bacterial infection than those who use only methotrexate. While the risk is not tremendously high, it is still a factor that needs to be taken into consideration by both patients as well as prescribing rheumatologists.
Infections are common in patients with rheumatoidarthritis and related disorders, but it is unclear if this is due to the treatments or the underlying disease process. Previous studies examining the impact of TNF blockers on infection have yielded variable results.
The goal of this most recent study was to determine if TNF inhibition raised the risk of serious bacterial infections compared to the use of methotrexate alone.
The study examined 2393 patients treated with TNF antagonists who were also on DMARDS, most often, methotrexate, and 2933 patients taking methotrexate alone. The most common TNF- blocker used was etanercept (Enbrel), followed by infliximab (Remicade).
During a median follow-up period of 17 months, infection-related hospitalization rates were 2.7% and 2.0% for the TNF blocker group and methotrexate-only group, respectively.
In order to calculate relative risk, researchers often use multivariate analysis to develop a number called a hazard ratio. If the number is less than one, then it means the substance in question is less hazardous than the control. If the number equals one, then the substance has the same risk as the control. And if the ratio is greater than one, it means the substance is more hazardous than the control.
TNF blocker use was associated with a hazard ratio of 1.9 for serious bacterial infection. So, TNF therapy combined with DMARD therapy is more hazardous than methotrexate alone as far as risk of infection.
The incidence of infections was highest within 6 months of initiating TNF inhibition therapy.
The most common serious infections in both groups were pneumonia/ lung abscess (empyema) followed by cellulitis/soft tissue infection.
The efficacy of TNFantagonist therapy for most rheumatoidarthritis patients needs to be balanced against the potential harm of an increased risk of infection associated with these agents. Vigilant monitoring for infection is recommended when using these agents.
(Curtis JR, Patkar N, Xie A, Martin C, Allison JJ, Saag M, Shatin D, Saag KG. Risk of serious bacterial infections among rheumatoidarthritis patients exposed to tumor necrosis factor α antagonists. Arthritis Rheum 2007;56:1125-1133).
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Misconception #1: Arthritis can be caused by cold and wet climate There are all kinds of theories floating around the cause of arthritis, different schools of thoughts have different theories, one of them being cold climate bring on arthritis, so the logical brain would say moving to a warm place would give relief. Does that mean people living in deserts will never have arthritis? The reality is irrespective of where you live; when you wear out your cartilage your bones starts rubbing against each other causing friction and pain.
On the flip side warm weather always bring on a soothing feeling, the same feeling you get when you have a hot relaxing bath or hot shower. So hot climate might relieve signs of arthritis but definitely doesn’t put an end to it. The other advantage of being in warm climate is that you will be more active as opposed to cold climate, who would want to go out when it is ice cold. This means that in warm weather you have more exercise which in turn improves your circulation which helps the cause a lot. But do bear in mind that warm climate can not reverse the damage that has already happened.
Misconception #2: Arthritis is caused by poor diet There is no lack of theories about poor diet and arthritis. Having said that a good healthy, balanced diet can improve anyone’s health and improve your well being. There have been some studies which showed that high uric levels can be a contributing factor to arthritis. This can be caused by diet but again there is no scientific evidence of the correlation.
Another study found that a type of arthritis called “reactive arthritis” can start after a round of food poisoning; this is due to the bacteria rather than the food itself. If you are that keen about diet try a diet high in vegetable fibre, high in calcium and low in unsaturated fats So the fact remains that diet can not help you cure arthritis.
Misconception #3: Arthritis puts limitations to your life There is a big misconception that once you get stamped with the arthritis label, you will have limitations on your life. My question is who imposes these limitations. Often we these limitations are imposed by close ones. How many times have you heard someone saying ‘you can’t do that, you have arthritis“. This is more of an overprotective nature coming through from your loved ones. People sympathies and end up doing to too much for the sufferer.
Yes, it does come with come challenges but that doesn’t mean that you are completely dependent. Misconceptions are widely prevalent; it is important get the facts right. As with everything gaining knowledge about the condition can save you both time and efforts when it comes to finding an effective solution.
The big shuttle dog acupressure point is great for back problems and rheumatoid arthritis. Learn how to trigger the big shuttleacupressure point on dogs with tips from a veterinary technician in this free dog care video. Expert: Dawn Smith Contact: www.traditionalchinesetherapy.com Bio: Dawn Smith has been a traditional Chinese herbal medicine practitioner for six years and a registered veterinary technician over 20 years. Filmmaker: Christian Munoz-Donoso
Rheumatoidarthritis treatment is a necessary yet complex process. There are many aspects that need to be taken into consideration in this fight against your own body. The first step is to see your doctor. There are several forms of arthritis, one of them being rheumatoid, that can lead to more serious complications including the inability to use your joint to its full function. What is important to know is that there are many rheumatoidarthritis treatment plans that can work for you and improve your overall well being, minimize your pain as well as slow the progression of the arthritis.
Standard Treatment Options For Arthritis
It is essential for you to seek out the help of your doctor. He or she will design a course of action to help treat your condition. Most of the time, this will include several types of medications. One of the first medications you will take includes a pain relief formula. Because arthritis is an inflammation of the joint’s lining, medications can help to lessen the swelling that happens there. It will take a few tries to get the right dosage down, but pain relief can be found. In addition to this, your doctor is also likely to give you a medication that will slow the progression of arthritis. By telling your body to stop attacking itself, the medication can slow down how fast arthritis envelopes your joint completely. This is critical as the progression can cause devastating results if left untreated. The combination of medications is vitally important.
Alternatives Are Out There, Too
By either using these alternative methods in combination with the rheumatoidarthritis treatment that your doctor described or doing them alone, they can be helpful in relieving some or all of the pain associated with arthritis. Some of these treatments include massage, nutritional supplementation which usually includes the compounds of glucosamine and chondroitin, as well as homeopathy. In addition to these, acupuncture, wearing copper jewelry and magnets have been shown to help stimulate the healing within the body, including helping to relieve the pain caused by arthritis inflammation.
Should you consider these alternative therapies for the treatment of your arthritis? Some doctors do not believe that they can provide you with the help you need while others do. The ultimate decision will be yours to make but many find that these therapies can be expensive and may only provide a certain level of benefit to your overall health. On the other hand, there are some that believe that things like acupuncture really can stimulate the healing in your body including helping you to improve your overall experience with arthritis. If you are not sure, talk to your doctor and do more research about each option.
The most important thing for you to do in regards to rheumatoidarthritis treatment is to seek out the help of a qualified doctor or even a specialist in the field. From here, develop a plan that is all inclusive and tells you everything that you need to know to better your daily experience with arthritis.
Do you think you may get or already have gout? Certain signs of a gout symptom exist that you should know in case you do encounter this debilitating condition. Following below are some risk factors that could elevate your chances of getting gout.
Men, ages 40 to 50, are the most likely to experience gout, but it can also develop in women after menopause. It also affects people who have suffered from the following:
- having kidney disease
- being obese
- being diabetic
- hardened arteries (otherwise known as hyperlipidemia)
- high blood pressure history,
or those who’ve undergone an organ transplant.
A family history of gout is one of the most common gout symptom risk factors. More than 18% of gout sufferers say they have a family member or several who’ve also had gout. This passing down from generation to generation usually happens because of weaker organs (such as the kidneys), or food and meal recipes that are high in purines being distributed to newer generations.
Other signals for gout you should watch out for are:
- lead exposure
- lost of alcohol intake, which leads to high levels of uric acid in your bloodstream
- enzymes in the body that are defective and interfere with your body’s ability to break down purines
You’ll know you’ve just experienced your first gout symptom when you see and feel your shiny, red, and painfully swollen big toe (or other joint). At first it seems simple but if it’s left untreated, you’ll suffer more pain progressively until wearing a sock or having a sheet over your foot hurts too much. You’ll also have longer and more frequent gout attacks in the future, and other joints (like ankles and elbows) will get infected.
If any of these gout symptom risk factors manifest themselves into an actual gout outbreak, you can take ibuprofen, in the form of Motrin or Advil. Or you can try some natural remedies at home to get rid of the pain temporarily until the gout goes away, such as placing an ice pack on the joint to numb it. Now matter what you do, seek treatment as soon as possible.
During my long nursing career I was never able to find relief from my own arthritis pain until I turned to natural or alternative medicine. Many people have found there was a way to relieve themselves from the crippling pain of arthritis, especially osteoarthritis, although many people with rheumatoidarthritis have reported that a major diet change has made their rheumatoidarthritis symptoms disappear and they continue on their own rheumatoidarthritis treatment relieved of pain.
The arthritic joints usually appear to be even larger, are stiff and painful, and usually feel worse the more they are used as the day goes on. Hurtful arthritis pain is usually experienced whenever a stiff or swollen joint is used even for the easiest tasks. Unlike other types of arthritis, such as rheumatoidarthritis or ankylosing spondilytis, osteoarthritis is not systemic in basis in other words it can’t be detected by using blood tests for diagnosis because it appears to be localized.
The cartilage is made up of chondrocytes, water, proteoglycans and collagen. The chondrocytes are basic cartilage cells and are essential for our balance and function. Collagen is the main protein found in all the connective tissues in the human body, including muscles, ligaments, and tendons. Proteoglycans are the very large molecules that help to make up cartilage. They bond to water, which ensures there will be high-fluid content in the cartilage.
In general, the possible causes and the factors leading to the deterioration of cartilage in arthritis and specifically osteoarthritis are still not known. And injuries can sometimes be the start of a long-term arthritic disease process. Arthritis, or rather osteoarthritis, can develop many years later after a single traumatic injury to a joint or even near a joint. And one possible cause of arthritis is the inflammatory response due to the over-reaction of the immune system to an injury or other assault in the body, such as an infection, even if minor.
Some people report that glucosamine, with or without chondroitin, helps and others say they tried them and they didn’t help them at all. To see if it might be allergy related – or helps, you can try avoiding the eight most allergic foods, one at a time. They are wheat, which is the most allergenic of all, corn, eggs, milk, nuts, peanuts, fish and shellfish. Keep in mind that if you take a joint supplement it should help to do three things – build up your cartilage, provide pain relief for your joints and enhance your flexibility and movement.
One successful natural treatment method involves avoiding all inflammatory foods. Another is to try massaging your fingers or other affected joints with virgin coconut oil once or twice a day. The supplements that may help any disease or arthritic ailment include sublingual methylcobalamin, vitamin B12, not cyanocobalamin. It dissolve slowly under the tongue, not be chewed and vitamin D3 gel capsules, especially if you can’t get a daily dose of 15 to 20 minutes or so of the sun on your arms and legs so you can make your own vitamin D3.
An acidic diet, which is made up of foods that are not alive, is considered to be inflammatory to the joints and other body processes. I started eating a diet of living foods (fruits, raw veggies, raw nuts and raw seeds), years ago, which caused my osteoarthritis to disappear and therefore relieve me of the crippling arthritis pain I had for years. If you attempt this diet it’s best to try it for at least 30 days, thereby eliminating any foods that might be the culprits.
If you really do want to get rid of your arthritis pain permanently it may take a major change in your diet and an ongoing commitment to it. Exercise is usually good for any joint affected by osteoarthritis, but check with your arthritis doctor first. And did I mention how important it is to make sure to keep moving, moving, and moving? Now if you have pain and swelling in your fingers, you can try squeezing a wad of Thera-putty which is made for this purpose, or exercising them with two of the Chinese chime balls which you can get cheaply from several sources. There are many exercises that can be used as a therapy or treatment for arthritis regardless of how much restriction of movement there is.
For arthritic fingers, a good exercise for many people is to put the finger tips together and press hard and release then repeat several times. Make sure to fight arthritis through plenty of movement and exercise. Keep a basket of arthritis treatment aids for arthritic hands, such as the Thera-putty, hand grips, and the Taiji Chinese chime balls to be used at bedtime or while you’re watching television.
Once you become completely knowledgeable about arthritis whether its osteoarthritis, rheumatoidarthritis, psoriatic arthritis, gouty arthritis, juvenilearthritis, or ankylosing spondylitis, you’ll be able to plan your own arthritis treatment program, natural or conventional or a combination of both. Conventional arthritis doctors may suggest their standard protocol for your joint pain and may tell you to take over-the-counter NSAIDS or prescribe COX-2 inhibitors which all have some serious side effects. Make sure you do your research before you take any arthritis drugs, medicines or medications. Naturopathic doctors may have other suggestions not listed here. They may have herb recommendations but do research on the herbs also.
A useful tip: if you’re going to take any arthritis drugs or prescription medications, make sure to ask your pharmacist for the drug inserts so you can read up on the drugs and understand any side effects or adverse reactions that they have, before you start taking them. Make sure to let your pharmacist know what other drugs, herbs and over the counter medications you’re taking too.
Knowing more about symptoms and treatments for arthritis, osteoarthritis or rheumatoidarthritis and how they work will ultimately help contribute to your arthritis pain relief. Once you understand the facts and warnings about arthritis, the symptoms, possible causes and the treatment approaches you can take, you’ll be on your way to recovery and hopefully your pain will disappear. Perhaps following some these tips and suggestions, with the approval of your arthritis doctor may help you get back in the swing of things fast and allow you to spend your days enjoying life free of pain once more.
No matter what type of arthritis people are actually talking about, they call it arthritis. What they don’t know is that arthritis is actually a cluster of over 100 different diseases that cause joint inflammation, damage, and disability. Arthritis is a disease that most often strikes people after the age of sixty-five, but it can happen at any age. Each of the different kinds of arthritis has its own distinct cause.
When you first suspect you have arthritis, you need to see your doctor right away. You’ll be doing yourself a favor if you get an early diagnosis and start treatment as soon as possible. Your doctor will be able to tell you which of the different arthritides (types of arthritis) you are suffering from. He will ask you how much pain you are having and where it is located. He’ll want to know if you’ve been having any swelling and stiffness as well as which of your joints you are having trouble moving. Then he’ll be able to determine the arthritide you’re suffering form and prescribe appropriate treatment.
A patient with osteoarthritis will have the most pronounced pains at night or after resting, whereas a person with rheumatoidarthritis will have more pain in the morning. Children and the elderly will typically experience less pronounced pain but will have more problems with movement and joint function.
Patients can suffer from a number of different arthritides including juvenile, gout/pseudogout, Ankylosing spondylitis, septic, and Still’s disease. Treatment varies from type to type, but it is generally some type of medication and arthroplasty. If other treatments fail to keep the arthritis under control, doctors have the option of performing prosthetic joint replacement surgery. This has proven to be both successful and popular.
The first case of human arthritis was recorded in approximately 4500 B.C., but paleontologists have traced the disease back even further through the bones of dinosaurs which give evidence to ankle osteoarthritis. In our own country, the earliest remains that have been found which show signs of arthritis are those of ancient Native Americans found in Tennessee and Kansas.
A mummy dating back to around 3000 B.C. is the earliest mummy scientists have found which exhibits signs of having had arthritis. As early as 500 B.C. records show that people were using willow bark to alleviate the pain and swelling of arthritis. In modern times, it has been estimated that at least a trillion doses of pain killers have been used in the search for relief from arthritis pain.
Rheumatoidarthritis (RA) is the most common form of inflammatory arthritis and affects more than 2 million Americans. The diagnosis is not easy to make in many instances. There are more than 100 different kinds of arthritis. Most of them involve inflammation. When a patient goes to a rheumatologist to get a diagnosis, there is a process of elimination in order to arrive at the proper diagnosis. This process of elimination is called “differential diagnosis.”
Differential diagnosis can be a difficult undertaking because so many forms of arthritis, particularly inflammatory forms of arthritis look alike. Generally it is helpful to divide the differential diagnosis of rheumatoidarthritis into two groups. The first group are the non-infectious diseases to consider and the second group are the infection-related conditions.
Since the discussion is rather long I have chosen to divide the article into two parts.
The following is a partial list of forms of inflammatory arthritis that can be seen and must be considered when evaluating a patient with inflammatory symptoms of arthritis and are not infection related.
RA is an autoimmune chronic inflammatory disease, primarily involving the peripheral joints (hands, wrists, elbows, shoulders, hips, knees, ankles, and feet). It can also affect non joint structures such as the lung, eye, skin, and cardiovascular system.
RA may start slowly with nonspecific symptoms, including fatigue, malaise (feeling “blah”), appetite loss, low-grade fever, weight loss, and vague joint pains, or it may have an explosive onset with inflammation involving multiple joints. The joint symptoms usually occur bilaterally- both sides of the body equally involved- and symmetric. Erosions- damage to the joint- can be seen with x-ray. In about 80% of cases, elevated levels of rheumatoid factor (RF) or anti-cyclic citrullinated antibodies (anti-CCP) are present in the blood. There appears to be a correlation between the presence of anti-CCP antibodies and erosions.
Juvenilerheumatoidarthritis (JRA) occurs in children under the age of 16. Three forms of JRA exist, including oligoarticular (1-4 joints), polyarticular (more than 4 joints), and systemic-onset or Still’s disease. The latter condition is associated with systemic symptoms — including fever and rash in addition to joint disease.
Polyarticular JRA has similar characteristics to adult RA. It causes about 30% of cases of JRA. Most children with polyarticular JRA are negative for RF and their prognosis is usually good.
Approximately 20% of polyarticular JRA patients have elevated RF, and these patients are at risk for chronic, progressive joint damage.
Eye involvement in the form of inflammation- called uveitis- is a common finding in oligoarticular JRA, especially in patients who are positive for anti-nuclear antibody (ANA), a blood test that is often used to screen for autoimmune disease. Uveitis may not cause symptoms so careful screening should be performed in these patients.
SLE is an inflammatory, chronic, autoimmune disorder that can involve the skin, joints, kidneys, central nervous system, and blood vessel walls. Patients may present with 1 or more of the following: butterfly-shaped rash on the face, affecting the cheeks; rash on other parts of the body; sensitivity to sunlight; mouth sores; joint inflammation; fluid around the lungs, heart, or other organs; kidney abnormalities; low white blood cell count, low red blood cell count, or low platelet count; nerve or brain inflammation; positive results of a blood test for ANA; positive results of a blood test for antibodies to double-stranded DNA or other antibodies.
Patients with lupus can have significant inflammatory arthritis. As a result, lupus can be difficult to distinguish from RA, especially if other features of lupus are not present. Clues that favor a diagnosis of RA over lupus in a patient presenting with arthritis affecting multiple joints include lack of lupus features, erosions (joint damage) seen on x-rays, and elevations of RF and anti-CCP antibodies.
Polymyositis (PM) and dermatomyositis (DM) are types of inflammatory muscle disease. These conditions typically present with bilateral (both sides involved) large muscle weakness. In the case of DM, rash is present. Diagnosis consists of finding the following: elevation of muscle enzyme levels in the blood [the two enzymes that are measured are creatine kinase (CPK) and aldolase], signs and symptoms, electromyograph (EMG)- an electrical test- alteration, and a positive muscle biopsy.
In addition, in many cases abnormal antibodies specific for inflammatory muscle disease can be elevated.
In both PM and DM, inflammatory arthritis can be present and can look like RA. Both inflammatory muscle disease and RA can affect the lungs. In RA, muscle function will usually be normal. Also, in PM and DM, erosive joint disease is unlikely. RF and anti-CCP antibodies are typically elevated in RA but not PM or DM.
SAs — psoriatic arthritis, reactive arthritis, ankylosing spondylitis, and enteropathic arthritis — are a category of diseases that cause systemic inflammation, and preferentially attack parts of the spine and other joints where tendons attach to bones. They also can cause pain and stiffness in the neck, upper and lower back, tendonitis, bursitis, heel pain, and fatigue. They are termed “seronegative” types of arthritis. The term ’seronegative’ means that testing for rheumatoid factor is negative. Symptoms of adult SAs include:
o Back and/or joint pain;
o Morning stiffness;
o Tenderness near bones;
o Sores on the skin;
o Inflammation of the joints on both sides of the body;
o Skin or mouth ulcers;
o Rash on the bottom of the feet; and
o Eye inflammation.
Occasionally, arthritis similar to that seen in RA can be present. Careful history and physical examination can often distinguish between these conditions, especially if an obvious disease that is promoting inflammation is present (psoriasis, inflammatory bowel disease, etc.). In addition, RA rarely affects the DIP joints- the last row of finger joints. If these joints are involved with inflammatory arthritis, the diagnosis of an SA is possible. (Note of caution: a condition known as inflammatory erosive nodal osteoarthritis can also affect the DIP joints). RF and anti-CCP antibodies are negative in SAs, although, rarely, in cases of psoriatic arthritis there may be elevations of RF and anti-CCP antibodies.
Gout is caused by deposits of monosodium urate (uric acid) crystals into a joint. Gouty arthritis is acute in onset, very painful, with signs of significant inflammation on exam (red, warm, swollen joints). Gout can affect almost any joint in the body, but typically affects cooler areas including the toes, feet, ankles, knees, and hands. Diagnosis is made by drawing fluid from an inflamed joint and analyzing the fluid. Demonstrating monosodium urate crystals in the joint fluid is diagnostic, although finding elevated serum levels of uric acid can also be helpful.
In most cases, gout is an acute single joint disease that is easy to distinguish from RA. However, in some cases, chronic erosive joint inflammation where multiple joints are involved can develop. And, in cases where tophi (deposits of uric acid) are present, it can be difficult to distinguish from erosive RA. However, crystal analysis of joints or tophi and blood tests should be helpful in distinguishing gout from RA.
Calcium pyrophosphate deposition disease (CPPD), also known as pseudogout, is a disease is caused by deposits of calcium pyrophosphate dihydrate crystals in a joint. The presence of these crystals in the joints leads to significant inflammation. Establishing the diagnosis includes using:
o Detailed medical history;
o Withdrawing fluid from a joint to check for crystals;
o Joint x-rays to show crystals deposition in the cartilage (chondrocalcinosis); and
o Blood tests to rule out other diseases (e.g., RA or osteoarthritis).
In most cases, CPPD arthritis presents with single joint inflammation. In some cases, CPPD disease can present with chronic symmetric multiple joint erosive arthritis similar to RA. RA and CPPD disease can usually be told apart by joint aspiration demonstrating calcium pyrophosphate crystals, and by blood tests, including RF and anti-CCP antibodies, which are usually negative in CCPD arthritis. A complicating feature is that RA and CPPD can coexist!
Sarcoidosis is an inflammatory joint disorder. The majority of patients with this disease have lung disease, with eye and skin disease being the next most frequent signs of disease. Although the diagnosis of sarcoidosis can be made on clinical and x-ray presentation alone, sometimes the use of tissue biopsy with the demonstration of “noncaseating granulomas” is necessary for diagnosis.
Arthritis is present in 15% of patients with sarcoidosis, and in rare cases can be the only sign of disease. In acute sarcoid arthritis, joint disease is usually of rapid onset. It is symmetric involving the ankles, although knees, wrists, and hands can be involved. In most cases of acute disease, lung and skin disease are also present. Chronic sarcoid arthritis can be difficult to distinguish from RA. Although RA-specific blood tests, such as RF and anti-CCP antibodies, can be helpful in distinguishing RA from sarcoidosis, in some cases a biopsy of joint tissue may be required for diagnosis.
Polymyalgia Rheumatica (PMR) is a disease that leads to inflammation of tendons, muscles, ligaments, and tissues around the joints. It presents with large muscle pain, aching, morning stiffness, fatigue, and in some cases, fever. It can be associated with temporal arteritis (TA), also known as giant-cell arteritis, which is a related but more serious condition in which inflammation of large blood vessels can lead to blindness and aneurysms. Also, a peculiar syndrome where use of the arms and legs leads to cramping because of insufficient blood flow (limb claudication) can occur. PMR is diagnosed when the clinical picture is present along with elevated markers of inflammation (ESR and/or CRP). If temporal arteritis is suspected (headache, vision changes, limb claudication), biopsy of a temporal artery may be necessary to demonstrate inflammation of blood vessels.
PMR and TA can present with symmetric inflammatory arthritis similar to RA. These diseases can usually be distinguished by blood testing. In addition, headaches, vision changes, and large muscle pain are uncommon in RA, and if these are present, PMR and/or TA should be considered.
In part 2 of this article, I will discuss infectious diseases that need to be considered in the differential diagnosis of rheumatoidarthritis. When RA is suspected, it is critical to consult with an expert rheumatologist.
Camp Milagros is a 4-day summer camp in Northern California for kids with Juvenile Rheumatoid Arthritis. For more information on Camp Milagros or our other programs, please call the Arthritis Foundation, Northern California Branch, at 1-800-464-6240.
