Depending on the etiology, pain may be present in 1,2, or more joints. Considering the patient's age, medical history, and medication profile is important. The patient's lifestyle and social history should also be considered, as certain activities may predispose a patient to specific infections. Among the major diagnoses that have to be considered in a nontraumatic swollen joint are gout (or any crystal-induced arthritis), infectious arthritis, osteoarthritis, and rheumatoid arthritis. A short discussion on low back pain is included.
Exercise in three to five sessions per week are recommended. Patients with rheumatoid arthritis (RA) should be advised not to exercise during periods of exacerbations flare-ups. This will depend on individuals and their symptoms. Low-impact activities are generally recommended in order to avoid stress on the lower limb joints. Comparable workload intensity to high-impact exercise can be achieved by adding dynamic upper limb exercises to low-impact exercises. Water-based activity may be suitable for arthritis.
Etiopathogenesis of reactive arthritis and ankylosing spondylitis. Curr Opin Rheumatol 1995 7 290. Clegg DO, et al. Comparison of sulfasalazine and placebo in the treatment of reactive arthritis (Reiter's syndrome). Arthritis Rheum 1996 39 2021. Cremers MCW, et al. Second-line treatment in seronegative spondyloarthropathies. Semin Arthritis Rheum 1994 24 71. Inman RD. Treatment of seronegative spondyloarthropathies. In Klippel J, Weyand CM, eds. Primer on the rheumatic diseases. Atlanta Arthritis Foundation, 1997 193. Thomson GT, et al. Post- Salmonella reactive arthritis late clinical sequelae in a point source cohort. Am J Med 1995 98 13. Gout is a heterogeneous disorder with primary and secondary forms characterized by hyperuricemia and urate crystal-induced arthritis.
In rheumatoid arthritis the most commonly used gold salts are sodium aurothiomalate and aurothioglucose (3). There is some reason to believe that adverse effects are less frequent with the suspensions (of aurothioglu-cose or aurothiosulfate) than with the more rapidly absorbed solution (of sodium gold thiomalate) (SEDA-16, 233) (4).
Patellofemoral osteoarthritis is an extremely common cause of anterior knee pain. This is encountered primarily in older individuals, but can be seen in younger patients with accelerated degenerative changes brought on by comor-bidities such as obesity. The classic radiographic features of PO include loss of articular cartilage with joint space narrowing, subchondral sclerosis and or cyst formation, and osteophyte formation along the posterior margin of the patella. The symptoms commonly seen with PO include morning knee joint stiffness, loss of mobility, pain with ambulation (particularly walking up an incline or along a flight of stairs), and weakness about the knee joint.
Alexander technique This technique was developed by an actor, F. M. Alexander, to improve his voice. He believed that the way we breathe affects the function of our bodies and that the relationship between the head, neck, and upper body are the primary controls of posture. Abnormal posture causes abnormal muscular tension in one muscle group and can adversely affect the whole body. Treatment with the Alexander technique usually involves individual or group lessons during which a teacher observes the posture and tension in a student. The teacher then explains, using touch and instructions, more efficient posture, movement, and breathing. The Alexander technique has not been adequately evaluated in well-designed studies. Apart from anecdotal experience, little scientific evidence is available with which to evaluate the Alexander technique as a therapy for arthritis-related problems.
Clinical radiologists require not only visual representations of MRI and CT data but also quantitative measurements representing the progression of chronic conditions such as rheumatoid arthritis of the knee. Since inflammation is confined to a thin irregularly shaped region called the synovial capsule it is necessary to segment a suitable approximation of the capsule, then compute quantitative measurements within the segmented region. We report preliminary results on applying topological tools to identify the desired region visually and to extract quantitative information, along with a protocol for clinical validation of the method.
Http www. arthritis .org This site is an outstanding resource for patients with arthritis and their families. The organization provides books and brochures for patients with arthritis, referrals to rheumatologists in an area, and publishes a magazine, Arthritis Today. Call tollfree 800-283-7800 or go to the web site. The web site has extensive information that is clearly written about all aspects of arthritis including surgery and drugs. The popular Drug and Supplement Guides are available. Other areas covered include financial planning, exercise, tips for living with arthritis, travel, marriage and dating, alternative therapies, and specific rheumatic diseases.
A serum sickness-like syndrome has been observed during sulfonamide administration. This diagnosis should be limited to patients with at least three of the symptoms of classical serum sickness, that is fever, rash, allergic arthritis, lymphadenopathy, and possibly leukopenia or neutropenia. Histologically, severe serum sickness-like syndrome seems to correspond to an allergic vasculitis (126,181). Most of the descriptions of serum sicknesslike syndrome with histopathological documentation have been associated with older sulfonamides that are no longer used (182). In some severe forms of serum sickness-like syndrome, the reaction can be complicated by a number of unusual organ manifestations, including plasmacytosis, lymphocytosis, monoclonal gammopathy (183,184), interstitial myocarditis (13,33), allergic pneumonitis, nephropathy, liver damage, and nervous system disorders (126,181).
Intra-articular hyaluronan is an alternative to NSAID therapy in the treatment of osteoarthritis of the knee. Intra-articular hyaluronan for knee osteoarthritis reduces pain similarly to NSAIDs. VI. Surgical therapies. Joint lavage and arthroscopic debridement are options for patients with osteoarthritis of the knee who have not responded to pharmacologic therapy. Carefully selected patients with osteoarthritis of the knee or hip may benefit from an osteotomy. Osteotomies can provide pain relief in patients who are not candidates for total joint arthroplasty.
(IX) collagen develop noninflammatory degenerative joint disease 28 . Mice deficient in both biglycan and fibromodulin develop severe and premature knee OA 7 , even though the cartilage defect may be secondary to tendon defects that cause subluxation of the joints. Genetic defects in the minor matrix components may cause OA in some instances, but not for most OA patients.
Commonly presents as an afebrile obese boy in early adolescence with knee, thigh, or hip pain without arthritis restricted range of motion, with or without preceding minor trauma. Disseminated gonococcal infection Henoch-Schonlein purpura (HSP) Juvenile rheumatoid arthritis (JRA) Kawasaki disease Lyme disease Painful arthritis, new murmur or congestive heart failure, recent group A streptococcal infection Fever, vesicular or pustular rash, tenosynovitis Purpuric rash below waist Chronic or recurrent fever and rash See discussion under Differential Diagnosis, earlier Polyarthralgia or polyarthritis in early stages, recent tick bite, fever, malaise 5. LCPD. Commonly presents as a boy, aged 4-9 years, who has hip pain without arthritis but with a limp or leg-length discrepancy.
Juvenile chronic arthritis is defined as a chronic arthritis persisting for at least 3 months in one or more joints in a child less than 16 years of age. 4 It is rare, affecting only about one in 1000 children, but produces profound medical and psychosocial problems. The commonest types of juvenile chronic arthritis are oligoarthritis affecting four or fewer joints (about 50 ) and polyarthritis affecting five or more joints (about 40 ). Systemic onset arthritis, previously known as Still's disease, accounts for about 10 of cases. It is usually seen in children under the age of 5 but can occur throughout childhood. The children present with a high remittent fever and coppery red rash, plus other features including lymphadenopathy, splenomegaly and pericarditis. Arthritis is not an initial feature but develops ultimately, usually involving the small joints of the hands, wrists, knees, ankles and metatarsophalangeal joints.
A small literature has examined electrophysi-ological activity in the context of rheumatoid arthritis and low back pain. Regarding rheumatoid arthritis, research suggests that patients, in comparison to healthy control participants, show larger amplitude N1 and P2 responses following repetitive, painful stimulation (Hummel et al, 2000). While patients' neural responses to stimuli were significantly different from controls, patients and control participants showed similar responses as measured by a peripheral index of pain sensitivity. This was taken to indicate that central influences may play a primary role in the experience of pain in rheumatoid arthritis patients. Finally, continuous EEG recordings measured in patients with low back pain who received heat therapy showed decreased power in the beta-1 and beta-2 frequency bands in comparison to low back pain patients who received analgesic treatment (Kettenmann et al, 2007).
This may rarely occur as a primary disorder however, degenerative arthritis of the ankle joint is more commonly secondary to recurrent episodes of trauma from lateral ligament instability or from the sequelae of intra-articular fractures involving the ankle joint. It may also occur as a secondary phenomenon to avascular necrosis of the talar dome secondary to talar neck fractures. The long-term outcome of septic arthritis of the ankle joint which damages the articular cartilage may be degenerative osteoarthrosis.
Rheumatoid arthritis is a chronic polyarthritis of unknown cause affecting between 1 & and 3 of the population. The term 'arthritis' is to some extent misleading as this disorder is a multisystem disease which can affect a number of other organs e.g. heart, nervous system, eyes, kidneys, lungs. It is a debilitating disorder in which drugs are helpful but not curative and patients often have to learn to cope with chronic or episodic pain, fatigue and psychological distress. Drug treatment both with non-steroidal anti-inflammatory drugs and disease-modifying anti-rheumatic drugs (such as sulphasalazine, methotrexate or gold) carries high side-effect levels, which can hugely affect adherence (Gotzche, 1989). For this and other reasons RA patients are high users of complementary therapies (Astin, 2002).
The pharmacokinetics of etanercept is similar across different adult populations, including women and the elderly, and across several inflammatory disease states. In addition, pharmacokinetic parameters in children receiving a weight-based dose are similar to those in adults. Etanercept has shown clinical efficacy in the treatment of rheumatoid arthritis, active polyarticular-course juvenile chronic arthritis, psoriatic arthritis, ankylosing spondylitis, and plaque psoriasis. Moreover, etanercept has demonstrated a similarly favorable safety profile across all indications.
A clearer understanding of the precise steps of the aging process will emerge as researchers identify the roles of each of our genes. For example, many of the molecular and cellular changes of aging may be controlled by the action of one gene, called p21. Its protein product turns on and off about 90 other genes, whose specific actions promote the signs of older age. The p21 gene intervenes when cells are damaged by radiation or toxins, promoting their death, which prevents them from causing disease. It also stimulates production of proteins that are associated with particular disorders seen in aging, including atherosclerosis, Alzheimer disease, and arthritis.
In addition to her parents' health problems, Pamela was recently diagnosed with rheumatoid arthritis, a systemic, progressive condition that results in considerable fatigue and requires her to take seven different medications to treat inflammation, pain, and autoimmune activity. Her prognosis is good if she carefully adheres to her medication schedule and does not become overly fatigued however, this regimen is proving more difficult than she anticipated. Pamela recognizes that because of her extremely busy schedule, she has difficulty taking her medications at the right times of day, so although she understands what she needs to do with the medications, Pamela misses many doses. Pamela's medical errors are playing a role in her own debilitated health.
The knee, a common site of osteoarthritis, provides a good illustration of the primary components of the joint that maintain joint stability and thus influence joint laxity. The major ligaments stabilizing the knee in translation and rotation are the anterior (ACL) and posterior (PCL) cruciate ligaments. The stiffness and elastic modulus of these ligaments decrease with age (Noyes and Grood, 1976 Woo et al., 1991). The major changes in muscle with age include reduced muscle activation (Stackhouse et al., 2001 Stevens et al., 2003), cross-sectional area (Frontera et al., 2000 Jubrias et al., 1997 Kent-Braun and Alexander, 1999), force per cross-sectional area (Jubrias et al., 1997), and maximum muscle strength (Frontera et al., 2000 Jubrias et al., 1997 Lindle et al., 1997). These age-associated changes in the properties of ligaments and muscle can cause increased joint laxity with age.