Copyright 2017 Biostar Nutrition Pte Ltd. All rights reserved. Published by Adam Glass.

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1 CardioClear7.com 1

2 Copyright 2017 Biostar Nutrition Pte Ltd All rights reserved Published by Adam Glass. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopied, recorded, scanned, or otherwise, except as permitted under Canadian copyright law, without the prior written permission of the author. Notes to the Reader: While the author and publisher of this book have made reasonable efforts to ensure the accuracy and timeliness of the information contained herein, the author and publisher assume no liability with respect to losses or damages caused, or alleged to be caused, by any reliance on any information contained herein and disclaim any and all warranties, expressed or implied, as to the accuracy or reliability of said information. The publisher and the author make no representations or warranties with respect to the accuracy or completeness of the contents of this work and specifically disclaim all warranties. The advice and strategies contained herein may not be suitable for every situation. It is the complete responsibility of the reader to ensure they are adhering to all local, regional and national laws. This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is sold with the understanding that neither the author nor the publisher is engaged in rendering professional services. If legal, accounting, medical, psychological, or any other expert assistance is required, the services of a competent professional should be sought. The words contained in this text which are believed to be trademarked, service marked, or to otherwise hold proprietary rights have been designated as such by the use of initial capitalization. Inclusion, exclusion, or definition of a word or term is not intended to affect, or to express judgment upon the validity of legal status of any proprietary right which may be claimed for a specific word or term. The fact that an organization or website is referred to in this work as a citation and/or potential source of further information does not mean that the author or publisher endorses the information the organization or website may provide or the recommendations it may make. Further, readers should be aware that the websites listed in this work may have changed or disappeared between when this work was written and when it is read. Individual results may vary. CardioClear7.com 2

3 Table Of Content ARTHRITIS-INTRODUCTION... 6 What is Arthritis?... 6 Broad Symptoms And Causes... 8 Symptoms... 8 Causes... 9 Common Types - Briefly Explained Osteoarthritis Rheumatoid Arthritis Psoriatic Arthritis CHAPTER 01-OSTEOARTHRITIS Understanding Osteoarthritis? Signs and Symptoms Early signs of Osteoarthritis: Pain and Tenderness: Stiff Joints: Unusual sensations: Less flexibility: Symptoms Of Osteoarthritis Hips: Knees: Hands: Spine: Risk Factors: Primary Secondary Treatment Methods Diagnosis: X-rays: Laboratory tests: Joint aspiration: Treating Osteoarthritis without Surgery Exercising: Stretching: Maintaining a healthy weight: Improving sleep: Eating anti-inflammatory foods: Taking Pain and anti-inflammatory medicines: COX-2 inhibitors: CardioClear7.com 3

4 Therapy: Physical Therapy: Occupational therapy: Yoga and Tai Chi: Ice or heat therapies: Massage therapy: Acupuncture: Use the Spa: Assistive devices: Use Tens: Treating Osteoarthritis with Surgery Arthroscopy: Joint Replacement: Complications of Joint replacement Post-surgery Rehabilitation and Recovery: Making the decision: Alternatives to Joint Replacement: CHAPTER 02-RHEUMATOID ARTHRITIS Understanding Rheumatoid Arthritis Signs and Symptoms Early Signs of Rheumatoid Arthritis Symptoms of Rheumatoid Arthritis Disorders with similar or overlapping symptoms: Risk Factors Primary Secondary Treatment Methods: Diagnosis: Citrulline Antibody Test: Sedimentation Rate (Sed Rate): Joint X-rays: Arthrocentesis: Treating Rheumatoid Arthritis without surgery Medications: Biological response modifiers/ Biological DMARDS: Synovectomy: Tenosynovectomy: Tendon Repair: Arthrodesis: Arthroplasty or Joint Replacement: Preparing for Rheumatoid arthritis Surgery: CHAPTER 03-PSORIATIC ARTHRITIS Understanding Psoriatic Arthritis CardioClear7.com 4

5 Distal arthritis: Asymmetric oligoarthritis: Symmetric polyarthritis: Arthritis mutilans: Spondyloarthritis: Signs and Symptoms Early signs of Psoriatic Arthritis Symptoms of psoriatic arthritis Risk Factors Primary Secondary Treatment Methods: Diagnosis: Treating psoriatic arthritis Maintaining a healthy weight: Exercise and Physical therapy: Nonsteroidal anti-inflammatory drugs (NSAIDs): Glucocorticoid injections: Disease modifying anti-rheumatic drug (DMARD) Gout Risk factors: Diagnosis and treatment: CHAPTER 04-LATEST DEVELOPMENTS IN ARTHRITIS TREATMENT Stem Cell therapies: Tiny electrical implant: Microvessicles: 'Self-care Strategies for Coping with Arthritis' Organize yourself: Manage pain and fatigue: Eat a healthy balanced diet: Rest: Exercise: Three exercise goals: Increase range of motion: Strengthen your muscles: Build endurance: Choosing Shoes: What not to wear Helpful gadgets: CONCLUSION CardioClear7.com 5

6 ARTHRITIS-INTRODUCTION What is Arthritis? Arthritis is among one of the most common and widely prevalent diseases of the joints and bones. In fact, more than being a disease, it falls under the category of conditions that develop over a period of time. According to statistics provided by the official Center for Disease Control and Prevention of the government of United States, around 52 million adults, constituting a whopping 27% of the population, were diagnosed with one form or another of arthritis, between 2010 and Moreover, 65% of the cases reported happened to adults above the age of 65. Based on these real time stats, what s projected for some 25 years down the lane, is the development of doctor diagnosed arthritis in about 78 million American adults. The projection suggests that there is a consistent increase in the number of people getting affected by arthritis. CardioClear7.com 6

7 In order to understand arthritis, let s take a look at the roots of this word. The word Arthritis derives from Greek, where Arthro translates to joint, and Itis means inflammation or swelling. This should give you an idea that arthritis, at its core, is all about inflammation and swelling of the joints of any part of the body. Understanding arthritis in detail requires us to first examine the basic element found around the bones and joints cartilage. Cartilage is basically a layer of soft connective tissue that surrounds the bone joints (where two bones meet), and prevents direct friction between them as joints move against each other and are stressed due to movements. Naturally, when you make movements, from something as simple as walking, to something as elaborate as performing exercises and other household chores, it is your bone joints that enable those movements by pressing against each other. Cartilage, forming a layer between hard joints, minimizes the adverse effects of this stress and friction. It is the central shock absorber of the joints. In terms of flexibility, it is somewhere between bone and muscle; softer than bones, but stiffer than the muscle. The protective ability of cartilage is inherent in the substance it is made of. The fibrous construction of the cartilage (collagen, elastin and proteoglycan fibers) renders it flexible enough to allow for smooth movement of the joints. The specific cells that produce these fibers are called chondrocytes. Upon secreting the substance that results in the formation of these fibers, the cells themselves become part of the fibrous substance. In other words, chondrocytes become entrenched in their own secretions. The onset of Arthritis begins when the cartilage is damaged, thereby directly exposing the joints. When these exposed joints move, the friction inevitably increases because of increased stress, and over a period of time, the joints become weaker and begin tearing down. There is a variety of reasons why cartilage is damaged, some of which include direct and impactful injury to any of the joints, extreme obesity that puts unbearable stress on the joints, and consistent immobility, which sends the joints into kind of a hibernation, where they become accustomed to non-movement and start getting damaged. CardioClear7.com 7

8 Broad Symptoms And Causes Symptoms Although the symptoms and causes of each type of arthritis vary, there are few general symptoms that can be outlined that occur regardless of the type. The presence of these may act as an alert to get yourself checked, so that the exact category of arthritis can be determined. The symptoms can be studied under two spectrums; first are the inflammatory factors, and second are the viral factors. Inflammatory Symptoms The presence of symptoms such as redness, pain and swelling around the joint area is the primary indication of arthritis. Although swelling is also experienced when the level of urea in blood is increased, what distinguishes it from arthritis is the presence of the other two; redness and pain. Also, stiffness in the joints and a resulting inability to move the joints easily are two major signs of alert for arthritis. Stiffness is mostly experienced in the morning right after waking up, when you simply cannot move about without hearing crackling sounds of the joints. It is only after doing some basic stretches that the joints become accustomed to movement. In extreme cases, quite visible joint deformation is also experienced; this could result to permanent movement disability. Viral symptoms These symptoms have the propensity to be somewhat deceptive as these could point towards a number of potential problems. Unlike swelling, redness and pain which are primarily the signs of arthritis, viral symptoms could be hard to diagnose, unless you get a detailed checkup done. A few of the major viral symptoms are a persistent fever that keeps coming back, constant lack of energy to perform daily tasks even after sufficient amount of sleep, repeated occurrence of chills in the body and immobility of the muscles. Abnormal headaches can also be experienced. One thing that s common in almost all these symptoms is that they are same for flu as well, specifically tiredness, chills and fever. Because of this similarity, there is a chance that for a good amount of time they get misdiagnosed as viral flu and infection. If you ve had a family history of arthritis, it is advisable that you get yourself checked if you find yourself experiencing these symptoms persistently. CardioClear7.com 8

9 Causes The same way that symptoms vary with each type of arthritis, different causes could result in different types of arthritis. As a general rule, the causes are triggered when the presence of certain external factors catalyze the internal factors (release of hormones and other substances) that result in the development of arthritis. Broadly, the causes can be examined filed under the categories of dietary, hereditary and immune system among others. The consistent intake of certain types of foods results in bone degenerating substances that trigger arthritis. Some of these food types and their respective releases are given below; Sugars: Abnormal intake of food items that have high sugar content can release cytokines which cause inflammation. Fast food: These contain trans-fats (solidified oil) that are substances proven to cause inflammation in the body; primarily in the joints. Saturated Fats: These fats do not get digested easily, and are rather deposited in the joints and other body parts; increasing pressure on the joints, as well as causing obesity. Saturated fats are found in red meat and dairy products made with full fat content. Hereditary factors account arthritis being developed from a young age, whereas immune factors account for a fervid immune system that ends up attacking itself. The details of these factors will be discussed later in the text, along with their respective types of arthritis. CardioClear7.com 9

10 Common Types - Briefly Explained Osteoarthritis Among some 100 types of arthritis, Osteoarthritis is the most common. It is also referred to as the degenerative joint disease or the wear and tear disease because of the way it progresses and gradually tears down the joints, causing complete immobility in extreme cases. The symptoms primarily include joint stiffness that occurs after prolonged period of inactivity, as well as prolonged activity or work. As such, it is quite tricky to manage this condition, as you have to have a balance between working and resting to avoid stiffness. Rheumatoid Arthritis Rheumatoid arthritis is mainly to do with the deformation and swelling of joints. This type is the result of a malfunction in the immune system, wherein it attacks the body rather than protecting it. Rheumatoid does not tear down or degenerate the joints - that is caused by damage in cartilage. It rather attacks the formation and structure of joints and cartilage. Like most other types of arthritis, this is also chronic; meaning that it sustains over a period of time, unlike acute diseases which happen all of a sudden. It also affects other body parts, in addition to joints, in the long run. Psoriatic Arthritis Psoriatic arthritis affects patients who already have psoriasis; a skin disease that causes redness and scaling in excessive patches. Although having psoriasis is not a condition; others with blood relatives having psoriasis can also get affected. Like rheumatoid arthritis, psoriatic arthritis is also an autoimmune disease. It has various forms, based on what parts of the body it affects. Some of these are Spondylitis which affects the spine, Distal Interphalangeal Predominant which affects the toe and finger joint nearest to the nails, Arthritis Mutilans which affects the smaller joints in the hands and feet. Which part of the body is affected easily determines the type of psoriatic arthritis a patient is suffering from. Symptoms and causes also may vary in accordance with the type. Now that we ve understood arthritis and its common types, it is time to look at the aforementioned arthritis types in a bit more detail. CardioClear7.com 10

11 CHAPTER 01-OSTEOARTHRITIS Understanding Osteoarthritis? In simple terms, Osteoarthritis refers to inflammation of the joints. A joint disease, Osteoarthritis mostly affects the cartilage. We ve already discussed what cartilage is. Known as wear and tear arthritis, Osteoarthritis is the most common type of arthritis. According to statistics provided by the official Center for Disease Control and Prevention of the government of United States, approximately 27 million adults, constituting a significant 13% of the population, were diagnosed with Osteoarthritis in The statistics further revealed that Osteoarthritis affects 13.9% of adults aged 25 years and older, as well as 33.6% (12.4 million) of those over 65. Osteoarthritis can occur in almost any body joint, and is associated with the disintegration of cartilage in them. Healthy cartilage does two things it helps absorb shock of movement and allows bones to glide over one another. Osteoarthritis causes the upper most layer of cartilage to disintegrate and deteriorate. As a result of this, the bones beneath the cartilage rub together, which in turn causes swelling, pain, and loss of joint motion. Furthermore, the joint may lose it shape and spurs may grow on the joint s edges. Generally, Osteoarthritis CardioClear7.com 11

12 occurs in joints of the spine, knees and hips. However, it can also affect the neck, thumb, toe, and fingers. So what are the signs and symptoms of Osteoarthritis? Let s take a look. Signs and Symptoms Early signs of Osteoarthritis: The following are some early signs of Osteoarthritis. If you experience any of these symptoms, you may be suffering from Osteoarthritis. However, you must visit your doctor before coming to any conclusion. Pain and Tenderness: People suffering from arthritis often experience aching neck, hips, back, and knees. Early signs of Osteoarthritis include pain and tenderness in the joints. When you move your affected joint in a certain way, you might feel a sharp pain. For example, opening a jar may cause pain in the fingers. On the other hand, when you press down on the joint, you ll get a feeling of discomfort. This feeling of discomfort is known as tenderness. Early signs of Osteoarthritis may include one or both types of pain. Stiff Joints: Along with pain, stiff joints are an early sign of Osteoarthritis. When you sit at your desk all day or wake up after a deep slumber, joint stiffness is a normal occurrence. However, this may also be an early sign of Osteoarthritis. If you often feel sluggish and want to go back to bed when you first wake up, you may be suffering from early Osteoarthritis. However, it is important for you to keep in mind that people with Osteoarthritis often start to feel better once they ve performed some gentle exercise, or have warmed up their joints through their daily routines. Unusual sensations: A shock absorber, cartilage allows your joints to move smoothly. When cartilage disintegrates, the bones rubbing together can cause a number of unusual sensations. A common occurrence in Osteoarthritis patients is the jarring of the joints. The jarring of the joints is an indication of the bones rubbing together. When you move, you may hear or feel your joints clicking or cracking. CardioClear7.com 12

13 Less flexibility: The final early sign of Osteoarthritis is the loss of flexibility. You might be suffering from Osteoarthritis If you notice that moving a particular area of your body isn t as easy as it once was. Osteoarthritis causes Joint stiffness and pain. Joint stiffness and pain contributes to two things loss of range of motion and loss of flexibility. The extent to which you can move your joints is known as your range of motion. An example of range of motion is bending and extending your knee. You might not be able to bend your knee like you normally do if you re suffering from Osteoarthritis. On the other hand, loss of flexibility occurs gradually so it might not be noticeable to you at first. The early signs of osteoarthritis include joint stiffness, pain, tenderness, and loss of flexibility. If you re suffering from early stages of osteoarthritis, you might experience a stiff back when you first wake up or your hips hurting after a game of basketball. However, as osteoarthritis progresses you might experience pain and discomfort, even when you re at rest. So what are the symptoms of osteoarthritis, regardless of its stage? Let s take a look. Symptoms Of Osteoarthritis Aching joints after exercise or first waking up are early signs of osteoarthritis. However, more symptoms come to the forefront as the disease progresses. Pain and stiffness in your joints that affect your ability to do certain activities and move the affected joints, are the main symptoms of osteoarthritis. The symptoms may come and go, and are related to factors such as the weather and your activity levels. Following are some common symptoms of osteoarthritis. Joint pain Tenderness or swelling in joints Increased pain and stiffness after periods of inactivity such as sitting or sleeping A clicking or cracking sound or unusual sensations in your joints Loss of muscle bulk Joints appearing larger than normal Inflammation when you move the affected joint It is important that you talk to your doctor if you experience any of the aforementioned symptoms. Your doctor will help you to find out if you re suffering from osteoarthritis. The most common areas affected by Osteoarthritis are joints in the hands, hips, spine, and knees. However, it can affect any joint in the body. CardioClear7.com 13

14 Hips: You ll find it difficult to move your hip joints if you have osteoarthritis in your hips. For example, getting in and out of the car, or bending down pick something up, might become difficult for you if you have hips osteoarthritis. Furthermore, you ll feel pain outside the hip or in the groin. When you move the hip joints, osteoarthritis in your hips will worsen. However, this type of osteoarthritis can affect you even when you re sleeping or at rest. Knees: The knees are most affected by osteoarthritis, simply because they are primarily weight-bearing joints. Osteoarthritis in your knees is usually caused by obesity or repeated injury. Your knee joints may feel painful, stiff or swollen if you have osteoarthritis in your knees. This in turn will make it difficult for you to walk, climb stairs, and get in and out of chairs. Finally, when you move the affected joint you may hear a soft, jarring sound. Hands: The three main areas of your hand that may be affected by Osteoarthritis include: The joint closest to the fingernail The base of the thumb The middle joints of your fingers You may experience swollen, painful, or stiff fingers. Furthermore, your finger joints may develop bumps. Although the bumps and swelling may remain, pain in the fingers decreases and disappears over time. The fingers may bend slightly sideways at the affected joints. Also, the back of your fingers may develop fluid-filled lumps or painful cysts. In some cases, a bump may develop where your wrist joins the base of the thumb. As a result of this, you may find opening jars, turning keys, or writing difficult. Spine: You may experience stiffness and pain in the lower back or neck if you have Osteoarthritis of the spine. Often, changes related to Osteoarthritis can put pressure on the nerves. This causes numbness or weakness in arms or legs. CardioClear7.com 14

15 Risk Factors: When there is damage in and around the joints that your body cannot fully repair, Osteoarthritis occurs. There are several factors that can increase your risk of developing Osteoarthritis. Although the exact causes of Osteoarthritis are unknown, repetitive movement could be exacerbate joint damage. Alternatively, Osteoarthritis could be a result of an injury. Regardless of the reason, there s erosion of the cartilage with Osteoarthritis. Risk factors are the things that increase your risk for osteoarthritis. There are two types primary and secondary. The primary risk factors are factors that you cannot prevent or change, such as your age or genetics. On the other hand, secondary risk factors are those that you can reduce by taking medicine or making lifestyle changes. Some examples are obesity, injury, and inactivity. Primary The following are the primary factors that that may increase your risk of developing osteoarthritis. Age: The strongest risk factor for osteoarthritis is age. Although it isn t a normal part of ageing, the risk of developing osteoarthritis increases with age. Adults over 45 are most likely to be affected by osteoarthritis. In fact, it is a common occurrence in the older population. As pointed out earlier, 33.6% (12.4 million) of those over 65 in the United States suffer from osteoarthritis. This percentage increases to 70% when we consider individuals over 70. The longer you use the joints, the greater your chance of cartilage disintegration. Therefore, age is a primary risk factor for osteoarthritis. Whether it s mild or severe, you re likely to develop osteoarthritis if you live 'long enough. Genetics: The second primary risk factor for osteoarthritis is genetics. A contributing factor in developing osteoarthritis may be an inherited defect in one of the genes responsible for manufacturing cartilage, meaning that it may run in families in some cases. According to doctors, genes can greatly influence osteoarthritis. Certain joint problems, such as the tendency towards cartilage wear and tear, are something that we may inherit. Birth abnormalities may also lead to osteoarthritis. Genes that put you at risk for osteoarthritis CardioClear7.com 15

16 may be something that you carry. In fact, most cases of hand osteoarthritis in women are said to be genetic. Furthermore, there have been cases where genetic reasons caused osteoarthritis in the knee and hip. Secondary The following are the secondary factors that that may increase your risk of developing osteoarthritis. Obesity: A risk factor that greatly increases your chances of developing osteoarthritis is obesity. As it puts added stress on your joints, extra weight or obesity can change the normal shape of your joint. The extra weight can also cause the joint to deteriorate faster. A primary risk factor for osteoarthritis, obesity causes excess strain on your joints, especially on those that bear most of your weight, such as your hips and knees. Therefore, obese people are more likely to develop osteoarthritis. We apply a force that is three to six times our body weight on our knees when walking, so the risk of developing knee osteoarthritis increases. During weight bearing movements, the force placed over your knees will be dependent on your body weight. To a lesser extent, body weight can influence osteoarthritis of the hips. When you re walking or standing, your hips can carry up to three times the body s weight. Any excess body weight will put strain on your joints and may cause osteoarthritis. CardioClear7.com 16

17 Injury: You will increase your chances of developing osteoarthritis in a joint if that joint sustains a traumatic injury. Overuse can also have the same effect. Both cases increase the chances of developing osteoarthritis at a young age. As it changes the structure of the joint and puts extra stress on it, damage to joint, bone or ligament can cause osteoarthritis at any age. You will suffer from wear and tear in later life if you injure your knee, ankle, or hip spine. This wear and tear is the damage in joints that precedes osteoarthritis. Joint damage can cause osteoarthritis whether the damage is a result of an injury or operation. You will also increase your chances of developing osteoarthritis in later life if you overuse your joint without giving it enough time to heal after an operation or injury. Over time, cartilage can be damaged by several minor injuries or a single major injury to a joint. Activities that damage the joint include heavy lifting, kneeling, or squatting. Inactivity: Your muscles and joints will get weak and stiff if you don t exercise enough. Weight gain is a byproduct of an inactive lifestyle, and by now you know that weight gain or obesity leads to osteoarthritis. Furthermore, you will weaken muscles and tendons that surround the joint by being inactive. You can keep joints properly aligned and stable if you have strong muscles. You can build strong muscles with low-impact activities such as swimming and walking. Other diseases: Diseases that damage joints and cause inflammation increase your risk of developing osteoarthritis. Osteoarthritis often occurs in joints severely damaged by an existing or previous condition. Some of these conditions include rheumatoid arthritis, gout, and hemochromatosis. Muscle weaknesses: Often, people with weak muscles are diagnosed with osteoarthritis. According to research, people with weak thigh muscles are prone to osteoarthritis, making it a factor that contributes to the development of osteoarthritis. CardioClear7.com 17

18 Treatment Methods Diagnosis: Before you get treatment for osteoarthritis, it is important for you to diagnose the condition. You should make an appointment to see your doctor if you experience joint pain, swelling and/or stiffness that won t go away. Your doctor will be able to determine whether you have osteoarthritis or not. Diagnosing osteoarthritis can be challenging, as there can be several reasons for joint discomfort. This is the why when you visit him/her, your doctor may ask questions about when and how you started experiencing the symptoms you have. Your doctor will also probably give you a physical examination. Your doctor will do so by looking at it, feeling it, and moving it through a range of motions. Furthermore, they will carry out an examination to assess the health of your lungs, liver, heart, and kidneys. The physical examination will look for: Mild to moderate swelling around the joint Crunching sound of bone rubbing on bone Limited range of motion Tenderness in the joint Pain with movement of the joint Mild inflammation over the joint Weak muscles surrounding the affected joint Joint deformity Joint instability Altered walking gait Unequal leg lengths Bone Lumps In order to reach a conclusive diagnosis, the doctors will go through your medical history and discuss the symptoms with you. Medical history plays a big part in the diagnosis. It can provide important clues to whether the arthritis is inflammatory or not. Furthermore, it will tell your doctor about the onset of osteoarthritis symptoms, a family history of the disease, past treatments or surgeries, or other significant information related to your condition. CardioClear7.com 18

19 It is important that you prepare yourself in advance for the visit to the doctor. In order to ensure that you don t leave out important clues, record or write down the information to bring with you. When you re being seen for a specific problem, you must recap all of the things in your medical record. This includes past surgeries and injuries. You must also note down any recent injuries so that you can discuss them with your doctor during your examination. Apart from the physical examination, other tests may be required to confirm the diagnosis of osteoarthritis, as well as ascertain the severity and extent of joint damage. Some of these tests include X-rays, laboratory test, and joint aspiration. X-rays: Whether you have osteoarthritis or not is something your doctors can determine with the help of x-rays. The speed with which joint damage is progressing is something a series of X- rays obtained over time can show. Bone damage, cartilage loss and extra bone growth that can develop on the surface of normal bones is what the X-rays of the affected joints can show. Laboratory tests: By ruling out conditions with similar symptoms, laboratory tests help diagnose osteoarthritis. However, there isn t any specific blood test for osteoarthritis. Joint aspiration: You doctor may perform joint aspiration if he or she suspects you have an infection, or is uncertain about the diagnosis after performing an X-ray test. Also known as arthrocentesis, joint aspiration is a procedure in which your doctor uses a needle to extract and inspect synovial fluid from affected joints. Synovial fluid is the liquid that lubricates the joint. Using the aforementioned methods, your doctor can confirm a diagnosis of osteoarthritis. You should see your doctor if: You experience unexplained and sudden swelling/ inflammation in any joint Joint pain accompanied by fever or rash Joint pain that makes it impossible for you to use that joint Mild joint discomfort that lasts more than six weeks CardioClear7.com 19

20 A person suffering from osteoarthritis will have to get treatment for osteoarthritis once the diagnosis is confirmed. Currently, there is no way to reverse osteoarthritis. However, you can effectively manage symptoms with medications, lifestyle changes, therapies, and surgery. The long-term management of osteoarthritis includes several factors such as: Getting a good amount of exercise Maintaining a healthy weight Improving joint flexibility and mobility Managing symptoms such as stiffness, pain and swelling Generally, the most important ways to treat osteoarthritis are exercising and maintaining a healthy weight. However, your doctor may suggest some other methods of treatment. Let s now take a look at the different, non surgical methods for treating osteoarthritis. Treating Osteoarthritis without Surgery Exercising: Exercise is one the most beneficial ways to manage osteoarthritis. Exercising is considered an important part of the treatment plan, even though some people may find it difficult to exercise when their joints hurt. According to studies, you can reduce pain and maintain/attain a healthy weight by performing simple exercises, such as walking in the park or around the neighborhood. A great combination treatment for osteoarthritis is gentle weight training, plus aerobic exercise. This treatment method can help you to strengthen the muscles around the affected joint. This will ensure greater support to the joint and will keep it healthy. In order to keep itself healthy, cartilage needs exercise to bring nutrients into it. It allows nutrients to flow into the cartilage by compressing and decompressing the cartilage. According to the U.S. Department of Health and Human Services, everyone, including those with osteoarthritis, need to get 150 minutes of moderate exercise per week. Performing certain exercises can help you to effectively manage osteoarthritis. By performing strengthening exercises, you can ease the burden on the joints affected by osteoarthritis. This will help you to reduce pain. You can also reduce stiffness and improve joint flexibility through range-of-motion exercise. Finally, you can reduce excess weight through aerobic exercise. However, before starting an exercise program you must consult your doctor. CardioClear7.com 20

21 Stretching: A form of exercise, stretching is a great way to manage pain. You can lessen stiffness, improve flexibility, and reduce pain by slowly and gently stretching joints. Maintaining a healthy weight: You ll add additional stress to weight-bearing joints such as knees, hips, back, and feet if you have excess weight. A great way to reduce the pain associated with osteoarthritis and limit further joint damage is losing weight. Increasing physical activity and eating fewer calories is the basic rule for losing weight. In case you re overweight, one thing that you can do to improve symptoms, and perhaps even slow progression, is controlling your weight. Most doctors will recommend this. You will find that even a modest amount of weight loss, such as 10 to 20 pounds, will prove to be extremely beneficial. Improving sleep: If you have joint pain, you may find it hard to sleep. Trouble falling sleep or staying asleep throughout the night is something at least half of the people with osteoarthritis have. However, research suggests that you can improve your condition by improving your sleep. So why is improving you sleep important? According to researchers, a lack of sleep may trigger inflammatory pathways that exacerbate osteoarthritis pain. There are many ways for you to improve your sleep and reduce pain, including the use of medicine. However, pain medication can have side effects. Therefore, you should try to improve your sleep by using simple strategies such as: Avoiding heavy meals before hitting the bed Avoiding watching TV in the bedroom Avoid drinking alcohol or caffeinated beverages before bed Maintain a comfortably cool, dark, and quiet environment in your bedroom Consult your doctor if you aren t able to improve your sleep through the aforementioned ways. CardioClear7.com 21

22 Eating anti-inflammatory foods: The swelling and inflammation of affected joint is a major cause of the pain associated with osteoarthritis. According to research, there are a number of foods that reduce inflammation and swelling. Particularly beneficial in controlling inflammation and improving joint healing are Omega-3 fatty acids, and in doing so, they slow progression of osteoarthritis. Most doctors advise people with osteoarthritis to eat plenty of vegetables, fish, whole grains, and healthy fats to reduce inflammation. Taking Pain and anti-inflammatory medicines: Using certain medications, you can treat osteoarthritis symptoms. Medicines for osteoarthritis are available in many different forms - they can be injected into a joint or are available as pills, lotions, creams, and syrups. The following are some commonly used medications for osteoarthritis. Pain Relievers/Analgesics: Known as Analgesics, the pain relievers for osteoarthritis include opioids, acetaminophen, and tramadol. However, they do not affect swelling. They are available by prescription or over-the-counter. Acetaminophen People with osteoarthritis, who have mild to moderate pain, will find acetaminophen quite effective. However, you could damage your liver if you take more than the recommended dosage of this medicine. Opioids You doctor may recommend an opioid medication if you re experiencing severe pain. Opioids are medications that act like opium and are available as Percocet, Vicodin, and Darvon. By blocking pain receptors in the brain, opioids relieve pain. CardioClear7.com 22

23 Opioids are powerful pain blockers. However, they can be addictive and also have many side effects. Opioids are usually safe when they re prescribed for pain relief. However, you must avoid driving or operating machinery while using Opioids because they cause drowsiness. The FDA recommends that you take these medications as prescribed, and not in excess. Pain-Relieving Creams, lotions, sprays: Also called topical pain relievers, pain-relieving creams are applied to the skin over the joints. These creams can provide relief from minor arthritis pain. Often used in conjunction with oral medications, pain-relieving creams, lotions and sprays are available over the counter. Some examples of these pain relievers include capsaicin, salicin, methyl salicylate, and methanol. Since the combination can cause too much heat, and even burns, topical pain-relievers should not be used with other heat treatments. Corticosteroids: Powerful anti-inflammatory medicines, Corticosteroids are either taken orally, or injected directly into a joint by a doctor. The stiffness and joint pain caused by osteoarthritis can make it difficult for you to play sports, work, or even perform routine activities. However, anti-inflammatory medications such as Corticosteroids allow you to perform these different activities by easing your pain. Hyaluronan injections: Hyaluronic acid, which these injections comprise of, are a natural component of synovial fluid, and act as a shock absorber and lubricant. However, hyaluronic acid seems to break down in people with osteoarthritis. In order to give themtemporary relief, doctors use hyaluronan injections to help lubricate joints. Generally, hyaluronan injections are used with people suffering from knee pain that caused by osteoarthritis, and are given once other treatments have failed. CardioClear7.com 23

24 Nonsteroidal anti-inflammatory drugs (NSAIDs): Typically, osteoarthritis pain is relieved by over-the-counter Nonsteroidal anti-inflammatory drugs (NSAIDs), such as naproxen sodium, aspirin, celecoxib, and ibuprofen, taken at the recommended doses. Available by prescription, stronger NSAIDs may slightly reduce inflammation along with relieving pain. Most commonly used drugs for easing inflammation and related pain, NSAIDS have some side effects. These include liver and kidney damage, bleeding problems, cardiovascular problems, and stomach upset. NSAIDS are available by prescription or overthe-counter. An NSAID is often prescribed at the lowest effective does for people who don t respond to acetaminophen, and they help to reduce inflammation and relieve pain. However, compared to acetaminophen they can trigger more side effects. Apart from causing bleeding problems and kidney damage, prolonged use of NSAIDs may also increase the risk of a heart attack or a stroke. NSAIDs and the risk for heart disease and stroke When it comes to the major causes of death for both men and women, heart disease is right there at the top. According to the US Centers for Disease Control and Prevention (CDC), approximately 735,000 people in the United States suffer from heart attacks each year. Heart disease accounts for 1 in every 4 deaths, causing the death of approximately 610,000 people every year. Although they re less overwhelming, the statistics related to stroke are still alarming. According to the US Centers for Disease Control and Prevention (CDC), each year about 800,000 cases of stroke are reported in the United Sates. Strokes account for 1 in every twenty deaths as almost 130,000 people die from them each year. The blockage of blood CardioClear7.com 24

25 flow to the brain is the main cause of most strokes. On occasion, a stroke may lead to longterm disability instead of death. For a long time it has been known that high levels of blood cholesterol and triglycerides, smoking, diabetes, and hypertension add to the risk factors for heart attacks and strokes. However, in 2015 the U.S. Food and Drug Administration (FDA) made an addition to the list. On July 9 th 2015, the FDA released a statement that said using non-aspirin nonsteroidal antiinflammatory drugs (NSAIDs) increased your likelihood of having a stroke or heart attack. Since aspirin is selective COX-1 inhibitor, it isn t included in FDA s warning and kept separate from other NSAIDs. COX-1 is beneficial from a cardiovascular standpoint, as it helps to control angiogenesis in endothelial cells. The use of aspirin can help prevent cardiovascular events. NSAIDs are linked to heart attack and stroke due to various factors. For example, sodium excretion and vasoconstriction are affected to varying degrees by all NSAIDs. A byproduct of vasoconstriction and sodium excretion is hypertension, which is an established a risk factor for heart attack and stroke. Compared to someone who takes NSAIDs, but doesn't have heart disease, you may have a higher risk of having a stroke or heart attack if you take NSAIDs and have heart disease. However, people without cardiovascular disease who take NSAIDs are also at increased risk of heart attack or stroke. It is recommended that you take the lowest possible dose, for the shortest time, if you need to take an NSAID. However, you must talk to your doctor if you have cardiovascular disease, or need to take NSAIDs for an extended period of time. Your doctor may discuss which NSAIDs are appropriate for you, and whether you should take other medications. The existing label warning in non-aspirin NSAIDs contained information on heart attack and stroke risk. However, they only stated these drugs may cause an increased risk of such events. The FDA is now changing this warning to a more assertive version. Today, it is mandatory for drug manufacturers to include warning labels that state that the risks of heart attack and stoke increase with the length of time you take NSAIDs, as well as with the strength of the dose. They also need to state that these risks are higher for people with heart disease, or other risk factors. CardioClear7.com 25

26 COX-2 inhibitors: Available under the brand name Celebrex, COX-2 inhibitors are NSAIDs designed to produce less stomach irritation. COX-2 inhibitors may be the best option for you, if you have a low risk for heart disease and acetaminophen doesn't do enough to relieve your pain. COX-2 inhibitors have the same risk of kidney damage as other NSAIDs. However, they cause less stomach upset. The FDA demands that these medications carry the same warning as over-the-counter NSAIDs. You must take COX-2 inhibitors at the lowest does required to relieve your pain. Therapy: Physical and occupational therapy can also help alleviate osteoarthritis symptoms. A range of treatment options for pain management is what physical and occupational therapists can provide you. Some of the treatment options include: Heat and cold therapies Range of motion and flexibility exercises Ways to properly use joints Assistive device Physical Therapy: Physical therapy may include individualized exercise programs that reduce pain, increase your range of motion, and strengthen the muscles around your joint. Equally effective are regular gentle exercise that you do on your own, such as walking or swimming. Occupational therapy: Occupational therapy provides you with ways that allow you to do your everyday tasks, without putting extra stress on your painful joint. For example, if you have finger osteoarthritis, a toothbrush with a large grip could make brushing your teeth easier, or if you have knee osteoarthritis, a bench in your shower could help relieve the pain of standing. CardioClear7.com 26

27 Yoga and Tai Chi: Gentle exercises and stretches, along with deep breathing, are involved in movement therapies, such as yoga and Tai Chi. In order to reduce the stress in their lives, many people use these. According to research, yoga and tai chi may improve movement and reduce osteoarthritis pain. These are safe when performed under the supervision of a knowledgeable instructor. However, you should avoid moves that cause pain in your joints. Ice or heat therapies: Many people use hot or cold to relieve osteoarthritis pain. This form of osteoarthritis treatment is known as thermotherapy. Icing may help when acute pain occurs. However, you should use moist heat to relieve pain when you re suffering from chronic pain. You should ask your doctor when and how to best use these two different remedies. Massage therapy: You can improve arthritis pain, stiffness and mobility by getting an hour-long massage each week, for at least two months. Using massage therapy, you can soothe the muscles that spasm around the joints. Blood flow is stimulated as the massage therapist kneads or lightly strokes the sore muscles. This can cause a stressed area to become more warm and relaxed. Since arthritic joints are very sensitive and need to be handled with care, you must ensure that your massage therapist has experience treating people with osteoarthritis. You can ask your doctor for a referral. Acupuncture: In order to relieve pain, inserting thin needles into specific points on the body is involved in the ancient Chinese practice of acupuncture. The research related to acupuncture for osteoarthritis is still ongoing. However, acupuncture is known to relieve the pain associated with osteoarthritis to some extent. There is a consensus now that acupuncture may be of value, even though it s been difficult to evaluate it for osteoarthritis. CardioClear7.com 27

28 Use the Spa: According to research, an effective osteoarthritis treatment is going to the spa. Known as hydrotherapy, using the spa can help relive joint pain, as it involves soaking in very warm water or water containing minerals. A natural remedy for arthritis symptoms are sulfur-rich mud baths. However, researchers and other people are yet to identify the mechanisms by which spa therapy relieves the pain caused by osteoarthritis. Assistive devices: Function and mobility are the two areas where assistive devices can help. Some examples are splints, walkers, shoe orthotics, canes, scooters, or helpful equipment such as steering wheel grips, long-handled shoehorns, or jar openers. You ll find most of these at medical supply stores and pharmacies. However, some items are typically fitted by a physical or occupational therapist, and prescribed by a doctor. Shoe wedges and custom knee braces are examples of such devices. You can support and protect arthritic joints, and relieve osteoarthritis pain, with the help of mechanical devices known as orthotics. By supporting the joint and relieving some of the stress caused by body weight or daily use, a brace placed on an inflamed joint provides pain relief. The braces also assist in realigning joints that have been distorted by arthritis. Another beneficial device is shoe orthotics. Shoe orthotics are soles that absorb some of the shock of walking. One of the most common orthotics is a cane. However, most people use it incorrectly. In order to get the maximum benefit out of the cane, you must get the correct length of cane for your height and learn how to use it. You can relieve pressure on sore knees, hips, ankles, and feet with the correct cane. CardioClear7.com 28

29 Use Tens: The final non-surgical way for you to treat osteoarthritis is using TENS. In order to disrupt pain signals, TENS (Transcutaneous Electrical Nerve Stimulation) sends electrical charges through patches placed on your skin, with the help of a handheld device. According to studies, TENS can improve function in arthritic joints and help reduce pain. In order to find out whether it will help your pain and how to properly use it, you should consult your doctor. However, you need to keep in mind that it isn t for everyone. If the cause of your pain is yet to be diagnosed or if you have an implanted defibrillator, using it is not an option for you. The aforementioned treatment methods were the non-surgical ways of treating osteoarthritis. On most occasions, these treatment methods are sufficient for effectively managing the symptoms. However, there are times when these non-surgical treatment methods don t work and surgery becomes necessary. There are various surgical treatments for osteoarthritis. The following section lists and explains them. Treating Osteoarthritis with Surgery The following are some surgical treatments for Osteoarthritis: Arthroscopy: A minor surgery, arthroscopy can moderately improve Osteoarthritis for a few months or years. Cleaning out the bone and cartilage fragments that cause pain and inflammation is the purpose of performing arthroscopy. At times, it is used to diagnose osteoarthritis. The surgeon inserts the arthroscope after making a small incision in this procedure. Containing a light and magnifying lens, it is a pencil-width fiber-optic instrument. Then, a miniature camera attached to the arthroscope allows the surgeon to see the inside of the joint. Whether arthroscopy really benefits those with osteoarthritis is debatable. It is unclear which patients are likely to benefit from it the most. However, there some studies suggest that people with mild-to- moderate osteoarthritis, and bone and cartilage fragments in the joint, are most likely to benefit from arthroscopy. It may also be beneficial for patients whose joints catch or lock with movement. CardioClear7.com 29

30 Joint Replacement: The surgeon removes damaged joint surfaces and replaces them with plastic and metal parts in joint replacement surgery. Infections and blood clots are some of the surgical risks involved in joint replacement. You may eventually need to replace artificial joints, as they can become loose and wear out over time. You may be considered for joint replacement if you fail conservative and comprehensive care. The main reasons to consider joint replacement include limitation of motion, severe osteoarthritis, and intractable pain. The functional capacity to rise from a chair is limited by the inability to flex the knee more than 90 degrees. Due to the risk of future loosening or implant failure and duration of the joint plant, life expectancy is also an important consideration. However, some people with osteoarthritis get prosthesis that lasts more than 20 years. You need to keep in mind that more complications are involved in a second surgery. Many people become candidates for artificial joint implants when osteoarthritis becomes so severe that immobility and pain makes normal functioning impossible. The procedure involved in getting these artificial joint implants is known as arthroplasty. The most established and successful replacement procedure is hip replacement, while knee replacement is a close second. Some less common joint surgeries include shoulders, elbows, wrist, and fingers. A method is yet to be devised for joint replacement of the spine. When two joints need to be replaced, fewer complications will arise if operations are done sequentially, rather than at the same time. Surgical procedures, such as joint replacement, are considered as the last resort for people with osteoarthritis. People with osteoarthritis are often advised by doctors to wait for as long as possible before going for joint replacement. However, you should not delay the procedure too long if you want to get the best results. So how do you know it s time to seek joint replacement surgery? Pain and significant limitations of movement, that cannot be treated with medications and therapies, are primary indications for surgery. In order to determine whether you need joint replacement or not, ask yourself the following questions: Do I still enjoy shopping, playing tennis or golf, or jogging in the park? Do the medications I take and the therapies I use alleviate the pain reasonably well? Is it possible for me to sleep at night without waking multiple times? Am I still able to perform routine daily activities such as getting in and out of the car, using the toilet, going up and down stairs, and getting out of a chair without much difficulty? CardioClear7.com 30

31 You probably don t need to consider joint replacement surgery yet if you answered yes to all of the aforementioned questions. On the other hand, you should discuss joint replacement surgery with your doctor as a possible option if you answered no to most of them. Keep in mind, joint replacement surgery may not be suitable for certain individuals. Joint replacement may not be suitable for the following people: Obese individuals People with other chronic medical conditions People with severe osteoporosis People with emotional, neurologic, and mental disorders Since implants wear out, and the patient will need at least one revision procedure later on, surgeons often prefer to delay joint implantation in young people with osteoarthritis. However, the rate of revision operations can be reduced by using newer, longer lasting materials. After joint replacement surgery, elderly patients with poorly controlled osteoarthritis usually do very well. Compared to younger people, it takes older patients longer to fully recover. However, there are many long-term benefits of surgery for older patients, such as significant improvements in pain and quality of life. The following are the different types of joint replacement. Minimally Invasive Joint replacement: A variety of new techniques for minimally invasive approach to knee and hip joint replacement are being explored by surgeons. These techniques involve smaller specialized instruments and a smaller incision. Giving the patient a shorter recovery time and less pain is the goal of this surgery. However, we re still in the early stages of minimally invasive joint replacement, or arthroplasty. As of now, there is no consensus on whether minimally invasive joint replacement achieves any additional benefits, beyond the recovery period or which minimally invasive technique works best. Unicondylar Knee joint replacement: Also known as unicompartmental knee arthroplasty, unicondylar knee joint replacement or arthroplasty may be useful for limited knee damage. Relatively sedentary patients, who are not obese and are older than 60, are advised to opt for this surgery. This type of joint replacement offers two benefits it may delay the need for a total knee replacement, and relieve pain. The insertion of small implants and a small incision is involved in this procedure. Important knee ligaments, which ensure more movement than a total knee replacement, are retained in this procedure. CardioClear7.com 31

32 Hip Resurfacing: A surgical alternative to total hip replacement, hip resurfacing involves placing a metal cap over the dome, and scraping the surfaces of the hip joint and femur. In order to ensure that a standard hip replacement can be performed down the line, the procedure preserves much of the bone. This procedure is a potentially good option for young, physically active individuals as it provides a faster recovery, more stability, and a greater range of motion. Revision Arthroplasty or Joint replacement: In cases where the original transplant fails, a repair or revision procedure known as arthroplasty revision may be used. Whether the bone defects that occurred are contained or uncontained, determines the specific procedure. Contained defects are those defects that can be repaired with the help of oversized cementless implants, the use of cement or small bone grafts. On the other hand, the more severe defects that require specially constructed implants, or a large bone graft to restore bone, are known as uncontained defects. The potential for complications increases in case a second arthroplasty is required. This means that the operation takes longer, more blood is lost and more bone is cut in arthroplasty revision. Also, people that undergo this surgery are generally older individuals and more prone to complications. CardioClear7.com 32

33 Complications of Joint replacement Although they are common, complications can occur in the surgery. Some of these complications are life threatening. Serious potential complications include deep blood clots in the legs, as well as blood loss and infection. The blood clots pose a risk of death as they can travel to the lungs. Individuals that are at a higher risk for blood clots include overweight or obese osteoarthritis patients. Some other complications are the risks associated with the use of general anesthesia. The following are some complications that you and your doctor need to watch out for: Blood Clots: The most common complication associated with joint replacement is blood clots. After joint replacement surgery, blood clots can occur in the large veins of the leg and pelvis. Following the surgery, your doctor will prescribe you blood thinning medication. In order to reduce the risk of developing blood clots, you ll have to take this medication for several weeks after the surgery. In order to keep the blood in the legs circulating, the doctor will give you compression stockings. Also, you ll be able to prevent blood clots from forming if you perform early movement,. such as standing, sitting, and walking, as recommended by your physician or physical therapist. In case it develops, the blood clot could travel to the lungs. This can be potentially fatal. In order to ensure that you know what to look out for, you ll be given instructions on what symptoms might indicate the clot has traveled to your lungs. In case you develop these symptoms, get medical help as soon as possible. Lung Congestion: Following a major surgery, pneumonia or lung congestion is always a risk. You ll be asked to regularly perform deep- breathing exercises while you are in the hospital, in order to overcome lung congestion or minimize its threat. CardioClear7.com 33

34 Infections: After the surgery, one of two things may happen your joint may become infected or the surgical wound may become infected. This could occur either right after you return home, or years after your surgery. After the surgery, your doctor will prescribe antibiotics in order to reduce the risk of infection. You ll be asked to take antibiotics prior to certain medical procedures, even if several years have passed after the surgery. You may need to remove your artificial joint in case it becomes infected. At times, the infection is cleared through surgery and does not require the removal of the joint. However, there are also times when antibiotic treatment and removal of the implants becomes necessary to clear the infection. Once the infection is completely cleared, a new joint may be considered. Scaring and Stiffness: Making scar tissue is your body s natural response after surgery. The scar tissue develops both deep inside the joint, and on the surface of your skin. Your joint may become stiff and difficult to move as the scar develops. Therefore, beginning activity as soon as possible after surgery is important. Following the surgery, you must continue regular physical therapy as prescribed by your doctor. A manipulation under anesthesia may be required, in case physical therapy doesn t improve stiffness. The manipulation will break up scar tissue. However, following this you will need to be careful about performing your prescribed physical therapy. Loosening or failure of implant: Implants wear out and may loosen over time. Today, they last longer due to newer materials. The average lifetime of most knee and hip replacements is approximately 20 years. However, there are some implants that last less than ten years, while others lasts more than thirty. In spite of the fact that some they all have different life spans, one thing is true for all of them they eventually wear out. This is something that concerns younger patients more, as they live longer with the implant and put more stress on the artificial joint. A revision surgery may be performed if the joint wears out. CardioClear7.com 34

35 Hip Dislocation: When the ball comes free from the socket, this is called dislocation of the hip replacement. Generally, this occurs after a fall. However, there are other things that could cause it. Even simple activities, such as sitting down on a low seat could cause dislocation. As a result of this, you will have to follow certain precautions, especially during the early part of your recovery process. The following are the precautions you may be required to take after hip replacement: Avoiding turning your foot inward Using elevated seats Sleeping with a pillow between your legs Avoiding behind your hip more than 90 degrees Avoiding crossing your legs Post-surgery Following surgery, a normal part of the recovery process is postoperative pain, swelling and bruising. Fortunately, there are ways for you to manage the pain, and make your recovery process easier. A lot of hard work is involved in getting the most function out of your new joint after the surgery. After the surgery, you ll probably be in the hospital for several days. In order to restore movement in the affected joints, physical therapists will teach you the appropriate exercises during your time at the hospital. However, once you go home the healing and recovery of the joint will be up to you. Joint replacement takes a significant toll on the body. This is the reason expecting to resume your routine activities only a week or so after the surgery is something you shouldn t do. Let s put it this way the damage caused to joints happened over time. Therefore, it s only natural that the healing and recovery of the joint will also happen over time. Bruising, swelling and pain are all-related. Therefore, they all have the same antidote rest. People with osteoarthritis need time to adjust to the artificial joint, even though the joint replacement eventually restores some mobility and provides pain relief. The following are the limitations after hip surgery: Patient with new hips cannot run. However, they can walk a few miles and climb stairs Osteoarthritis patients must learn new ways to perform activities that require bending down, as artificial hips should not be flexed more than 90 degrees. CardioClear7.com 35

36 Limitations after knee surgery include: Osteoarthritis patients cannot run after knee replacement surgery. However, there is improvement when walking. It may be difficult to climb stairs with artificial knee joints as they have a limited range of motion. You will need to prepare for what comes afterward before you consider joint replacement surgery. You will also need to have realistic expectations of how much work is required for the best outcome, and how much of an improvement to expect. Most people who undergo joint replacement experience major improvements in their ability to perform routine activities such as cleaning house, engaging in low-intensity exercise and stair climbing, as well as dramatic reductions in pain. However, you need to keep in mind that a joint replacement is an artificial joint, and you will have to limit some of your activities with them. These include high impact activities. The following are some of the activities that you should avoid after joint replacement, or perform only after talking to your doctor: A high-impact aerobics class Skipping Karate or other martial arts Playing soccer, basketball, football or other high-impact sports Skiing, running or jogging Rehabilitation and Recovery: Depending on the condition of the patient at that particular time, he or she is sent home, or to a rehabilitation facility, after knee replacement surgery. The average rehabilitation stay is approximately a week to ten days, in case the osteoarthritis patient is sent to a facility. A physical therapist, recommended by your doctor, will visit your home to treat you, in case you re sent directly home from the hospital. As the final stage of the rehabilitation process, your doctor may ask you to go to an outpatient physical therapy facility. Depending on your progress, outpatient therapy mat last from one to two months. Because every person is different, your doctor and physical therapist will help you to determine the course of rehabilitation on an individual basis. This is something you must keep in mind. CardioClear7.com 36

37 If you treat it well, your new hip or knee can last 20 years or longer. However, it will wear out or become loose sooner than expected, if you put stress and strain on the joint. After the surgery, you should perform activities that put less strain on your joints, such as cycling and swimming. Without overstressing it, these exercises can help the new joint significantly. A surgeon can put in the new hip or knee. However, only you have the ability to exercise it. Therefore, you should commit to an exercise program before pursuing joint replacement surgery. The exercise program should include: In order to gradually and safely increase your mobility, regular walking, first at home and then outdoors for longer distances Resuming routine activities, such as getting up and down from a chair, climbing stairs, and standing, gradually In order to strengthen the muscles around your joint, performing the exercises advised by your physical therapist regularly at home Provided you choose joint replacement surgery, you re likely to have an excellent outcome, if you do all of the aforementioned things. So is joint replacement surgery good for you? According to a 2008 study, compared to people who did not have surgery, people with osteoarthritis, especially older individuals, that underwent joint replacement surgery significantly improved their osteoarthritis symptoms. Whether joint replacement is right for you is something we ll briefly discuss in the next section. Making the decision: One of the most successful operations in medicine, that has improved the lives of millions of people, is joint replacement. People with osteoarthritis often ask when they should consider joint replacement surgery. Unfortunately, there isn t a straightforward answer to this. However, you may require joint replacement surgery if you feel a loss of function in your knee or hip, and are suffering from extreme pain. Osteoarthritis can affect your every move including sitting, walking, lying down or climbing stairs. One thing that can bring relief is surgery. However, doctors advise people with osteoarthritis to try other treatments before turning to joint replacement surgery. When non-surgical treatments such as the use of assistive devices, physical therapy, and medication do not work, joint replacement may become necessary to treat osteoarthritis. CardioClear7.com 37

38 Other signs indicating the need of joint replacement surgery include loss of mobility, aching in the joint followed by periods of relative relief, pain that increases in humid weather, stiff joints after periods of rest or inactivity, and/or pain after extensive use. Anti-inflammatory and pain relieving medications, physical therapy, and assistive devices may help, but most of the times surgery is required to treat symptoms. You'll only feel pain when walking long distances in the early stages of osteoarthritis. However, you ll feel pain even when performing routine activities such as dressing, putting on shoes, or taking short walks, as osteoarthritis progresses. In many ways, osteoarthritis of the hip and knee can negatively affect your life. However, the good news is that there is a solution, and it is joint replacement surgery. Most people return to an active and pain free life after the surgery, even though the joint requires time to heal afterwards. The surgery also improves walking ability and overall health. Your primary care doctor will probably recommend an orthopedic surgeon to you who ll help you determine when and if you need joint replacement surgery. He or she will also inform you about the type of surgery you require. The orthopedic surgeon may advise you against getting a in certain cases, such as if your bone isn t strong enough, you don t have enough of a bond or you have an infection. In favor of less invasive treatments, doctors generally try to delay total knee replacement for as long as possible. However, joint replacement may offer you an opportunity to relieve pain and return to normal activities if you have advanced joint disease. Alternatives to Joint Replacement: There are several other options if you feel a joint replacement isn t right for you. They include realignment, fusion, and synovectomy. Let s take a brief look at these alternatives to joint replacement. Osteotomy (bones realignment): Cutting and removing bone or adding a wedge of bone near a damaged joint is involved in the procedure known as osteotomy. For example, osteotomy transfers weight from an area affected by osteoarthritis to an undamaged area. On many occasions, osteotomy is used to correct misalignment of the hip, or hip dysplasia that occurs early in life. Individuals who are too young for total joint replacement, such as people with osteoarthritis in their 30s and younger, are the best candidates for osteotomy. CardioClear7.com 38

39 The biggest benefit of this surgery is that it can stop damage and delay the need for a joint replacement. However, only specialized surgeons can perform osteotomy, as it is a complex and highly specialized surgery. Synovectomy: The lining of the joints or the synovium can grow too much, or become inflamed in people with inflammatory osteoarthritis. As a result of this, the surrounding cartilage and joints are damaged. Using either traditional open surgery or arthroscopy, surgeons remove most or all of the affected synovium in synovectomy. The best candidates for synovectomy are people with osteoarthritis, that have limited cartilage damage in the affected area, and have tried anti-inflammatory medications, but continue to have overgrowth or inflammation of the synovium around the hips, fingers, wrist, elbow, and knee. People that undergo synovectomy may be able to reduce their intake of anti-inflammatory medications. This surgery improves function and relieves pain. However, it is possible that this procedure may provide only temporary relief of symptoms, and limit range of motion. Fusion or Arthrodesis: In order to join two or more bones and make one continuous joint in the spine, fingers, thumbs, wrists or ankles, surgeons use rods, plates, pins or other tools, in the procedure known as Arthrodesis or fusion. The bones grow together and lock in place over time. The most suitable candidates for this type of joint replacement are people with severe damage from osteoarthritis. The results of Arthrodesis should last a lifetime, as it is an extremely durable process. People that have this surgery can safely take part in high-impact physical activity. However, this surgery may reduce flexibility as merging joints inhibits their motion. It also puts stress on surrounding joints, as it changes the normal biomechanics of the joint. CardioClear7.com 39

40 CHAPTER 02-RHEUMATOID ARTHRITIS Understanding Rheumatoid Arthritis An autoimmune disease, Rheumatoid arthritis is a condition in which the body s immune system responsible for protecting its health by attacking foreign substances like viruses and bacteria mistakenly attacks the joints. Basically, the body attacks itself. As a result of this, inflammation occurs, and this causes the tissue that lines the inside of the joints (the synovium) to thicken, causing pain and swelling in and around the joint. Joints on both sides of the body such as both hands, both knees, and both wrists are affected by Rheumatoid Arthritis. According to statistics provided by the official Center for Disease Control and Prevention of the government of United States, approximately 1.5 million adults, constituting a noticeable 1.3 %population, were diagnosed with Rheumatoid Arthritis in The statistics further revealed that people aged over 85 and 65-77, were much more likely to get Rheumatoid Arthritis than people aged The cartilage can be damaged if the inflammation caused by Rheumatoid arthritis goes unchecked. This can cause damage to the elastic tissue that covers the ends of a joint s bones and the bones themselves. Over time, the joint spacing between bones can become CardioClear7.com 40

41 smaller, as there s a loss of cartilage. Rheumatoid arthritis causes joints to lose their mobility and become painful, loose, and unstable. It can also cause joint deformity. Doctors recommend early diagnosis and aggressive treatment to control Rheumatoid arthritis, as it occurs early on and cannot be reversed. The cartilage can be damaged if the inflammation caused by Rheumatoid arthritis goes unchecked. This can cause damage to the elastic tissue that covers the ends of a joint s bones and the bones themselves. Over time, the joint spacing between bones can become smaller, as there s a loss of cartilage. Rheumatoid arthritis causes joints to lose their mobility and become painful, loose, and unstable. It can also cause joint deformity. Doctors recommend early diagnosis and aggressive treatment to control Rheumatoid arthritis, as it occurs early on and cannot be reversed. The joints commonly affected by Rheumatoid arthritis include the knees, elbows, hands, feet, ankles and wrists. Usually, the joint effect is symmetrical. This means that if one hand or knee is affected, usually the other is too. Rheumatoid arthritis is also referred to as a systemic disease, because it can affect body systems such as respiratory or cardiovascular systems. So what are the signs and symptoms of Osteoarthritis? Let s take a look. Signs and Symptoms Early Signs of Rheumatoid Arthritis The early signs of Rheumatoid arthritis include minor symptoms that appear and disappear all of a sudden, on both sides of the body. The progression of these symptoms usually happens over weeks or months. Symptoms of Rheumatoid arthritis can change each day, and are unique for every person. However, there are some signs that may be an early indication of this condition. The following are some early signs of Rheumatoid arthritis. If you experience any of these symptoms, you may be suffering from Osteoarthritis. However, you must visit your doctor before coming to any conclusions. Fatigue: The first indication of Rheumatoid arthritis is fatigue. Prior to any other symptoms becoming prominent, you may find yourself feeling unusually fatigued. It often comes before the emergence of other symptoms, and it can fluctuate from day to day, or week to week. It may even accompany depression and feelings of illness. CardioClear7.com 41

42 Stiffness in the morning: An early indication of all forms of arthritis, including Rheumatoid arthritis, is morning stiffness. Usually, stiffness that lasts for some time indicates degenerative form of arthritis. On the other hand, if the arthritis lasts for several hours, it may indicate inflammatory arthritis. 0Stiffness that occurs after prolonged sleeping or sitting can also be an indication. Stiffness in the Joint: A common early sign of Rheumatoid arthritis is stiffness of the smaller joints. Whether you re active or not, this can take place at any given time. The joints of the hands are usually the first to become stiff. Pain and Tenderness: Regardless of whether the joint is moving or at rest, joint tenderness or pain follows joint stiffness. Joint tenderness or pain equally affects the right and left hand side of the body. The wrists and fingers are usually where the pain occurs in early Rheumatoid arthritis. However, shoulders, ankles, feet, or knees may also be affected. Minor Swelling: Minor swelling of the joints is an early indication of Rheumatoid arthritis. This means that your joints may seem bigger than what they normally look like. Your joints may also be warm to touch because of this swelling, and it lasts anywhere from a few days to a few months. Fever: A low-grade fever may indicate that you have Rheumatoid arthritis, if it s accompanied by other symptoms, such as inflammation and joint pain. However, you re probably suffering from an infection or some other illness if the fever is higher than 100 F. Numbness and tingling: Tingling, numbness, or a burning feeling in your hands is also an indication of Rheumatoid arthritis. CardioClear7.com 42

43 Decrease in range of motion: Ligaments and tendons can lose stability and deform due to inflammation in your joints. You may not be able to straighten and bend joints as the disease progresses. In short, the pain caused by Rheumatoid arthritis may affect your range of motion. If you re suffering from early stages of osteoarthritis, see your doctor to get a proper diagnosis. The early signs of Rheumatoid arthritis include joint stiffness, pain, tenderness, minor swelling, and decrease in range of motion. However, as Rheumatoid arthritis progresses the symptoms also change/increase. So what are the symptoms of Rheumatoid arthritis, regardless of its stage? Let s take a look. Symptoms of Rheumatoid Arthritis A serious autoimmune disease, Rheumatoid arthritis attacks the joints and other body parts. However, diagnosing this condition can be a tough task. Often, symptoms of Rheumatoid arthritis mimic other illnesses. Furthermore, lab tests aren t perfect you could have Rheumatoid arthritis, even if your test results are negative. However, there are some symptoms that are related only to Rheumatoid arthritis, and these indicate this condition, regardless of its stage. Let s now look at these symptoms. Hard to heal injuries: When the symptoms are due to Rheumatoid arthritis, you may have an injury such as a sprained ankle that seems to be refusing to heal, or healing at a slower rate than normal. This symptom is more evident in younger people. If you have Rheumatoid arthritis, you may have a swollen knee a day after you play soccer or some other sport. Inflammation in the forefoot: The forefoot is one area in which people with Rheumatoid arthritis have pain or inflammation. Often, women stop wearing heels due to the pain. As a result of plantar fasciitis, some people with Rheumatoid arthritis may develop pain in the heel. Caused by swelling of the tissue near the heel, plantar fasciitis is a common foot disorder. CardioClear7.com 43

44 Dryness of the eyes, mouth, nose, throat, or skin: An autoimmune disease, Sjogrens syndrome can cause dryness of the eyes, mouth, nose, throat, or skin in people with Rheumatoid arthritis. The dryness is due to inflammation that prevents glands from unhitching moisture. This symptom may occur even in the early stages of Rheumatoid arthritis. However, your doctor will confirm Rheumatoid arthritis in you only if this symptom is accompanied by some other symptoms of RA. Your doctor may rule out Rheumatoid arthritis in you, if dryness of the eyes, mouth, nose, throat, or skin, in isn t accompanied by other symptoms of RA. Achy Joints: Aching in the joints is one of the most overriding symptoms of Rheumatoid arthritis. Often, people think that their pain is a result of overexertion or osteoarthritis. However, osteoarthritis usually occurs in old age. At times, this aching in the joints is misdiagnosed as chronic fatigue syndrome or fibromyalgia. As pointed out earlier, fatigue is a symptom of Rheumatoid arthritis. Rheumatoid arthritis joint pain isn t brief, rather it lasts more than a week. Furthermore, this pain can be symmetrical you will feel pain in both hands, ankles, knees or feet, at the same time. Locked Joints: Locked joints are what people with Rheumatoid arthritis can experience at times. Usually, they occur in the knees or elbows. Why? They happen because there s significant swelling of the tendons around the joint, which prevents it from bending. This can lead to painful cysts behind the knee. Often, people mistake the symptom for meniscus tear. A condition that also leads to cysts, meniscus tears are a knee joint injury that usually occurs in sportsmen. Nodules: Nodules grow under the skin near the affected joints and manifest as small, firm lumps. Often, they appear at the back of the elbows, while on other occasions they re found in the eyes of people with RA. Nodules may show up in the early stages of Rheumatoid arthritis. However, they re also common in people with advanced Rheumatoid arthritis. At times, nodules mimic another form of arthritis, known as gout. CardioClear7.com 44

45 Digestive Problems or Stomach Pain: You re more likely to develop stomach bleeding, ulcers and conditions such as diverticulitis and colitis, if you have Rheumatoid arthritis. Inflammation from Rheumatoid arthritis or side effects from medications such as corticosteroids or nonsteroidal anti-inflammatory drugs (NSAIDs) can cause this. Also, you re highly likely to have diarrhea or constipation, which indicates and warns that the amount of good and bad bacteria in your intestine is out of balance. Weight loss: You may experience flu-like symptoms when you have Rheumatoid arthritis. At times, this includes loss of appetite, which may lead to muscle or simple weight loss. If you have Rheumatoid arthritis, you may even become malnourished. This means that you need to be watchful about what and how much you eat. In order to get the right nutrition and calories every day, work with your doctor. Inflammation of lungs lining: If you have Rheumatoid arthritis, the lining of your lungs may become inflamed. Known as pleurisy, this is an inflammation of the lining of the lungs. The feeling of pain when you try to take a deep breath is the most noticeable symptom of pleurisy. The inflammation can lead to scaring in the lungs and shortness of breath over time. However, you can treat this with anti-inflammatory medications. There is a possibility that your lung symptoms are due to Rheumatoid arthritis medications. If you have any trouble breathing, you should tell your doctor about it. Breathing Problem: You re at a higher risk for scarring of the tissues in the lungs if you have Rheumatoid arthritis. Therefore, you should visit your doctor if you re short of breath during routine activities, or have a cough that won t go away. CardioClear7.com 45

46 Broken bones: Bone loss that raises your risk of fractures, can be triggered by some Rheumatoid arthritis.if you avoid exercise and physical activity your bones may become weaker. A broken bone may indicate that you re developing osteoporosis. A disease that causes your bones to get thinner is known as osteoporosis. Once you re tested and diagnosed, you can treat osteoporosis. Depression or anxiety: At times, depression or anxiety is an indication of Rheumatoid arthritis. According to a CDC study, depression or anxiety is seen in about one-third of people with arthritis. If you notice changes in your mood, talk to your doctor. In order to help treat this symptom, your doctor will suggest therapy or medicine to you. Swollen Lymph Nodes: Along with the appendix, spleen, tonsils, and certain areas of the small intestine, Lymph nodes are a part of the immune system. By producing antibodies that directly attacks infectious bacteria, the immune system protects us from diseases and infections. On the other hand, an over-active immune system can occur, due to unknown triggers. This over activity produces auto-antibodies, which are directed against body components. This causes autoimmune diseases, such as lupus or Rheumatoid arthritis, to develop. This symptom occurs when there is lymph node swelling, or enlargement of lymph nodes. The term used for this is called lymphadenopathy. The infected areas are where painful lymph nodes are commonly found. In Rheumatoid arthritis, the enragement or swelling of the lymph nodes is limited to the nodes voiding the infected area. For example, one or more lymph nodes in the armpit of the same side may swell and become painful if a finger is infected, or lymph nodes in the groin are likely to swell and hurt if a toe is infected. Rheumatoid arthritis is a systemic illness, that primarily results in inflamed joints. However, it can affect several systems of the body. Overactive lymph nodes that produce auto antibodies are what patients with Rheumatoid arthritis have. Examples of such anti bodies are anti- CCP anti bodies and Rheumatoid factor. At times, lymph nodes in Rheumatoid arthritis do not cause pain, even though they become enlarged. Lymph nodes caused by Rheumatoid arthritis affect many areas throughout the body. CardioClear7.com 46

47 Anemia: An autoimmune disorder, Rheumatoid arthritis causes chronic inflammation of the joints. One of the most common symptoms of Rheumatoid arthritis is anemia. In fact, about 60 percent of the people with Rheumatoid arthritis have anemia. This may occur due to the failure of the bone marrow to produce enough new red cells. It is especially important for you to recognize and treat anemia, because anemia-related fatigue contributes to the wearing nature of Rheumatoid arthritis. Chest Pains: According to a 2015 study, people with Rheumatoid arthritis are more likely to die from heart-related problems than those without RA. About 40% of people with Rheumatoid arthritis have symptoms in areas on their body, apart from joints. The areas include the skin, lungs, eyes, and muscles. Disorders with similar or overlapping symptoms: Because, many other conditions have similar symptoms, Rheumatoid arthritis can be difficult to diagnose. There are several disorders with symptoms that overlap with rheumatoid arthritis. The following are some of these disorders. Lupus: A potentially fatal autoimmune disease, Lupus affects many parts of the body, including internal organs, blood vessels, skin, and joints. Because they share many symptoms, distinguishing between Rheumatoid arthritis and Lupus is hard. Joint pain is the most obvious similarity between the two. Other shared symptoms include swelling, inflammation, fatigue, a periodic fever, and decrease in energy levels. Fortunately, there is a way to tell them apart. Unlike Rheumatoid arthritis, Lupus does not cause erosive, deforming arthritis. Furthermore, the joint symptoms in Lupus tend to be mild. CardioClear7.com 47

48 Gout: When excess levels of uric acid form needle-like crystals in a joint, gout occurs. The primary symptoms of gout are swelling and severe pain. Gout is an extremely painful type of arthritis, and its symptoms begin in the big toe. The symptoms of gout that mimic Rheumatoid arthritis include redness, warmth, swelling, and pain. While it typically attacks the toe, gout can extend to any part of the body including the fingers, elbows, wrists, knees, ankle, and foot. Gout can cause erosive, deforming arthritis if it goes untreated. The best way to know whether you have Rheumatoid arthritis or gout is to make an appointment with your doctor for a diagnosis. However, there are few things that can help differentiate the diseases. The following are some of them: Usually, gout occurs in the foot. To be precise, it occurs at the base of the big toe Even though it can affect any joint on either side of the body, Rheumatoid arthritis usually occurs in the small joints of the feet, wrists, and hands Intense swelling and agonizing pain accompanies gout Even though it can be painful, a joint affected by Rheumatoid arthritis is not always swollen or red Rheumatoid arthritis pain varies in intensity and quality. Sometimes it s excruciating while on other occasions it s mild Pseudogout (CCPD): A form of arthritis, Pseudogout is triggered by deposits of calcium crystals in the joints. Spontaneous, painful swelling is what Pseudogout causes. It also causes inflammation joint pain and fluid buildup around the joint. Scleroderma: An autoimmune disease, Scleroderma attacks the skin and tissues. Scleroderma is a form of degenerative arthritis. Both Rheumatoid arthritis and Scleroderma attack connective tissues and cause pain, swelling and immune system responses. However, there are a few differences between the two. First and foremost, Scleroderma hardens the skin and causes inflammation inside, and outside, the body. On the other hand, Rheumatoid arthritis causes inflammation, but it does not spread to the skin.a less common form of arthritis, Scleroderma hardens the skin and causes random swelling and scarring to occur. Due to chronic inflammation within the blood vessels, Scleroderma causes blood vessel disease. On the other hand, Rheumatoid arthritis causes joint pain and swelling. CardioClear7.com 48

49 Osteoarthritis: We ve already covered Osteoarthritis. However, we ll do a quick recap. In simple terms, Osteoarthritis refers to inflammation of the joints. A joint disease, Osteoarthritis mostly affects the cartilage. Known as wear and tear arthritis, Osteoarthritis is the most common type of arthritis. Osteoarthritis can occur in almost any body joint and is associated with the disintegration of cartilage in joints. Healthy cartilage does two things it helps absorb shock of movement and allows bones to glide over one another. Osteoarthritis causes the upper most layer of cartilage to disintegrate and deteriorate. As a result of this, the bones beneath the cartilage rub together, which in turn causes swelling, pain, and loss of joint motion. The joint may lose it shape and spurs may grow on the joint s edges. Generally, Osteoarthritis occurs in the spine, knees and hips. However, it can also affect the neck, thumb, toe, and fingers. They are differences between Rheumatoid arthritis and Osteoarthritis, even though they share a lot of symptoms. The first difference is the cause behind the symptoms themselves. While mechanical wear and tear on joints causes Osteoarthritis, Rheumatoid arthritis is caused by an autoimmune disease which causes the body s own immune system to attack the body s joints. Rheumatoid arthritis tends to affect the middle joints of the fingers, while Osteoarthritis affects the joints at the ends of the fingers. Morning stiffness in joints caused by Osteoarthritis doesn t last more than 20 minutes after you wake up. On the other hand, morning stiffness in joints caused by Rheumatoid arthritis lasts for more than 45 minutes. Apart from the aforementioned diseases, there are some other diseases that resemble Rheumatoid arthritis, such as drug-induced lupus and Sjorgen s syndrome. Finding the difference between these diseases and RA is important. CardioClear7.com 49

50 Risk Factors Rheumatoid arthritis affects about 1.5 million people in the U.S. and can affect adults at any age. However, this form of arthritis appears in women between the ages 30 and 60 while symptoms of RA start appearing in men after they cross 50. Women are two or three times more likely to develop Rheumatoid arthritis than men. An autoimmune disease, Rheumatoid arthritis is a condition in which your immune system starts attacking your body s own tissues instead of viruses and bacteria. This causes inflammation. Normally, inflammation dies down fairly quickly. However, inflammation becomes a long-term (chronic) process in Rheumatoid arthritis. What sets off the inflammation in Rheumatoid arthritis is not clear. However, there s some evidence that lifestyle factors affect your risk of developing RA. You are at a risk if you: Drink a lot of coffee Eat a lot of red meat Smoke Apart from the aforementioned things, another thing that may increase your chances of developing rheumatoid arthritis is the genes that you inherit from your parents. However, it is important for you to keep in mind that genetics alone cannot cause Rheumatoid arthritis. Even if your father had Rheumatoid arthritis, and you have the same genetic material as him, your chances of developing RA are 1 in 5.The severity of Rheumatoid arthritis varies from person to person. Apart from genetics, there are many risk factors for developing Rheumatoid arthritis, including temperature and weather. There are two types of risk factors, namely primary and secondary risk factors. Primary risk factors are factors that you cannot prevent, such asyour age and genetics, while secondary risk factors are ones that you can control or prevent through medications or lifestyle changes. The following are some risk factors for developing Rheumatoid arthritis. CardioClear7.com 50

51 Primary The following are the primary factors that that may increase your risk of developing Rheumatoid arthritis: Genetics: You may have an increased risk of Rheumatoid arthritis if a member of your family has the disease. The chances of developing Rheumatoid arthritis are greater in people who have a close family member with RA. According to experts, you do not inherit the disease itself, rather you inherit the genes that give you the chance to develop Rheumatoid arthritis. Your chances of having Rheumatoid arthritis are increased by certain genetic material that is inherited from your family members. For example, you re about twice as likely as others to carry a gene linked to Rheumatoid arthritis, if your ancestors came from Europe, and your chances of having RA are greater if you have a twin with the disease. On the other hand, if you have a parent with RA, your risk goes up, but only slightly. However, the genes alone aren t enough to cause Rheumatoid arthritis. According to experts, these genes will only become active when other risk factors of RA trigger them. Age: Rheumatoid arthritis can occur at any age. However, it usually appears in women between the ages 30 and 60, and in men after they cross 50. Gender: Women are two or three times more likely to develop Rheumatoid arthritis than men. In fact, of all the people living with Rheumatoid arthritis, only 25 % belong to the male gender. The remaining 75% are women. The major reason for this is probably the female hormone estrogen. Usually, the first symptoms of RA in women appear after age 40. This is the same time when their estrogen levels are changing due to the onset of menopause. CardioClear7.com 51

52 Secondary The following are the secondary factors that that may increase your risk of developing Rheumatoid arthritis. Smoking: One of the most likely Rheumatoid arthritis triggers is smoking, especially if you have a genetic inclination for developing the disease. Studies reveal that smoking doubles your chances of developing RA and can cause problems even after you develop it. Smoking interferes with the treatment process by making your body less responsive to it. Environmental factors: You may be at a higher risk of developing Rheumatoid arthritis if you re constantly exposed to silica or asbestos. However, this cause is uncertain and there isn't any solid research behind it. Obesity: Most people don t consider obesity as a risk factor for Rheumatoid arthritis. However, a study that compared the weight of people with Rheumatoid arthritis with the weight of people without RA, found that obesity was associated with about a 25% higher risk of developing the disease. The best diet for reducing arthritis is one that s high in beans, grains, vegetables, and fruits. People who appear obese or are overweight seem to have a higher risk of developing RA. This is especially true in women 55 or younger. Lack of Omega-3s: Omega-3 fatty acids reduce inflammation and therefore, also the risk of diseases like Rheumatoid arthritis. Omega-3s are present in nuts and oily fish such as sardines, mackerel, salmon, and tuna. Alternatively, you can take omega-3s pills. According to a few studies, people that consume omega-3s suffer from fewer RA symptoms. It was also noted that people that consumed omega-3s required fewer over-the-counter medications to reduce the pain and swelling caused by Rheumatoid arthritis. CardioClear7.com 52

53 Vitamin D deficiency: A study that examined the link between Rheumatoid arthritis and vitamin D found that the risk of RA was higher in people with low levels of Vitamin D and that people with high levels of vitamin D were 25% less likely to develop Rheumatoid arthritis. The ways of increasing your vitamin D levels include taking vitamin D supplement, eating foods rich in vitamin D and getting out in the sunlight. You can measure your vitamin D levels through a blood test. Testosterone: Low testosterone in men may be an indication of Rheumatoid arthritis. Also known as low T, low testosterone indicates low levels of male sex hormone testosterone. Drinking Coffee or Tea: A strong connection between the risk of developing Rheumatoid arthritis and drinking decaffeinated coffee is suggested by some studies. Others show that women that drank large amounts of tea had a higher risk of developing the disease. However, what remains unclear is whether the risk is in the tea itself, or the method of preparation. CardioClear7.com 53

54 Eating excessive amounts of red meat: Over-indulging in red meat is something you should avoid, since there are many dangers associated with it. One of them is the development of Rheumatoid arthritis. However, recent studies have found that people consuming high levels of red meat were two to three times more likely to develop the disease than people who consumed less than an ounce of red meat each day. Some people with Rheumatoid arthritis claim that their symptoms improve when they stop consuming red meat. However, it is important for you to keep in mind that lean cuts of red meat provide sufferers with important nutrients and protein. Avoiding Breastfeeding: Almost all recent studies indicate that Rheumatoid arthritis is less common among women who breastfeed. Breastfeeding seems to offer a certain degree of protection against Rheumatoid arthritis. Women who didn t breastfeed were two times more likely to get RA than those who do. Women that never gave birth had a higher Rheumatoid arthritis risk than women who had children. Treatment Methods: Diagnosis: Before getting treatment for Rheumatoid arthritis, you must first diagnose the condition. You should make an appointment to see your doctor if you experience any of the signs and symptom. There is no single diagnosis method. Instead, the doctor will perform a physical examination, while also consulting the patient's medical history. In order to determine if there s inflammation and tenderness, an examination of the joints will be carried out, while the skin may be examined to look for rheumatoid nodules. In order to help diagnose the condition, the doctor may order X-rays or blood tests. The doctor will also rule out diseases that resemble RA, such as gout, lupus, and fibromyalgia. The physical examination is a key part of the diagnostic process. Your doctor will evaluate your joints, as well as check your general health, such as the heart and lung function, pulse rate and blood pressure. CardioClear7.com 54

55 Your doctor will examine how your joints function and ask whether the joints are painful when used. In order to find out if there s any inflammation, your doctor will assess your joints for warmth and swelling. They will then examine you for signs of the disease outside of the joints, and will record the number of swollen and tender joints, as well their severity. Basically, the physical examination will look for: Affected Joints Swelling, tenderness, and warmth Reduced Range of motion Reduced mobility Symptoms in other areas of the body such as skin, lungs, and eyes Presence of bumps or rheumatoid nodules over pressure points in the body Presence of fluid on the joint Pain or soreness during movement Unusual positioning of the joints Redness Any abnormalities or growths in the joint In order to reach a conclusive diagnosis, the doctor will go through your medical history and discuss the symptoms with you. Medical history plays a big part here It will tell your doctor when the onset of symptoms occurred, whether or not you have a family history of the disease, your past treatments or surgeries, and any other significant information related to your condition. Apart from the physical examination, other tests may be required to confirm the diagnosis and ascertain its. Some of the tests include blood tests, Joint X-rays and Arthrocentesis. Often, people mistake diseases such as lupus, fibromyalgia, and gout for Rheumatoid arthritis because these diseases closely resemble RA, as we mentioned before. Citrulline Antibody Test: In order to reach a diagnosis, doctors usually run blood tests. Certain anti-bodies present in a majority of Rheumatoid arthritis patients are what these tests look for. The anti-bodies include antinuclear bodies (ANA), Rheumatoid factor (RF), and anti-cyclic citrullinated peptide antibodies (ACPA). CardioClear7.com 55

56 Present in about 75% to 80% of Rheumatoid arthritis patients, Rheumatoid factor (RF) indicates the severity of the disease. For example, a high RF may be an indication of a more aggressive Rheumatoid arthritis. Detecting Rheumatoid arthritis earlier on is an advantage of anti-cyclic citrullinated peptide antibody (ACPA) tests. This helps patients treatment sooner, and better manage the disease. Although it isn t a definitive diagnosis for Rheumatoid arthritis, the presence of antinuclear bodies (ANA) can indicate the presence of an autoimmune disorder. Sedimentation Rate (Sed Rate): There are some blood tests that your doctor may run to determine the extent of the inflammation in the joints, and in other parts of the body. Also known as erythrocyte sedimentation rate or ESR, the sedimentation rate test measures the speed with which red blood cells make their way to the bottom of a test tube. Usually, if the sedimentation rate or ESR is high, it means that there is a good amount of inflammation in the body. C-reactive protein (CRP) test is another blood test that measures inflammation. A high CRP usually indicates high inflammation levels. Joint X-rays: An X-ray is another test that helps diagnose Rheumatoid arthritis. Since they don t show soft tissue damage, X-rays aren t helpful early in the disease. However, because they show erosion, doctors can use x-rays in later stages to monitor the progression of the disease over time. Some other tests for diagnosing Rheumatoid arthritis may include magnetic resonance imaging (MRI), ultrasound and bone density scans. CardioClear7.com 56

57 Arthrocentesis: In order to obtain joint fluid to test in the laboratory, your doctor may perform a joint aspiration procedure known as arthrocentesis. Using a syringe and a sterile needle, fluid is drained from the joint. After being drained, the fluid is analyzed to detect the causes of joint swelling. The removal of the fluid may relieve joint pain. For more immediate pain relief, doctors may inject cortisone into the joint during the aspiration procedure. Once the diagnosis is confirmed, a person suffering from Rheumatoid arthritis will have to get treatment for it. Currently, there isn t any cure for Rheumatoid arthritis. However, there are number of ways through which you can ease symptoms. When the patient has few to no symptoms, the treatments are aimed at remission. Early on in the disease process, treatments are used to minimize or slow joint damage and improve the patient s quality of life. They usually involve managing symptoms with medications, rest, exercise, and therapies. I In some cases surgery may be required. Usually, maintaining a healthy weight and exercising are good enough to treat the symptoms of Rheumatoid arthritis. However, your doctor may suggest a few other ways. Let s now take a look at the different non-surgical methods for treating Rheumatoid arthritis. CardioClear7.com 57

58 Treating Rheumatoid Arthritis without surgery Rest: Getting enough sleep is important for you to maintain optimal health and it becomes even more important if you have Rheumatoid arthritis. If you re suffering from the disease, you must ensure that you get at least eight hours of sleep. If you cannot enough sleep during the night, take a nap in the afternoon. Muscle relaxation exercises, deep breathing exercises and guided imagery can help you relax if stress is preventing you from getting enough sleep. Other things that may help ease stress and tension include massage, meditation, and hypnosis. Talk your doctor if you re suffering from insomnia. They will suggest appropriate treatment plans which will help you get a better night s sleep. Exercise: A great way to increase range of motion, strengthen muscles, and fight fatigue is regular exercise. Good low-impact choices include walking, swimming, gentle stretching, and water aerobics. Gentle exercises have been proven to help fight pain. It is important that you avoid high-impact sports when your joints are tender or severely inflamed. Apart from those mentioned above, another good option to reduce Rheumatoid arthritis pain is Yoga. Exercise is the only way people with RA can maintain strength and flexibility. It is important that you choose an activity that you enjoy, and you should avoid overdoing it. There are many benefits to exercising. For example, weight-bearing exercises keep your bones strong. Being cautious is always a wise thing to do when it comes to exercise. Consult your doctor for a list of activities that will be safe for you to do. Consulting a physical therapist is also a good idea, as they can tutor you on the proper ways to perform various exercises. Tai Chi: A Chinese martial art, Tai Chi combines slow, gentle movements with awareness and deep breathing, exercising the body, mind, and spirit. Studies show that Tai Chi may improve function in those with Rheumatoid arthritis. It is important that you don t perform moves that make your pain worse, and take lessons from a professional. CardioClear7.com 58

59 Maintaining a healthy weight: You can better manage pain by maintaining a healthy weight. According to a 2013 study, people who are obese or overweight need an increased amount of medication to control inflammation. This in turn decreases their chances of symptom relief. Therefore, maintaining a healthy weight is important to overcome the symptoms of Rheumatoid arthritis. Cream, Gels and Lotions: A good way to ease painful joints is topical creams, gels, and lotions that you can rub directly onto the skin. You may experience temporary joint pain relief as the skin absorbs the ingredients. You ll find topical creams in spray form as well. If you want to get the best results, look for products that contain menthol, camphor, salicylates, and capsaicin. Fish oil: According to a few studies, fish oil may help reduce the pain and stiffness caused by Rheumatoid arthritis. However, fish oil supplements can increase the likelihood of bleeding or bruising, and can interfere with certain medications. There are many benefits of using fish oil for people with Rheumatoid arthritis, including reduced pain and inflammation. In fact, some researchers suggest that there are as effective as nonsteroidal inflammatory drugs. The recommended dose for people with RA is one or two fish oil capsules per day. However, make sure that you talk to your doctor before using fish oil supplements. Physical Therapy: In order to help heal and strengthen a body part or area that is giving you problems, your doctor may prescribe physical therapy. In order to help ease pain and get you back into shape, the physical therapist will use gentle strengthening exercises, range of-motion exercise, transcutaneous electrical stimulation, and ice and heat therapy. Typically a shortterm option, physical therapy is performed few times a week for several weeks, until you re feeling better. A terrific bridge to an exercise program, physical therapy is recommended for early treatment of Rheumatoid arthritis. CardioClear7.com 59

60 Occupational Therapy: Apart from physical therapy, another good bridge to a regular exercise plan is occupational therapy. Helping a person live as independently as possible, regardless of age or condition, is what occupational therapy looks to do. In order to identify problem areas in your daily life, and find out the ways to eliminate them, an occupational therapist will work with you. For example, typing on a keyboard all day long may cause your hands and wrists to be painful and swollen. In order to ensure that you avoid overuse injuries and use the computer more comfortably, the therapist will help you modify your work area., They will also identify the assistive devices you require to help make your routine tasks easier. Heat and Cold Therapy: Heat therapy is one of the simplest ways to treat Rheumatoid arthritis. You can soothe painful joints and aching muscles by taking a relaxing 15-minute hot bath or shower. Alternatively, you can use a heating pad or hot towel to apply heat to an affected area. This will help you to relax tense muscles and relive pain and stiffness. Alternating hot packs with cold ones can also provide relief. In order to ease swelling and pain, apply an ice pack to inflamed joints. Relaxing muscles spasms and numbing pain are the two things cold therapy can help you to do.it is important that you don t overdo hot or cold therapy. In order to find out how to use heat and cold therapy safely, talk to your doctor or a physical therapist. Acupuncture: With the help of fine needles, gently placed near nerve endings, the ancient Chinese practice of acupuncture stimulates the body s natural painkillers to provide relief from Rheumatoid arthritis. Some studies suggest that acupuncture can provide temporary relief from joint pain caused. However, it isn t a viable long-term option and there has only been minimal research done on it. CardioClear7.com 60

61 Massage: Massages can be wonderful, or agonizing, depending on how your body is feeling. They can be extremely beneficial in helping you relax, and ease the muscle tension caused by joint stress, if your joints and muscles aren t feeling too tender. Whether massage can help you or not on a particular day is something you ll have to decide for yourself. If you think it might help your body feel better, give it a try. However, you must ensure that your massage therapist has previously treated people with Rheumatoid arthritis. According to a 2013 study that involved 42 people with Rheumatoid arthritis, light or medium massages from a therapist once a month can provide relief from pain, and a greater range of motion. Orthotics: A form of mechanical aids, orthotics can help support and protect your joints. Braces that keep your joints properly aligned or padded insoles for your shoes and splints are examples of orthotics. Furthermore, special gloves for hand and finger Rheumatoid arthritis are also available. In order to determine the best orthotics options for yourself, take help from a physical therapist. Smoking Cessation: Many people don t consider Rheumatoid arthritis as a reason to quit smoking since they aren t aware of the effect smoking has on their condition. If you re one of them, you need to know that smoking makes Rheumatoid arthritis worse. Often, people with RA don t quit smoking because they see it as a way to cope with the pain, feelings of isolation and lack of support. Apart from worsening Rheumatoid arthritis, it causes lung cancer, Osteoporosis, cardiovascular disease and stroke.. You should quit if you re a smoker and want to decrease your chances of developing Rheumatoid arthritis or improve your RA symptoms. The following are reasons for you to quit and improve your overall health. Talk to your doctor: The first way to quit smoking is talking to your doctor. They will inform you about the different options available to you. This includes focus groups related to smoking cessation, medications, and physical or mental therapies. CardioClear7.com 61

62 Choose a plan to follow: After talking to your doctor, choose the smoking cessation plan you want to follow. Pick a day for quitting smoking: Pick the day you plan to quit smoking. By doing so, you will motivate yourself to quit and start working towards your goal. Inform your friends and family: In order to ensure that they don t offer you cigarettes, making it harder for you to quit, inform your friends and family as their help will make it easier. At times, you ll be tempted to smoke, but the right support from friends and family will ensure that you stay clear of cigarettes. Find activities to distract yourself: If you want to quit smoking, you ll need to find activities to distract yourself. For example, you should keep gum with you to chew when the urge hits you. Alternatively, you can keep yourself busy by listening to music. Know what to expect: When you re trying to quit smoking, there are certain things that you should expect. Your body will go through withdrawal because nicotine is a drug. As a result of this, you ll feel angry, frustrated, anxious, cranky, unable to sleep, restless and depressed. You may also gain weight. Since you ll know what to expect, you ll be better able to cope with the withdrawal affects. Don t give up: In case you relapse, avoid giving up. Before you can kick the habit, you may require several tries. Medications: The sooner the treatment begins, the better the outcome will be if you re diagnosed with Rheumatoid arthritis. You can alleviate symptoms by using many different medications. All of these medications have the same goal bringing a patient into remission. The following are the main types of Rheumatoid arthritis medications: Disease- modifying antirhenatic drugs (DMARDs) Nonsteroidal antiinflammatory drugs (NSAIDs) COX-2 inhibitors Analgesics Biological response modifiers/ Biological DMARDs Kinase inhibitor Corticosteroids CardioClear7.com 62

63 As they are fast acting and relieve symptoms quickly, drugs that reduce pain and inflammation such as analgesics and NSAIDs are considered as first-line drugs. On the other hand, medications such as DMARDs and biological response modifiers take longer to have an effect, but help prevent joint damage and inflammation. Analgesics (pain relievers): For minor pain, analgesics such as acetaminophen are useful. Analgesics play a role both in the early stages of Rheumatoid arthritis, and even in the later stages of the disease. Until DMARDs become effective, analgesics help relieve pain. As long as they don t exceed the recommended dose, most people can take acetaminophen without any problems. The recommended dose is doses of 1 gram every 4 to 6 hours. Acetaminophen can reduce mild pain. However, it does not help with swelling or inflammation. Over the counter medicines include acetaminophen with caffeine or aspirin. Prescription medicines are acetaminophen with narcotics, propoxyphene, or codeine. Used to treat moderate to severe pain, another prescription analgesic is tramadol. Typically, tramadol is taken every 4 to 6 hours, and it may be taken with or without food. It is important for you to keep in mind that there are many side effects of tramadol, including gastrointestinal symptoms, muscle tightness, nervousness, headache, sleepiness, weakness, and dizziness. Given to manage Rheumatoid arthritis related pain, neuromodulators are another pain reliever. There is little evidence to show that neuromodulators are effective analgesics. However, because neuromodulators such as capsaicin have minimal side effects, they may be considered as an add-on analgesic with NSAIDs for people with RA who have persistent pain, and have failed to respond to other pain medications. The final analgesics for Rheumatoid arthritis are muscle relaxants, such as drugs that reduce muscles spasm such as valium, benzodiazepines, and Zopiclone. Muscles relaxants provide short-term relief. However, there are many side effects associated with them, such as dizziness and drowsiness. CardioClear7.com 63

64 Anti-Inflammatory Medicines: Used to treat Rheumatoid arthritis, anti-inflammatory drugs include (NSAIDs) and COX-2 inhibitors. Nonsteroidal anti-inflammatory drugs (NSAIDs): Temporary relief of pain and inflammation is what over-the-counter nonsteroidal antiinflammatory drugs (NSAIDs) can provide. Examples of NSAIDs are naproxen and ibuprofen. If necessary, your doctor may prescribe a more potent dose. The NSAIDs your doctor may prescribe include: Anaprox Celebrex Clinoril Daypro Feldene Lodine Relafen Toradol NSAIDs don t change the course of Rheumatoid arthritis, instead they ease the pain and discomfort. All NSAIDs have the same analgesic, anti-inflammatory and antipyretic properties, even though they differ in structure. However, individual patient response and tolerance to different NSAIDs can vary. In order to work, NSAIDs inhibit arachidonate cyclo-oxygenase (COX enzyme), and in doing so, inhibit the production of thromboxanes and prostaglandins. COX-1 and COX-2 are the two types of COX enzymes. In most tissue, COX-1 is expressed. This includes platelets. Induced in primary inflammatory cytokine and inflammatory cells when they are activated, the COX-2 enzyme is responsible for producing inflammation mediators. Most NSAIDS inhibit both isoenzymes. The inhibition of COX-2 is the major cause of the anti-inflammatory action of NSAIDs. On the other hand, the inhibition of COX-1 causes their unwanted side effects. Gastrointestinal irritation is the most common side effect of NSAIDs. At times, gastrointestinal irritation can lead to stomach bleeding or ulcers. CardioClear7.com 64

65 In order to prevent or minimize the side effects, NSAIDS must be taken with food. However, this will not decrease the risk of bleeding. You will also increase the risk if you take a combination of NSAIDs or NSAIDs and aspirin together. It should also be noted that longterm use of NSAIDs may cause heart problems. NSAIDs may lead to impaired renal function in some patients, since prostaglandins regulate blood flow in the kidneys. This may cause salt and water retention, as well as increased blood pressure. A warning that the medications may increase the chance of having a stroke, heart attack, or stomach bleeding is what all prescription NSAIDs come with. You may decrease gastrointestinal irritation, ulceration, or bleeding caused by anti-inflammatory agents if you take NSAIDs together with gastroprotective agents such as proton pump inhibitors. COX-2 inhibitors: In order to lessen the effect on the stomach, another type of NSAID called COX-2 inhibitor was designed. COX-2 inhibitors achieve their objective by blocking an inflammationpromoting agent called COX-2. Initially, it was thought that COX-2 inhibitors worked as well as traditional NSAIDs. However, the FDA re-evaluated the risks and benefits of COX-2 inhibitors after they received reports of heart attacks and strokes. Following reports of heart attacks and stroke in some patients, two COX-2 inhibitors (rofecoxib and valdecoxib) were taken off the market. COX-2 inhibitors are now available with strong warning and a recommendation that these medications should be prescribed for the shortest duration possible, and at the lowest possible dose. Like other NSAIDS, COX-2 inhibitors don t delay the progression of the disease. Instead, they provide relief from symptoms. Celecoxib is the only COX-2 inhibitor available for short-term use. Using the medication for one to two weeks is considered safe. Side effects of long-term use include: Increased risk of heart attack and stroke Impaired kidney function Fluid retention High blood pressure Gastrointestinal bleeding and ulcers Talk to your doctor if you need to take NSAIDs for longer period of time. In order to prevent stomach bleeding and gastrointestinal ulcers, your doctor may prescribe treatments such as an H2 inhibitor, a proton pump inhibitor, or misoprostol. CardioClear7.com 65

66 Corticosteroids: Often known as steroids, Corticosteroids are powerful drugs that reduce inflammation. Quick relief from pain and inflammation is what corticosteroids can provide Rheumatoid arthritis patients. In order to curb RA symptoms, corticosteroids suppress the overactive immune system. Corticosteroids are not the anabolic steroids that build up muscles. Corticosteroids act throughout the body and their impact isn t limited to the immune system. Using these drugs for a short period of time to control flares is recommended. Following the recommended dosage will help you to avoid the side effects. You may need to take steroids for a long time if you have severe Rheumatoid arthritis. Corticosteroids have both short-term and long-term side effects. The short-term side effects include irritability, acne and weight gain, while long-term effects include osteoporosis, psychological problems, diabetes, glaucoma, cataracts, bone thinning and high blood pressure. In order to quickly reduce inflammation at the start of the treatment, you may use high doses of corticosteroids in combination with disease- modifying antirheumatic drug (DMARDs). However, steroids may be discontinued entirely, or tapered down to very low doses, when DMARDs begin to take effect. At times, corticosteroids are injected directly into joints affected by Rheumatoid arthritis. This is a good way to get the benefits of the drug with limited side effects. However, injections should be limited to no more than a few per year for safety reasons. CardioClear7.com 66

67 Disease Modifying Anti-Rheumatic Drugs (DMARDs): As far as Rheumatoid arthritis is concerned, the topmost pain relief strategy to control inflammation is using disease modifying anti- rheumatic dugs (DMARDs). All other pain relief strategies to control inflammation are secondary to DMARDs. Even though they are slow acting, DMARDs are the most effective medications for controlling Rheumatoid arthritis. All DMARDs appear to slow or stop the changes in the joints. However, different DMARDs have different structures, and the mechanisms of action for most of these agents are unknown. DMARDS can delay the progression of bone damage and alter laboratory characteristics of disease activity. Within eight to ten weeks, patients taking DMARDs show some response. However, this variable depends on the drug and patient. The doses of DMARDs depends on its side effects. When the maximum dose is reached, an additional DMARD is added, or the initial DMARD is stopped and switched to another. Since most DMARDs can cause bone marrow toxicity and some can cause liver toxicity, they require monitoring to ensure safety. Monitoring includes urea and electrolyte level test, liver function tests and a full blood count. In order to determine how well medications are working, regular blood or urine tests should also be performed. Methotrexate is the most commonly used DMARD. Methotrexate: The most commonly used DMARD, methotrexate slows down the damage to the joint and is effective in reducing signs and symptoms of Rheumatoid arthritis. You ll see results from this drug within six to eight weeks. Other DMARDs that you can use in conjunction with methotrexate include hydroxychloroquine, sulfazine. Methotrexate has some side effects, including bleeding, bruising, liver problems, anemia, diarrhea and mouth sores. Hydroxychloroquine: An anti-malarial drug, hydroxychloroquine is effective in the treatment of Rheumatoid arthritis. For added benefits, hydroxychloroquine is used in conjunction with methotrexate and sulfasalazine. Before using this drug, you must keep its side effects in mind. The side effects include experiencing dizziness, headache, stomach pain, weight loss, loss of appetite, mood changes, itching, and hair loss. CardioClear7.com 67

68 Sulfasalazine: Another effective DMARD, Sulfasalazine reduces symptoms and slows down the joint damage. The side effects of sulfasalazine include vomiting, nausea, headache, itching, rash, stomach upset, and pain, decreased appetite and decreased sperm count. Leflunomide: Used in patients who cannot take methotrexate, leflunomide shows similar effectiveness to that. The side effects of leflunomide include skin rash, itching, cold symptoms, numbness or tingling, back pain, headache, weight loss, dizziness, diarrhea and mild stomach pain. CardioClear7.com 68

69 Biological response modifiers/ Biological DMARDS: The newest class of drugs used to treat Rheumatoid arthritis is biological response modifiers. For many people with Rheumatoid arthritis, these modern biologics have greatly improved treatment. Since they re made with the help of biotechnology, biological DMARDs are different from traditional disease DMARDs. In order to make them act like natural proteins in your immune system, biological DMARDs are genetically engineered. In order to help combat joint damage, your doctor may suggest that you start drug therapy immediately after your diagnosis. Often, the first drug prescribed is methotrexate. However, if methotrexate doesn t work well, your doctor will prescribe you a biologic drug. Biological DMARDs slow the progression of Rheumatoid arthritis. However, they don t cure it. Compared to other drugs, biologics have fewer side effects. A biologic may benefit people who don t respond to Rheumatoid arthritis drugs such as methotrexate. At times, biologics are given alone. However, there are also occasions when they re given in combination with another type of drug. For most people with Rheumatoid arthritis, taking a biologic drug with methotrexate is effective. Unlike traditional DMARDs, biologics target the molecules that cause inflammation in Rheumatoid arthritis. Here is a simple explanation of this. The development of Rheumatoid arthritis itself involves inflammatory cells in the joints. The inflammatory process that ultimately causes the joint damage seen in rheumatoid arthritis is what biological DMARDs cut down. On the other hand, traditional DMARDs work by modifying the body s own immune response to the inflammation. Biological DMARDs are considered to be more effective and more specifically targeted than traditional DMARDs, because they attack the cells at a more specific level of inflammation. Theyinclude rituximab, abatacept, etanercept, tofacitinib, tocilizumab, infliximab, golimumab, adalimumab, pegol, anakinra, and certolizumab. Anti- TNF agents: Some biological DMARDs are known as anti-tnf drugs. A protein known as tumor necrosis factor increases inflammation. Anti-TNF agents target this protein when excess amounts of it are present in the blood or joints. Also known as tumor Necrosis factor (TNF)-inhibitors, anti-tnf agents is the largest group of biological DMARDS available today to treat Rheumatoid arthritis. Anti-TNF agents include etanercept, golimumab, certolizumab, infliximab, and adalimumab. CardioClear7.com 69

70 Adalimumab: An injectable drug, adalimumab reduces inflammation caused by Rheumatoid arthritis. However, there are some side effects of using the medicine, including weakening of the immune system, bacterial or viral infections, cold, headaches, and injection site reactions. Adalimumab blocks a substance in your body that causes inflammation and makes your immune system react. The recommended dose is taking 40 mg once every two weeks, or 40 mg every week. People who aren t taking methotrexate may use the dose of 40 mg. Etanercept: An injected drug, Etanercept is used to treat Rheumatoid arthritis, as well as other types of arthritis. Etanercept works to lower the levels of TNF in your body, which helps to control excess inflammation. There are some serious side effects of etanercept, including weakening of the immune system, serious infections, upper respiratory infections, injection site reactions, loss of body fat and muscle, severe rash, bleeding, bruising, stomach pain, vomiting, dizziness and headaches. Rheumatoid arthritis patients should take etanercept as a single-use pre-filled syringe of 50 mg once per week. Infliximab: An injected drug, infliximab is used to treat Rheumatoid arthritis and a number of other diseases. Infliximab works by blocking the action of a protein in your body called tumor necrosis factor-alpha (TNF-alpha). In order to treat Rheumatoid arthritis, infliximab may be combined with methotrexate. The side effects of infliximab include stomach pain, headaches, coughing and respiratory infections. If you have an infection, avoid using infliximab. Your body s ability to fight infections is what infliximab may decrease. Your dose may depend on your general health. Therefore, before taking this drug tell your doctor about all your health conditions. Golimumab: An injectable drug, golimumab is used to treat Rheumatoid arthritis and other conditions. Golimumab works just like other anti-tnf agents. There are many side effects of golimumab including weakening of the immune system, viral infections such as cold or flu, upper respiratory infections, injection skin reactions, redness, swelling, and dizziness. The recommended dose is 50 mg, to be injected under your skin once per month. Golimumab may be given with or without methotrexate, or other non-biologic disease modifying antirheumatic drugs (DMARDs). CardioClear7.com 70

71 Non-TNF biologic agents: Non-TNG agents include abatacept, anakinra, rituximab, and tofacitinib. Even though they are also biological DMARDs, non-tnf agents work a bit differently from TNF inhibitors. Rituximab: By destroying another category of immune cells called b-cells, rituximab help control Rheumatoid arthritis. The activity of the drug in the body is complex, and its actions are yet to be fully understood. However, rituximab seems to slow down the joint destruction and reduce the signs and symptoms of Rheumatoid arthritis. The side effects of rituximab include headache, fever, chills, stomach pain, nausea, diarrhea, heartburn, flushing, night sweats, weakness, muscle or joint pain, back pain, or dizziness. Abatacept: Inhibiting the production of the cytokines tumor necrosis factor (TNF) alpha, interferon-γ, and interleukin-2 and decreasing T cell proliferation is what abatacept does. Side effects of abatacept include headache, nausea, diarrhea, stomach pain, indigestion, dizziness, flushing, back pain, or cold symptoms. Anakinra: The action of an immune system protein called interleukin-1 (IL-1) is what anakinra blocks. This protein is often known as master cytokine. By blocking the action of master cytokine, anakinra controls local and systemic inflammation in the body. The side effects of anakinra are nausea, diarrhea, stomach pain, headache, and cold symptoms such as stuffy nose, sneezing, sore throat. CardioClear7.com 71

72 Tofacitinib: Also known as a Kinase inhibitor, tofacitinib is a new class by itself. Tofacitinib works by blocking a cellular signaling pathway inside cells. This prevents the production of the components that cause inflammation. Traditional biologics block inflammation from the outside of the cells. However, Kinase inhibitors work from within. The only biological DMARD that isn t injected, tofacitinib comes as a pill, which is taken twice per day. Side effects of tofacitinib include: Infection caused by Bacteria Pneumonia Acute Infection of the Nose, Throat, or Sinus Diarrhea Shingles Head Pain Here, we tell you exactly what to expect and why you don't have a thing to be nervous about. The following are the different surgeries for Rheumatoid arthritis. High Amount of Fats in the Blood Synovectomy: Inflamed joint tissue known as synovium limits your range of motion or ability to function, and causes a great amount of pain. Removing synovium is what Synovectomy is used for. In order to access and remove inflamed joint lining, ligaments, and other structures may be moved aside. An effective filter, synovium clears spoilage and viral infections, or even potential bacteria, from the joint. However, inflammatory cells and inflammatory debris clog the filter in Rheumatoid arthritis. This causes the promotion of inflammation in, and of synovium. Preventing or stopping further damage to the joint is the goal of synovectomy. If drug treatment fails to resolve persistent pain and swelling in 3 to 6 months then you may consider this procedure for alleviating these symptoms. In order to ensure that it can still perform its function of releasing synovial fluid, part of the synovium is left intact during synovectomy. The synovial fluid acts as joint lubricant. There are two different ways of performing synovectomy using arthroscopic methods or making a large incision that exposes the entire joint. The extent of repair required and the joint involved determine the choice of approach. If medications such as DMARDs or corticosteroid injections aren t able to improve early rheumatoid arthritis, then synovectomy is a useful treatment option. However, it is important for you to keep in mind that synovectomy is a temporary fix, even though it provides relief of pain and swelling. The synovium will continue to become overgrown, as long as rheumatoid inflammation continues. Bleeding within the joint and a slight risk of infection are the risks involved in synovectomy. CardioClear7.com 72

73 Tenosynovectomy: Removing the inflamed synovial lining of the extensor tendons is the purpose of tenosynovectomy. The extensor tendons help the fingers extend. Swelling over the back of the hand and the wrist occur due to the inflammation of the synovial lining. In case it continues, this swelling and inflammation can eventually cause fissures in the tendons. Tenosynovectomy is used to treat the restricted or painful motion of a tendon that is caused by thickening and adhesions within the tendon covering. The operation is usually performed under a local anesthetic that lasts about half an hour. In tenosynovectomy, the surgeon divides the pulley, which restricts the excursion of the tendon. For this purpose, the surgeon uses a tourniquet. For the five to ten minutes after its inflation, the tourniquet can be uncomfortable. It is possible that the surgeon may remove only the lining of the joint and preserve the pulley in Rheumatoid arthritis patients. The reason for this is simple People with Rheumatoid arthritis have a number of weak pulleys. Therefore, entirely removing the valuable remaining pulleys might not be such a good thing to do. In order to use tenosynovectomy as an affective prophylactic procedure for Rheumatoid arthritis, it has to be performed before there s significant tendon damage. Preventing recurrent tenosynovitis and subsequent tendon rupture is what tenosynovectomy is usually considered for. Tendon Repair: Tendon rupture can often result from swelling and inflammation of joints or the related changes to bones and other structures that happens in Rheumatoid arthritis. Tendons located in the wrist and hands are particularly prone to ruptures. The use of tendons from other areas in the body is involved in surgical repairs, including end-to-end and end-to-side reconstructions. Arthrodesis: In order to achieve permanent immobilization of a joint, a surgical procedure that involves fusion of bones is used. This procedure is known as arthrodesis. By fusing the bones together, arthrodesis eliminates pain. Arthrodesis or joint fusion is performed when replacing the affected joint isn t possible. However, fusing the bones prevents the movement of the joint. The small joints of the hand and feet and the spine are where bone fusion is mostly done. CardioClear7.com 73

74 The surface layer of bone and cartilage is removed from the ends of the bones that are to be fused together during the arthrodesis procedure. After this, using rods and screws, the joints are locked into place once it is positioned in the most functional alignment. In cases where there s no joint stability and joint movement causes pain, arthrodesis is the most useful procedure. Typically preferred for certain joints such as wrist, thumb, ankle, hindfoot, and first toe, arthrodesis provide relief of pain and even allows the patient to maintain some limited joint function. Several months may be required to recover from this procedure. Arthroplasty or Joint Replacement: Rheumatoid arthritis may eventually progress to the point that normal functioning is impossible even after using the aforementioned procedures. Under such circumstances, you may consider artificial (prosthetic) replacement joint implants for wrists and hands, ankles, hips, knees, shoulders or other joints. People who are over 50, or have rapidly progressing joint damage, are best suited for arthroplasty. The lifetime of the joint replacement is usually about twenty years. Joint replacement can both relieve pain and restore joint function. Arthroplasty has a high success rate. Joint replacement surgery is successful in nine out of ten cases. There are several different types of joint replacement. Depending on joint location, and the nature of damage to joints and related structures, arthroplasty can involve the use of different artificial (prosthetic) and natural components. An orthopedic surgeon performs this procedure under general anesthesia. After opening the joints, the surgeon will disengage tendons and ligaments from the bone. After this, he or she will dislocate the joints and remove the damaged parts of the bone. The surgeon will preserve the bone as much as they possibly can. In arthroplasty, the stability of the replacement joint depends on how much bone remains. The prosthetic joint is cemented into place once the bones are reshaped. Then, tendons and ligaments are reattached. There are risks associated with joint replacement surgery, even though great advances have been made since its inception. One of the major concerns with joint replacement is the risk of infection at the site of surgery. Such an infection may require removal of the prosthetic joint. Nerve damage and formation of blood clots in the area of the surgery are some of the other complications. There is also a chance that the replacement joint may loosen or dislocate. Prosthetic joints can wear out over time. There are several different types of joint replacement. The following are some of them: CardioClear7.com 74

75 Minimally invasive Joint Replacement: For RA of the hip and knee, total hip replacement and total knee replacement are very successful surgical treatments. Over the past few years, hip and knee replacement surgery is now performed as with minimally invasive techniques. There are many benefits of minimally invasive joint replacement including less tissue trauma, as the muscles and tendons aren t cut, instead they re avoided or separated. The rehabilitation is also faster and less painful, there s less scarring and smaller incisions, the hospital stay is shorter and there s reduced blood loss, and less need for pre-surgery blood transfusions. Finally, returning to routine activity after the surgery is faster. Revision Arthroplasty or Joint replacement: In cases where the original transplant fails, a repair or revision procedure known as arthroplasty revision may be used. Whether the bone defects that occurred are contained or uncontained determines the specific procedure. Contained defects are those defects that can be repaired with the help of oversized cementless implants, the use of cement or small bone grafts. On the other hand, the more severe defects that require specially constructed implants or large bone graft to restore bone are known as uncontained defects. The potential for complications increases if a second arthroplasty is required. This means that the operation takes longer, more blood is lost and more bone is cut. People that undergo this surgery are generally older individuals and more prone to complications. Total knee replacement: A surgical procedure, total knee replacement involves the replacement of the diseased cartilage and bone of the knee joint with artificial materials. After removing them, a surgeon replaces the damaged sections of your knee joint with parts that are usually constructed of metal and very hard plastic. Reducing pain and improving function is what the artificial joint (prosthesis) does. If more conservative treatments haven t helped, and hip pain caused by RA interferes with daily activities, then knee replacement surgery may be an option for you. CardioClear7.com 75

76 Total Elbow Replacement: One of the procedures used to restore the function and relieve the pain in elbows affected by Rheumatoid arthritis is total elbow replacement. The outcomes of surgeries are what the advent of arthroplasty procedure has improved. In total elbow replacement surgery, the damaged elbow joint will be replaced with the new artificial joint after the scar tissue is removed and elbow muscles are balanced.the artificial joint will be fixed to the outside of ulna and the inside of the humerus. In order to ensure joint stability and connect the limb with other bones, hinge pins may be used. Total Wrist joint replacement: Also known as total wrist arthroplasty, total wrist joint replacement is used to treat the symptoms of Rheumatoid arthritis that haven t responded to non-surgical treatments, such as medication or therapy. Eliminating your pain and increasing the mobility of your wrist joint is the goal of wrist joint replacement. Wrist joint replacement is performed under general or regional anesthesia. In total wrist joint replacement, your surgeon will perform an incision over the back of the wrist. To expose the wrist joint, the surgeon will then move away the tendons. In order to ensure smooth surface for implants attachment, the surgeon will remove the damaged surfaces of the arm bone with the help of a surgical saw, and they may also remove the first row of carpal bones. In order to insert the radial components of the prosthesis, a special instrument is used to hollow out the inside of the radius bone. The surgeon will prepare for the insertion of the carpal components of the prosthesis once a proper fit is established. A plastic spacer is fit between the metal components, and cement is inserted into the components. Using its range of motion, the wrist joint is tested once the new prosthesis is in place. After testing the wrist, the surgeon stitches together the joint capsule, repairs the muscles and tendons, and closes the skin. CardioClear7.com 76

77 Preparing for Rheumatoid arthritis Surgery: If you want to see great results then it is important that you prepare yourself for Rheumatoid arthritis surgery. In order to prepare you for the surgery, your doctor may ask you to do several things. In order to help avoid infection, they may ask you to temporarily stop some of your medication. You may also be required to take aspirin, or other blood thinning drugs a week or so before the operation. Your doctor may also ask you to give blood in advance, in case you need it during the surgery. The following are some of the things you can do to improve your recovery and lower the risks of complications during surgery: Before the surgery, treat any tooth or gum disease that you may have. This will help you to prevent infection from mouth bacteria. Before the surgery, treating urinary tract infection is important. Therefore, tell your doctor if it hurts to pee. If you want to heal faster after the surgery then eat a healthy and balanced diet. It will provide you to the energy you need to heal. After surgery, people who are fitter do better. Therefore, exercising is important. Quit smoking if you re a smoker. Smoking cessation reduces the risks of complications after the surgery. If you re going to get joint replacement surgery, try to lose any extra weight. Less weight means less stress on the artificial joint, which in turn will help it to last longer. It is important that you prepare your home before the surgery. This means finding someone to help you with routine activities such as cleaning, cooking, shopping etc. Tape down electrical cords or loose carpets to reduce the likelihood of falls. CardioClear7.com 77

78 CHAPTER 03-PSORIATIC ARTHRITIS Understanding Psoriatic Arthritis Psoriatic arthritis causes your immune system to be over reactive, which in turn causes inflammation in your joints. It generally affects people who have psoriasis. A skin disease related to your immune system, psoriasis causes red patches of skin topped with silvery scales. Most people are diagnosed with psoriatic arthritis after developing psoriasis. However, the appearance of skin lesions is not always a prerequisite for joint problems. Often, doctors misdiagnose Psoriatic arthritis as gout, osteoarthritis, or Rheumatoid arthritis. A chronic disease, psoriatic arthritis causes the inflammation of the skin and joints as well as stiffness and swelling in people with psoriasis. Men and women are equally affected by psoriatic arthritis. Before developing arthritis symptoms, most people with psoriatic arthritis develop symptoms of psoriasis. However, symptoms of arthritis are noticed before the appearance of psoriasis in about 15 percent of cases. CardioClear7.com 78

79 Certain groups of joints are what psoriatic arthritis tends to affect. The following are the different types of psoriatic arthritis: Distal arthritis: The end joints of the fingers and toes are what this type of psoriatic arthritis affects. Asymmetric oligoarthritis: Fewer than five small or large joints in the body are what this type of psoriatic arthritis affects. However, it does not necessarily occur on both sides of the body. Symmetric polyarthritis: Five or more joints on both sides of the body are what this type of Psoriatic arthritis affects. The symptoms of symmetric polyarthritis are similar to those of Rheumatoid arthritis. Arthritis mutilans: The joints are destroyed and deformed by this type of psoriatic arthritis. A shortening of the affected fingers or toes often accompany arthritis mutilans. Spondyloarthritis: The joints of the spine are what this type of psoriatic arthritis affects. The most common type of psoriatic arthritis is polyarthritis. A close second is oligoarthritis. However, less than twenty percent of patients get distal arthritis, arthritis mutilans, or spondyloarthritis. The main symptoms of psoriatic arthritis include joint pain, swelling, and stiffness. These symptoms can affect any part of your body, including your fingertips and spine. The symptoms of psoriatic arthritis range from relatively mild to severe. So what are the signs and symptoms of psoriatic arthritis? Let s take a look. CardioClear7.com 79

80 Signs and Symptoms Early signs of Psoriatic Arthritis Psoriatic arthritis can either develop quickly and be severe, or can develop slowly with mild symptoms. Extensive joint damage that occurs in later of the disease can be prevented by early recognition, diagnosis, and treatment of psoriatic arthritis. Psoriatic arthritis may seem like cartilage tear, and can develop in a joint after an injury. The following are some early signs of psoriatic arthritis: Redness and pain of the eye A reduced range of motion Fatigue Morning stiffness and tiredness Pain, throbbing, swelling, and tenderness in one or more joints Nail changes Tenderness, pain, and swelling over tendons Psoriatic arthritis usually affects the distal joints in fingers or toes. Symptoms of psoriatic arthritis Apart from the distal joints in fingers or toes, you may experience symptoms of psoriatic arthritis in your knees, ankle, or lower back. Psoriasis occurs before the joint disease in 85 percent of patients. It is important to tell your doctor about any aches and pains if you ve been diagnosed with psoriasis. Both psoriatic arthritis and psoriasis are chronic diseases that get worse over time. However, you may have periods when your symptoms improve as well, as periods when symptoms become worse. Joints on just one or both sides of your body can be affected by psoriatic arthritis. Just like Rheumatoid arthritis, psoriatic arthritis causes joints to become warm to touch, swollen and painful. However, there are some symptoms related solely to psoriatic arthritis. The following are those symptoms: Swollen fingers and toes: it can cause painful swelling of your fingers and toes. Before having significant joint symptoms, you may develop swelling and deformities in your hands and feet. CardioClear7.com 80

81 Foot Pain: People with psoriatic arthritis may feel pain at the points where ligaments and tendons attach to their bones. This is especially true for the sole of the foot or the back of the heel. Lower back pain: As a result of psoriatic arthritis, some people may develop a condition called spondylitis. This cauases inflammation of the joints between your spine s vertebrae and in the joints between your spine and pelvis This leads to lower back pain. Any of the 78 joints in the body can be affected by psoriatic arthritis. However, some joints are more prone to this disease than others. Approximately one in four people with psoriatic arthritis will experience pain and stiffness in their back or neck. Unlike other forms of arthritis, psoriatic arthritis doesn t usually affect major organs, such as the lungs or liver. However, you may develop a painful red eye. A condition called uveitis causes this. If untreated, the painful red eye may lead to permanent eyesight damage. Finally, people with psoriatic arthritis have a slightly greater risk of developing heart disease than people without the condition. Therefore, you should address anything that could aggravate this risk, such as: Obesity Excessive alcohol intake Blood pressure problems Smoking Risk Factors Researchers are yet to identify the exact cause of psoriatic arthritis. However, they believe that the disease develops due to a combination of primary and secondary risk factors. Risk factors are the things that increase your risk for psoriatic arthritis. There are two types of risk factors primary and secondary. The primary risk factors are factors that you cannot prevent or change, such asyour age, genetics, or immunologic factors. On the other hand, secondary risk factors are those risk factors that you can reduce by taking medicine or making lifestyle changes. Some examples of secondary risk factors are obesity, environmental factors, and having psoriasis. There are several factors that increase your risk of psoriatic arthritis. The following are some of them: CardioClear7.com 81

82 Primary Genetics: Approximately forty percent of people with psoriatic arthritis have a parent or sibling with the disease. Therefore, a person whose close relative is a psoriatic arthritis patient is about fifty times more likely to develop the disease than a person who isn t related to anyone with PA. A person is also highly likely to have, or develop PA, if his or her identical twin has the condition. According to genetic researchers, certain chromosomes increase the risk of developing PA while some genetic factors contribute towards its severity. Age: Anyone can develop psoriatic arthritis. However, the people most affected by it are adults between the ages of 30 and 50. Immunologic factors: Researchers have noted a variety of immune system abnormalities in people with psoriatic arthritis. This is a birth condition and cannot be prevented. Therefore, it s a primary risk factor. Secondary Having Psoriasis: The single greatest risk factor for developing psoriatic arthritis is having psoriasis. People who are most likely to develop psoriatic arthritis include individuals who have psoriasis lesions on their nails. Obesity: About forty percent of people with psoriatic arthritis are obese. This clearly shows that obesity is a major risk factor for psoriatic arthritis. Therefore, you can reduce your risk of developing psoriatic arthritis by maintaining a healthy weight. CardioClear7.com 82

83 Environmental factors: Another risk factor for psoriatic arthritis is exposure to certain infections. The development of psoriatic arthritis is what exposure to certain infections may lead to. According to some experts, there is a link between the development of psoriatic arthritis and streptococcal infection. However, this link is yet to be proven. People infected with the human immunodeficiency virus (HIV) are more likely to develop psoriatic arthritis than the general population. Having an injury: Although it isn t proven yet, a joint injury may cause psoriatic arthritis in some people. After an injury, an inflammatory reaction is thought to set off the psoriatic arthritis. Therefore, you should take extra care to protect your joints. Injury to the skin: Most people who have psoriasis are likely to develop psoriatic arthritis. According to studies, injury to the same causes plaque psoriasis. For example, psoriasis may be triggered by a skin inflammation, skin infection, or even excessive scratching. Emotional stress: An increase in emotional stress has led to the development of psoriatic arthritis in many people. Therefore, emotional stress is a risk factor for PA. Alcohol: Many people consider alcohol a risk for psoriasis. Young to middle-aged men are most prone to this risk. CardioClear7.com 83

84 Treatment Methods: Diagnosis: Before you get treatment for psoriatic arthritis, it is important for you to perform a diagnosis of the condition. You should make an appointment to see your doctor if you experience joint pain, swelling and/or stiffness that won t go away. Your doctor will be able to determine whether you have psoriatic arthritis or not. In order to diagnose psoriatic arthritis, your doctor will: Obtain your medical history Perform a physical examination Check inflammation by taking x-rays of the joints Apart from the aforementioned things, your doctor may perform blood tests or joint fluid tests to rule out other diseases, such as gout or Rheumatoid arthritis. In order to detect joint and soft-tissue inflammation that is not visible on x-rays, a magnetic resonance imaging test (MRI) may be used in some cases. A loss in bone mineral density may cause psoriatic arthritis. Therefore, tests are also done to determine if you have an increased risk of bone fractures, or are at risk for osteoporosis. Often, psoriatic arthritis is confused with other forms of arthritis, such as osteoarthritis and Rheumatoid arthritis. However, psoriatic arthritis can be differentiated from other forms of arthritis through conditions specific to it, such as nail problems, skin lesions, and specific patterns of inflammation. CardioClear7.com 84

85 Treating psoriatic arthritis Psoriatic arthritis can affect you inside and out. Therefore, treating it is important. The first rule of treating psoriatic arthritis is controlling the inflammation that causes your joints to ache and swell. You can relieve joint pain and swelling, as well as other symptoms of psoriatic arthritis, by getting treatment for it. Your doctor will recommend treatment based on the severity of the condition and your reaction to it. The following are the treatment methods for psoriatic arthritis. Maintaining a healthy weight: As pointed out earlier, approximately forty percent of all people with psoriatic arthritis are obese. This clearly indicates the importance of maintaining a healthy weight to avoid psoriatic arthritis.researchers have proven that by losing weight psoriatic arthritis patients can improve their response to medical treatments. Exercise and Physical therapy: Exercising is a great treatment method for psoriatic arthritis. Exercise can help you to relieve the pain and stress associated with psoriatic arthritis. You can also relieve the symptoms of psoriatic arthritis with the help physical and ice and cold therapy. The exercises and physical therapy methods involved in the treatment of psoriatic arthritis are pretty much the same as that of osteoarthritis and Rheumatoid arthritis. Nonsteroidal anti-inflammatory drugs (NSAIDs): You can control inflammation and relieve the pain of psoriatic arthritis with the help of nonsteroidal ant-inflammatory drugs (NSAIDs). As it stops your body from making the chemicals that cause inflammation, your doctor may recommend you a nonsteroidal antiinflammatory drug if your arthritis is mild. In order to ensure an anti-inflammatory effect, NSAIDs must be taken in sufficient doses and continuously. Before NSAIDs can become fully effective as an anti-inflammatory drug, they need to be taken for several weeks. Your doctor may recommend increasing the dose gradually, or switching to another NSAID if the initial NSAID does doesn t improve symptoms. You can get NSAIDs by prescription, or over the counter. The most common NSAIDs include naproxen, ibuprofen, and aspirin. There are many side effects of NSAIDs, including bleeding, ulcers, stomach pain, strokes, and heart attacks. The side effects are more likely to occur if you take NSAIDs for an extended period of time. If you have stomach problems, your doctor may suggest celecoxib (Celebrex). Celecoxib is a selective NSAID. Selective NSAIDs i.e. COX- 2 inhibitors are as effective as non-selective NSAIDS and are less likely to cause gastrointestinal injury and side effects. CardioClear7.com 85

86 Glucocorticoid injections: Also called steroids, glucocorticoids can relive pain and suppress inflammation when injected into joints affected by psoriatic arthritis. Because they may cause severe skin psoriasis, psoriatic patients aren t recommended oral glucocorticoids. There are only a few side effects, including a brief flare of pain after an injection. Disease modifying anti-rheumatic drug (DMARD) Your doctor may prescribe a disease-modifying anti rheumatic drug (DMARD) if your disease doesn t respond well to NSAIDs, or is severe. DMARDs can help slow or stop swelling, pain and joint and tissue damage. Although they may take longer to work, DMARDS are stronger than NSAIDs. The most commonly used DMARDs for psoriatic arthritis include: Leflunomide Methotrexate Sulfasalazine Cyclosporine Leflunomide: Sold under the brand name Arava, leflunomide improves the symptoms of both skin and joint disease. Leflunomide is usually prescribed for Rheumatoid arthritis. However, recent medical studies state that leflunomide, which comes in a pill, is beneficial to some people with psoriatic arthritis. Methotrexate: An immunosuppressive drug, methotrexate is approved by FDA as a treatment method for psoriasis. It is widely and successfully used for treating psoriatic arthritis. Methotrexate effectively relives the symptoms of psoriatic arthritis and helps prevent joint destruction. The production of skin cells is what methotrexate reduces. It may also suppress the immune system. People with swollen joints caused by psoriatic arthritis are often recommended methotrexate. Usually taken as a pill or by injection once per week, methotrexate is well tolerated in low doses. However, the long-term use of this drug can cause several side effects, such as liver damage. When using methotrexate for psoriatic arthritis, it is important for you to follow your doctor s instructions carefully. CardioClear7.com 86

87 Sulfasalazine: A DMARD, sulfasalazine may be effective for skin lesions and joint pain caused by psoriatic arthritis. Of all psoriatic patients, about one-third respond rapidly to sulfasalazine. However, not all psoriatic patients benefit from this treatment, because many patients cannot tolerate side effects such as gastrointestinal effects. You also shouldn t use sulfasalazine if you re allergic to sulfa drugs. Given in doses of four tables twice a day, sulfasalazine may cause dizziness, vomiting, headaches, rash, nausea or abdominal pain in some psoriatic patients. Cyclosporine: A drug that suppresses the immune system, cyclosporine is used to treat severe psoriasis and psoriatic arthritis. Before the availability of TNF inhibitors, cyclosporine was in high demand. However, it still may be helpful for some people with psoriatic arthritis, although you may not see a response until three to four months after you have started the course. A more effective way of using cyclosporine than taking the treatment alone is adding methotrexate to it. High blood pressure and impaired kidney function are side effects of cyclosporine. Biological Response modifiers: Given by injection or intravenous (IV) infusion, biological response modifiers or biologics, are protein-based drugs used for treating psoriatic arthritis. Biologics treat psoriatic arthritis by either blocking proteins in the immune system, or blocking the action of a specific type of immune cell called T-cell. The proteins in the immune system include tumor necrosis factoralpha (TNF-alpha), interleukin 17-A, or interleukins 12 and 23. These cells and proteins play a major role in the development of psoriasis and psoriatic arthritis. Unlike traditional systemic drugs that impact the entire immune system, biologics target specific parts of the immune system. Tumor necrosis factor inhibitors: Part of biologic DMARDs or biologic response modifiers, tumor necrosis factor (TNF)-alpha inhibitors interfere with the immune response and inflammation. Drugs in this class are proteins that interfere with the actions of TNF. Some biologic agents or TNF inhibitors include etanercept, adalimumab, golimumab, and infliximab. Often, doctors recommend biologic agents when a traditional DMARD such as methotrexate has been ineffective. TNF inhibitors work rapidly and they may be used alone or in combination with other DMARDs, NSAIDs, and/or glucocorticoid injections. People with psoriatic arthritis who cannot tolerate DMARDs, or haven t fully responded to DMARDs, are given biologics. Depending on the medication, TNF inhibitors must be either given intravenously or injected under the skin. CardioClear7.com 87

88 Ustekiumab: By selectively targeting the proteins or cytokines, interleukins 12 and 23, ustekinumab treats psoriatic arthritis. Psoriatic inflammation is what interleukins 12 and 23 are associated with. Secukinumab: Also known as Cosentyx, secukinumab binds to and inhibits a protein or cytokine called interleukin 17-A. It is involved in inflammatory and immune responses. People with psoriatic arthritis have elevated levels of interleukin 17-A. Secukinumab interrupts the inflammatory cycle of psoriasis by inhibiting cytokines that trigger inflammation. By doing so, it improves the symptoms of psoriatic arthritis in many people. Apremilast: Sold under the brand name otezla, apremilast is used for treatment of long-term inflammation diseases such as psoriatic arthritis. Apremilast works by blocking a specific enzyme called PDE-4. By blocking P,DE-4, apremilast slows other reactions that lead to inflammation. This improves flexibility in joints. There are some side effects of apremilast, including sudden weight loss, depression, headache, nausea, vomiting, and diarrhea. Surgery: Surgery is something most people with psoriatic arthritis will never need. However, if nothing else has worked (which rarely happens) then surgery can relieve pain, make an affected joint work and allow you to perform your routine activities. The diseased lining of a joint is removed by synovectomy. You may need arthroplasty if the damage is really bad. You may use joint fusion to make your joint stronger, more stable, and less painful in case it cannot be replaced. CardioClear7.com 88

89 Gout Apart from osteoarthritis, Rheumatoid arthritis, and psoriatic arthritis, another common form of arthritis is gout. One of the most painful forms of arthritis, gout causes pain and swelling in one or more joints. When too much uric acid builds up in the body, gout occurs. Uric acid buildup can lead to: Deposits of uric acid that look like lumps under the skin Deposits of sharp uric acid crystal in joints, usually in the big toe Kidney stones in the kidneys caused by uric acid crystals You can reduce the risk of having gout by improving your lifestyle. This includes losing weight, eating a healthy diet, and avoiding excessive intake of alcohol or sugar-sweetened soft drinks. There are several symptoms of gout, including attack in the big toe which causes it to become sore, red, warm, and swollen. Other symptoms include: Stiffness in joints Heat Redness Swelling Pain Apart from the big, gout can affect the elbows, wrists, fingers, knees, heels, ankles, and insteps. There are many causes of gout, including another illness, alcohol or drugs, or stressful events. So what are the things that cause gout? Let s take a look. CardioClear7.com 89

90 Risk factors: The buildup of too much uric acid in the body is what primarily causes gout. The breakdown of substances called purines is where uric acid comes from. You ll find purines in all of your body s tissues as well in foods, such as anchovies, dried beans and peas and liver. Under normal circumstances, uric acid would dissolve in the blood, passing through the kidneys and out of the body in urine. However, uric acid may build up in the blood if: The body increases the amount of uric acid it makes The kidneys are unable to get rid of enough uric acid A person eats foods high in purines Hyperruricemia is the name given to the condition in which high levels of uric acid are present the blood. The majority of people with hyperuricemia don t develop gout. However, you may develop gout if excess uric acid crystals form in your body. You re likely to develop gout if you: Are a man Are obese Are exposed to environmental factors such as lead Have family members with disease Eat foods high in purines Drink too much alcohol Use medicines such as aspirin, levodopa or cyclosporine Have an enzyme defect that makes it hard for your body to break down purines Have had an organ transplant Diagnosis and treatment: In order to diagnose gout, your doctor will ask about your symptoms, medical history, and family history of the condition. Your doctor may draw a sample of fluid from an inflamed joint to look for crystals associated with gout in order to reach a diagnosis. They may also perform the diagnosis through x-rays or MRI. In order to treat gout, doctors prescribe the use of: Nonsteroidal anti-inflammatory drugs (NSAIDs) Corticosteroids, such as prednisone Colchicine Apart from the aforementioned medications, your doctor may prescribe medicines that lower the level of uric acid in the blood. CardioClear7.com 90

91 CHAPTER 04-LATEST DEVELOPMENTS IN ARTHRITIS TREATMENT Although no cures for arthritis have been discovered, there is a lot of research being done. Arthritis isn t the name of one disease, rather it s a broad term that encompasses over hundred varying disorders. Chronic pain, limited mobility, and decreased range of motion characterize all of these disorders and the joints are involved in all of them. Arthritis has no known cure. However, advances in science are helping us to identify ways to improve the diagnosis and treatment of arthritis. Over the past five decades, research has brought about major advances in finding causes, as well as better ways to treat arthritis. New developments have helped reduce pain, restore movement, correct deformities, and reduce deaths. There was a time when the only way to get around was crutches or cranes in case you destroyed a hip or knee joint. However, in the past three decades researchers have created artificial joints for people with arthritis. Today, people with arthritis can move freely by replacing worn-out joints with artificial ones. New treatments are being developed every day, and by the time you read this there might be an even better way of treating this condition. The following are some of the latest developments in arthritis treatment. CardioClear7.com 91

92 Stem Cell therapies: Currently, there are no FDA approved stem cell therapies for treating arthritis. You may come across companies with web sites that offer stem cell treatments. However, most of these claims aren t supported by scientific evidence. Therefore, you must talk you doctor before going for any stem cell treatment. To date, no one has been able to determine the long-term effectiveness of current treatments. Therefore, the door to explore other potential therapies like stem cell therapies is still open. There is some way to go before stem cell therapies are used to cure arthritis. However, there s good reason to think that they could be beneficial. Stem cells have nti-inflammatory and regenerative capacities For example, some stem cells have proven to stimulate blood vessel formation, inhibit inflammation, dampen the immune system response, repair tissue, and evem stem cells can make cartilage. Today, a number of research teams around the globe are working to develop stem cell therapies for arthritis. The researchers are trying to find out how stem cells work, which are the most anti-inflammatory and best suited to making chondrocytes. Chondrocytes are the cells found in healthy cartilage. They are also trying to determine the best ways to safely administer stem cells and scale up cell numbers for larger trails. Stem cell therapy has demonstrated a profound healing activity in animals with various forms of arthritis For example, a company that provides treatment services to animal owners and veterinarians routinely utilizes stem cells in horses with various joint deformities to accelerate healing. Apart from healing damaged tissues, stem cells can modulate the immune system. According to many researchers, stem cell treatments have the potential to alleviate suffering and change the face of human disease. Stem cells offer significant potential for generation of tissues that can potentially replace diseased and damaged areas in the body, and with minimal risk of side effects. The complications of Rheumatoid arthritis include tissue damage and inflammation. Therefore, adult stem cells may be able to cure Rheumatoid arthritis by targeting inflamed areas of the body and producing antiinflammatory agents. CardioClear7.com 92

93 Tiny electrical implant: Latest developments in arthritis treatments provide Rheumatoid arthritis patients with a great new way to end the crippling pain caused by the disease. The breakthrough treatment is a tiny electrical implant. A rheumatologist at the Academic Medical Centre in Amsterdam, Professor Paul-Peter Tak, tested 20 rheumatoid arthritis patients to check the effectiveness of a tiny electrical implant in treating RA. In one of the patients, massive improvements were seen after the breakthrough medical trials of the electronic device. The condition of test patient Monique Robroek s was so bad she couldn t even walk across the room. Even the strongest medications for Rheumatoid arthritis couldn t ease the excruciating discomfort that she endured each day. However, the new electronic implant somehow cured her pain. Today, Monique has her normal life back she s biking, driving, and walking the dog. Professor Paul-Peter Tak and other researchers at Academic Medical Centre in Amsterdam hope to cure millions of people of rheumatoid arthritis patients around the globe with this new discovery. They believe that within a decade this incredible discovery could pave the way for RA patients to be effectively cured. In order to hack a patient s nervous system, doctors embed the electronic implant into the neck. The size of a cent piece, the tiny device sends electrical impulses into a major nerve, which sends brain signals to the body s major organs. Researchers were able to reduce the activity of the spleen, a key immune system organ, by firing impulses for just three minutes a day. Patients spleens were producing fewer chemicals that cause the abnormal inflammation in the joints of people with Rheumatoid arthritis within days of the tests. Microvessicles: British scientists are developing a bubble-based treatment that could cut the need for hip replacement and relieve the pain of arthritis. This treatment involves the use of microvessicles the tiny particles naturally made by the body to protect and repair damaged joints. By doing so, it treats arthritis better as it reduces pain and improves movement significantly. This may cut the need for complicated, painful, and expensive hip and knee replacements. According to researchers at Queen Mary University of London, microvessicles is rich in protein Annexin A1. It protects the cartilage that lines and cushions the joints from the havoc of arthritis. In an experiment involving mice affected by arthritis, a microvessicles injection was injected into the affected joints of the mice. The result of this was reduced cartilage damage. Arthritis was so severe in mice, that it made unusually low levels of microvessicles. It was further observed that microvessicles may even repair damage. This is surely a great discovery because even though existing treatments can stop further cartilage damage, they cannot reverse the damage already done. CardioClear7.com 93

94 'Self-care Strategies for Coping with Arthritis' You ll probably have several healthcare professionals involved in your care if you ve been diagnosed with arthritis. However, self-management of arthritis is the most important part of your healthcare. Therefore, you must know the self-care strategies for coping with arthritis. Following are the some ways you can cope with arthritis: Organize yourself: In order to determine what works best for you and take charge of your treatment plan, keep track of symptoms, pain levels, medications and possible side effects. Manage pain and fatigue: Allowing pain and fatigue to become overwhelming is something you need to avoid. In order to do so, combine your medication regimen with non-medical pain relieving techniques. The key to living well with arthritis is learning and using natural therapies to manage fatigue. Eat a healthy balanced diet: When combined with exercise, a healthy diet can help you achieve and maintain a healthy weight. By now, we already know the importance of maintaining a healthy weight. Look to add foods that are rich in antioxidants and have anti-inflammatory properties into your diet. Rest: A great way to relieve the symptoms of arthritis and cope with the disease is rest. Rest is especially beneficial when joints feel painful, swollen, or stiff. Exercise: Exercise is probably the last thing you d want to do when you re in pain. However, exercise is beneficial for managing arthritis, and your overall health. Exercise can help you to lose weight, boost your mood, improve sleep quality, preserve and increase joint range of motion, and strengthen muscles that support your painful joints. CardioClear7.com 94

95 Three exercise goals: Following are exercise goals that most structured exercise programs target. Therefore, you should also have the same exercise goals. Increase range of motion: The first exercise goal that you should have is increasing your range of motion. There are certain exercises that can increase your joints flexibility and mobility. Move a joint as far as it can go, then try to push a little farther in order to increase your range of motion. Strengthen your muscles: Strengthening the muscles surrounding the aching joints is an excellent way to provide them with more support. In order to build muscles, strengthening exercises use resistance. You can use your own body weight as resistance. Build endurance: The final exercise goal that you should have is building endurance. You can build your heart and lung function through activities such as walking, swimming and bicycling. This in turn can help you to increase endurance and overall health. CardioClear7.com 95

96 Choosing Shoes: What not to wear It is important for arthritis patients to choose comfortable shoes because most types of arthritis affect the feet. You will only make your arthritis pain worse if you try to squeeze your feet into tight-fitting or uncomfortable shoes. On the other hand, you will be able to reduce foot pain and walk around more easily if you wear the right shoes. The shoes you need to avoid include high heels and tight flats. Even though they may look good, soaring heels aren t good for your feet. You will squeeze you toes and thrust your foot into an uncomfortable position if you wear pointy high heels. Therefore, you should avoid them if you have arthritis. Apart from high heels, you should avoid tight flats. In case they re rigid and have a pointy toe, flats can be rough on your feet. You may even develop hammertoes if you wear flats. The ideal shoes for arthritis patients include low, comfortable heels, and stability shoes. It is important that the height of your shoes puts your foot in a comfortable, natural angle. Ensure that your shoes have rubber soles. Rubber soles prevent you from slipping, and act as shock absorbers. Finally, make sure that your shoes have a wide toe box. This would ensure that your feet have plenty of room to move around. Helpful gadgets: The Faculty University of Harvard recommends some useful gadgets for arthritis patients. You can click here to find out the different gadgets meant for different areas of the house. CardioClear7.com 96

97 CONCLUSION Arthritis is counted among one of the most common and widely prevalent diseases of the joints and bones. In fact, more than being a disease, it falls under the category of conditions that develop over a period of time. According to statistics provided by the official Center for Disease Control and Prevention of the government of United States, around 52 million adults, constituting a whopping 27% population, were diagnosed with one for or another of arthritis between 2010 and Although the symptoms and causes of each type of arthritis vary, there are few general symptoms that can be outlined regardless of the type. The presence of these may act as an alert to get yourself checked so that the exact category of arthritis can be determined. The symptoms can be studied under two spectrums; first are the inflammatory factors and second are the viral factors. The common types of arthritis include osteoarthritis, rheumatoid arthritis, and psoriatic arthritis. These are the arthritis types that we discussed in detail in the book. We also briefly discussed another form of arthritis: gout. CardioClear7.com 97