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Archive for the ‘Arthritis’ Category

Rheumatoid Arthritis: An Introduction

Sunday, February 5th, 2017

Rheumatoid arthritis (RA) is starting to cement itself as a debilitating disease that affects people of all ages.1 In fact, its now the third most common type of arthritis, in terms of incidence, behind osteoarthritis and gout.2

According to the Arthritis Foundation, as many as 1.5 million people in the United States are affected by rheumatoid arthritis, with 41 out of 100,000 people being diagnosed with the disease annually.

Women are three times more likely to have rheumatoid arthritis, commonly occurring between the ages of 30 and 60. Men are also prone to experiencing the disease, but at a later age in their lives.3

Rheumatoid arthritis accounts for 22 percent of deaths from arthritis and other rheumatic conditions in the U.S., as noted in a report entitled Science has ARTHRITIS on the Run , written by Dr. Walter G. Barr and published by the Arthritis Foundation.4

Globally, rheumatoid arthritis is said to affect 1 about percent of the population. While this seems like a small number, its not an amount that should be taken lightly, since in other countries, RA is already gaining ground.

In a report published in 2009, The Australian Institute of Health and Welfare Agency stated that around 400,000 Australians were diagnosed with rheumatoid arthritis.5 That number rose slightly to 445,000 following self-reported estimates in 2011 to 2012.6

Meanwhile, information by Arthritis Research U.K. published in 2014 showed that around 400,000 adults in the U.K. already have rheumatoid arthritis, with 20,000 new patients being diagnosed every year.7

In 2016, Glenn Frey, co-founder and front man of the band The Eagles passed away at age 67 due to complications from rheumatoid arthritis, acute ulcerative colitis, and pneumonia. But what ultimately played a part in his untimely demise was the rheumatoid arthritis medication he was using.

The thing about rheumatoid arthritis is that one can heal from it if the disease is treated immediately, but in Freys case, the medication that was supposed to help him heal didnt work, but instead set him up for devastating effects.

This is why if you use or know someone who uses rheumatoid arthritis medications, it pays to be vigilant as common treatment protocols used for RA patients nowadays can pose health risks and lead to serious consequences.

Not all of the drugs in the market used to treat different diseases are as efficient and effective as they claim to be.

The good news is that an autoimmune disease like rheumatoid arthritis, and the pain that arises from it, can be treated naturally. Read this guide and get all the information you need to know about rheumatoid arthritis.

What Is Rheumatoid Arthritis?

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Rheumatoid Arthritis – National Library of Medicine – PubMed …

Monday, December 19th, 2016

Evidence reviews Antimalarials for treating rheumatoid arthritis

Antimalarials have been used for the treatment of rheumatoid arthritis (RA) for several decades. This review found four trials, with 300 patients receiving hydrochloroquine and 292 receiving placebo. A benefit was observed in the patients taking hydroxychloroquine compared to placebo. There was no difference between the two groups in terms of those who had to withdraw from trials due to side effects.

The purpose was to examine the effectiveness of patient education interventions on health status (pain, functional disability, psychological wellbeing and disease activity) in patients with rheumatoid arthritis (RA). Patient education had a small beneficial effect at first followup for disability, joint counts, patient global assessment, psychological status, and depression. At final followup (314 months) no evidence of significant benefits was found.

In rheumatoid arthritis (RA), the joints are swollen, stiff and painful. Nonsteroidal antiinflammatory drugs (NSAIDs) such as ibuprofen are often recommended to ease the pain and swelling in the joints. Paracetamol (also known as acetaminophen) is another type of medication to relieve pain in RA.

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Antimalarials have been used for the treatment of rheumatoid arthritis (RA) for several decades. This review found four trials, with 300 patients receiving hydrochloroquine and 292 receiving placebo. A benefit was observed in the patients taking hydroxychloroquine compared to placebo. There was no difference between the two groups in terms of those who had to withdraw from trials due to side effects.

The purpose was to examine the effectiveness of patient education interventions on health status (pain, functional disability, psychological wellbeing and disease activity) in patients with rheumatoid arthritis (RA). Patient education had a small beneficial effect at first followup for disability, joint counts, patient global assessment, psychological status, and depression. At final followup (314 months) no evidence of significant benefits was found.

In rheumatoid arthritis (RA), the joints are swollen, stiff and painful. Nonsteroidal antiinflammatory drugs (NSAIDs) such as ibuprofen are often recommended to ease the pain and swelling in the joints. Paracetamol (also known as acetaminophen) is another type of medication to relieve pain in RA.

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Psoriatic arthritis – Wikipedia

Wednesday, December 14th, 2016

Psoriatic arthritis (also arthritis psoriatica, arthropathic psoriasis or psoriatic arthropathy) is a type of inflammatory arthritis[1][2] that will develop in between 6 and 42% of people who have the chronic skin condition psoriasis.[3] Psoriatic arthritis is classified as a seronegative spondyloarthropathy and therefore occurs more commonly in patients with tissue type HLA-B27.

Pain, swelling, or stiffness in one or more joints is commonly present in psoriatic arthritis.[4] Psoriatic arthritis is inflammatory, and affected joints are generally red or warm to the touch.[4] Asymmetrical oligoarthritis, defined as inflammation affecting one to four joints during the first six months of disease, is present in 70% of cases. However, in 15% of cases the arthritis is symmetrical. The joints of the hand that are involved in psoriasis are the proximal interphalangeal (PIP), the distal interphalangeal (DIP), the metacarpophalangeal (MCP), and the wrist. Involvement of the distal interphalangeal joints (DIP) is a characteristic feature and is present in 15% of cases.

In addition to affecting the joints of the hands and wrists, psoriatic arthritis may affect the fingers, nails, and skin. Sausage-like swelling in the fingers or toes, known as dactylitis, may occur.[4] Psoriasis can also cause changes to the nails, such as pitting or separation from the nail bed,[4]onycholysis, hyperkeratosis under the nails, and horizontal ridging.[5] Psoriasis classically presents with scaly skin lesions, which are most commonly seen over extensor surfaces such as the scalp, natal cleft and umbilicus.

In psoriatic arthritis, pain can occur in the area of the sacrum (the lower back, above the tailbone),[4] as a result of sacroiliitis or spondylitis, which is present in 40% of cases. Pain can occur in and around the feet and ankles, especially enthesitis in the Achilles tendon (inflammation of the Achilles tendon where it inserts into the bone) or plantar fasciitis in the sole of the foot.[4]

Along with the above noted pain and inflammation, there is extreme exhaustion that does not go away with adequate rest. The exhaustion may last for days or weeks without abatement. Psoriatic arthritis may remain mild, or may progress to more destructive joint disease. Periods of active disease, or flares, will typically alternate with periods of remission. In severe forms, psoriatic arthritis may progress to arthritis mutilans[6] which on X-ray gives a "pencil-in-cup" appearance.

Because prolonged inflammation can lead to joint damage, early diagnosis and treatment to slow or prevent joint damage is recommended.[7]

The exact causes are not yet known, but a number of genetic associations have been identified in a genome-wide association study of psoriasis and psoriatic arthritis including HLA-B27.[8][9]

There is no definitive test to diagnose psoriatic arthritis. Symptoms of psoriatic arthritis may closely resemble other diseases, including rheumatoid arthritis. A rheumatologist (a doctor specializing in diseases affecting the joints) may use physical examinations, health history, blood tests and x-rays to accurately diagnose psoriatic arthritis.

Factors that contribute to a diagnosis of psoriatic arthritis include:

Other symptoms that are more typical of psoriatic arthritis than other forms of arthritis include inflammation in the Achilles tendon (at the back of the heel) or the Plantar fascia (bottom of the feet), and dactylitis (sausage-like swelling of the fingers or toes).[10]

Magnetic resonance image of the index finger in psoriatic arthritis (mutilans form). Shown is a T2 weighted fat suppressed sagittal image. Focal increased signal (probable erosion) is seen at the base of the middle phalanx (long thin arrow). There is synovitis at the proximal interphalangeal joint (long thick arrow) plus increased signal in the overlying soft tissues indicating oedema (short thick arrow). There is also diffuse bone oedema (short thin arrows) involving the head of the proximal phalanx and extending distally down the shaft.

Magnetic resonance images of the fingers in psoriatic arthritis. Shown are T1 weighted axial (a) pre-contrast and (b) post-contrast images exhibiting dactylitis due to flexor tenosynovitis at the second finger with enhancement and thickening of the tendon sheath (large arrow). Synovitis is seen in the fourth proximal interphalangeal joint (small arrow).

(a) T1-weighted and (b) short tau inversion recovery (STIR) magnetic resonance images of lumbar and lower thoracic spine in psoriatic arthritis. Signs of active inflammation are seen at several levels (arrows). In particular, anterior spondylitis is seen at level L1/L2 and an inflammatory Andersson lesion at the upper vertebral endplate of L3.

Magnetic resonance images of sacroiliac joints. Shown are T1-weighted semi-coronal magnetic resonance images through the sacroiliac joints (a) before and (b) after intravenous contrast injection. Enhancement is seen at the right sacroiliac joint (arrow, left side of image), indicating active sacroiliitis.

There are five main types of psoriatic arthritis:

The underlying process in psoriatic arthritis is inflammation; therefore, treatments are directed at reducing and controlling inflammation. Milder cases of psoriatic arthritis may be treated with NSAIDs alone; however, there is a trend toward earlier use of disease-modifying antirheumatic drugs or biological response modifiers to prevent irreversible joint destruction.

Typically the medications first prescribed for psoriatic arthritis are NSAIDs such as ibuprofen and naproxen, followed by more potent NSAIDs like diclofenac, indomethacin, and etodolac. NSAIDs can irritate the stomach and intestine, and long-term use can lead to gastrointestinal bleeding.[11][12] Coxibs (COX-2 inhibitors) e.g. Celecoxib or Etoricoxib, are associated with a statistically significant 50 to 66% relative risk reduction in gastrointestinal ulcers and bleeding complications compared to traditional NSAIDs, but carry an increased rate of cardiovascular events such as myocardial infarction (MI) or heart attack, and stroke.[13][14] Both COX-2 inhibitors and other non-selective NSAIDS have potential adverse effects that include damage to the kidneys.

These are used in persistent symptomatic cases without exacerbation. Rather than just reducing pain and inflammation, this class of drugs helps limit the amount of joint damage that occurs in psoriatic arthritis. Most DMARDs act slowly and may take weeks or even months to take full effect. Drugs such as methotrexate or leflunomide are commonly prescribed; other DMARDS used to treat psoriatic arthritis include cyclosporin, azathioprine, and sulfasalazine. These immunosuppressant drugs can also reduce psoriasis skin symptoms but can lead to liver and kidney problems and an increased risk of serious infection.

The most recent class of treatment is called biological response modifiers or biologics has been developed using recombinant DNA technology. Biologic medications are derived from living cells cultured in a laboratory. Unlike traditional DMARDS that affect the entire immune system, biologics target specific parts of the immune system. They are given by injection or intravenous (IV) infusion.

Biologics prescribed for psoriatic arthritis are TNF- inhibitors, including infliximab, etanercept, golimumab, certolizumab pegol and adalimumab, as well as the IL-12/IL-23 inhibitor ustekinumab.

Biologics may increase the risk of minor and serious infections.[citation needed] More rarely, they may be associated with nervous system disorders, blood disorders or certain types of cancer.[citation needed]

A first-in-class treatment option for the management of psoriatic arthritis, apremilast is a small molecule phosphodiesterase-4 inhibitor approved for use by the FDA in 2014. By inhibiting PDE4, an enzyme which breaks down cyclic adenosine monophosphate, cAMP levels rise, resulting in the down-regulation of various pro-inflammatory factors inlcuding TNF- and the up-regulation of anti-inflammatory factor interleukin 10.

It is given in tablet form and taken by mouth. Side effects include headache, back pain, nausea, diarrhea, fatigue, nasopharyngitis and upper respiratory tract infections, as well as depression and weight loss.

Patented in 2014 and manufactured by Celgene, there is no current generic equivalent available on the market.

A review found tentative evidence of benefit of low level laser therapy and concluded that it could be considered for relief of pain and stiffness associated RA.[15]

Retinoid etretinate is effective for both arthritis and skin lesions. Photochemotherapy with methoxy psoralen and long wave ultraviolet light (PUVA) are used for severe skin lesions. Doctors may use joint injections with corticosteroids in cases where one joint is severely affected. In psoriatic arthritis patients with severe joint damage orthopedic surgery may be implemented to correct joint destruction, usually with use of a joint replacement. Surgery is effective for pain alleviation, correcting joint disfigurement, and reinforcing joint usefulness and strength.

Seventy percent of people who develop psoriatic arthritis first show signs of psoriasis on the skin, 15 percent develop skin psoriasis and arthritis at the same time, and 15 percent develop skin psoriasis following the onset of psoriatic arthritis.[16]

Psoriatic arthritis can develop in people who have any level severity of psoriatic skin disease, ranging from mild to very severe.[17]

Psoriatic arthritis tends to appear about 10 years after the first signs of psoriasis. For the majority of people this is between the ages of 30 and 55, but the disease can also affect children. The onset of psoriatic arthritis symptoms before symptoms of skin psoriasis is more common in children than adults.[18]

More than 80% of patients with psoriatic arthritis will have psoriatic nail lesions characterized by nail pitting, separation of the nail from the underlying nail bed, ridging and cracking, or more extremely, loss of the nail itself (onycholysis).[18]

Men and women are equally affected by this condition. Like psoriasis, psoriatic arthritis is more common among Caucasians than Africans or Asians.[19]

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Induced pluripotent stem cell – Wikipedia

Tuesday, December 13th, 2016

Induced pluripotent stem cells (also known as iPS cells or iPSCs) are a type of pluripotent stem cell that can be generated directly from adult cells. The iPSC technology was pioneered by Shinya Yamanakas lab in Kyoto, Japan, who showed in 2006 that the introduction of four specific genes encoding transcription factors could convert adult cells into pluripotent stem cells.[1] He was awarded the 2012 Nobel Prize along with Sir John Gurdon "for the discovery that mature cells can be reprogrammed to become pluripotent." [2]

Pluripotent stem cells hold great promise in the field of regenerative medicine. Because they can propagate indefinitely, as well as give rise to every other cell type in the body (such as neurons, heart, pancreatic, and liver cells), they represent a single source of cells that could be used to replace those lost to damage or disease.

The most well-known type of pluripotent stem cell is the embryonic stem cell. However, since the generation of embryonic stem cells involves destruction (or at least manipulation) [3] of the pre-implantation stage embryo, there has been much controversy surrounding their use. Further, because embryonic stem cells can only be derived from embryos, it has so far not been feasible to create patient-matched embryonic stem cell lines.

Since iPSCs can be derived directly from adult tissues, they not only bypass the need for embryos, but can be made in a patient-matched manner, which means that each individual could have their own pluripotent stem cell line. These unlimited supplies of autologous cells could be used to generate transplants without the risk of immune rejection. While the iPSC technology has not yet advanced to a stage where therapeutic transplants have been deemed safe, iPSCs are readily being used in personalized drug discovery efforts and understanding the patient-specific basis of disease.[4]

iPSCs are typically derived by introducing products of specific set of pluripotency-associated genes, or reprogramming factors, into a given cell type. The original set of reprogramming factors (also dubbed Yamanaka factors) are the transcription factors Oct4 (Pou5f1), Sox2, cMyc, and Klf4. While this combination is most conventional in producing iPSCs, each of the factors can be functionally replaced by related transcription factors, miRNAs, small molecules, or even non-related genes such as lineage specifiers.

iPSC derivation is typically a slow and inefficient process, taking 12 weeks for mouse cells and 34 weeks for human cells, with efficiencies around 0.01%0.1%. However, considerable advances have been made in improving the efficiency and the time it takes to obtain iPSCs. Upon introduction of reprogramming factors, cells begin to form colonies that resemble pluripotent stem cells, which can be isolated based on their morphology, conditions that select for their growth, or through expression of surface markers or reporter genes.

Induced pluripotent stem cells were first generated by Shinya Yamanaka's team at Kyoto University, Japan, in 2006.[1] They hypothesized that genes important to embryonic stem cell (ESC) function might be able to induce an embryonic state in adult cells. They chose twenty-four genes previously identified as important in ESCs and used retroviruses to deliver these genes to mouse fibroblasts. The fibroblasts were engineered so that any cells reactivating the ESC-specific gene, Fbx15, could be isolated using antibiotic selection.

Upon delivery of all twenty-four factors, ESC-like colonies emerged that reactivated the Fbx15 reporter and could propagate indefinitely. To identify the genes necessary for reprogramming, the researchers removed one factor at a time from the pool of twenty-four. By this process, they identified four factors, Oct4, Sox2, cMyc, and Klf4, which were each necessary and together sufficient to generate ESC-like colonies under selection for reactivation of Fbx15.

Similar to ESCs, these iPSCs had unlimited self-renewal and were pluripotent, contributing to lineages from all three germ layers in the context of embryoid bodies, teratomas, and fetal chimeras. However, the molecular makeup of these cells, including gene expression and epigenetic marks, was somewhere between that of a fibroblast and an ESC, and the cells failed to produce viable chimeras when injected into developing embryos.

In June 2007, three separate research groups, including that of Yamanaka's, a Harvard/University of California, Los Angeles collaboration, and a group at MIT, published studies that substantially improved on the reprogramming approach, giving rise to iPSCs that were indistinguishable from ESCs. Unlike the first generation of iPSCs, these second generation iPSCs produced viable chimeric mice and contributed to the mouse germline, thereby achieving the 'gold standard' for pluripotent stem cells.

These second-generation iPSCs were derived from mouse fibroblasts by retroviral-mediated expression of the same four transcription factors (Oct4, Sox2, cMyc, Klf4). However, instead of using Fbx15 to select for pluripotent cells, the researchers used Nanog, a gene that is functionally important in ESCs. By using this different strategy, the researchers created iPSCs that were functionally identical to ESCs.[5][6][7][8]

Reprogramming of human cells to iPSCs was reported in November 2007 by two independent research groups: Shinya Yamanaka of Kyoto University, Japan, who pioneered the original iPSC method, and James Thomson of University of Wisconsin-Madison who was the first to derive human embryonic stem cells. With the same principle used in mouse reprogramming, Yamanaka's group successfully transformed human fibroblasts into iPSCs with the same four pivotal genes, OCT4, SOX2, KLF4, and C-MYC, using a retroviral system,[9] while Thomson and colleagues used a different set of factors, OCT4, SOX2, NANOG, and LIN28, using a lentiviral system.[10]

Obtaining fibroblasts to produce iPSCs involves a skin biopsy, and there has been a push towards identifying cell types that are more easily accessible.[11][12] In 2008, iPSCs were derived from human keratinocytes, which could be obtained from a single hair pluck.[13][14] In 2010, iPSCs were derived from peripheral blood cells,[15][16] and in 2012, iPSCs were made from renal epithelial cells in the urine.[17]

Other considerations for starting cell type include mutational load (for example, skin cells may harbor more mutations due to UV exposure),[11][12] time it takes to expand the population of starting cells,[11] and the ability to differentiate into a given cell type.[18]

[citation needed]

The generation of iPS cells is crucially dependent on the transcription factors used for the induction.

Oct-3/4 and certain products of the Sox gene family (Sox1, Sox2, Sox3, and Sox15) have been identified as crucial transcriptional regulators involved in the induction process whose absence makes induction impossible. Additional genes, however, including certain members of the Klf family (Klf1, Klf2, Klf4, and Klf5), the Myc family (c-myc, L-myc, and N-myc), Nanog, and LIN28, have been identified to increase the induction efficiency.

Although the methods pioneered by Yamanaka and others have demonstrated that adult cells can be reprogrammed to iPS cells, there are still challenges associated with this technology:

The table at right summarizes the key strategies and techniques used to develop iPS cells over the past half-decade. Rows of similar colors represents studies that used similar strategies for reprogramming.

One of the main strategies for avoiding problems (1) and (2) has been to use small compounds that can mimic the effects of transcription factors. These molecule compounds can compensate for a reprogramming factor that does not effectively target the genome or fails at reprogramming for another reason; thus they raise reprogramming efficiency. They also avoid the problem of genomic integration, which in some cases contributes to tumor genesis. Key studies using such strategy were conducted in 2008. Melton et al. studied the effects of histone deacetylase (HDAC) inhibitor valproic acid. They found that it increased reprogramming efficiency 100-fold (compared to Yamanakas traditional transcription factor method).[32] The researchers proposed that this compound was mimicking the signaling that is usually caused by the transcription factor c-Myc. A similar type of compensation mechanism was proposed to mimic the effects of Sox2. In 2008, Ding et al. used the inhibition of histone methyl transferase (HMT) with BIX-01294 in combination with the activation of calcium channels in the plasma membrane in order to increase reprogramming efficiency.[33] Deng et al. of Beijing University reported on July 2013 that induced pluripotent stem cells can be created without any genetic modification. They used a cocktail of seven small-molecule compounds including DZNep to induce the mouse somatic cells into stem cells which they called CiPS cells with the efficiency at 0.2% comparable to those using standard iPSC production techniques. The CiPS cells were introduced into developing mouse embryos and were found to contribute to all major cells types, proving its pluripotency.[34][35]

Ding et al. demonstrated an alternative to transcription factor reprogramming through the use of drug-like chemicals. By studying the MET (mesenchymal-epithelial transition) process in which fibroblasts are pushed to a stem-cell like state, Dings group identified two chemicals ALK5 inhibitor SB431412 and MEK (mitogen-activated protein kinase) inhibitor PD0325901 which was found to increase the efficiency of the classical genetic method by 100 fold. Adding a third compound known to be involved in the cell survival pathway, Thiazovivin further increases the efficiency by 200 fold. Using the combination of these three compounds also decreased the reprogramming process of the human fibroblasts from four weeks to two weeks. [36][37]

In April 2009, it was demonstrated that generation of iPS cells is possible without any genetic alteration of the adult cell: a repeated treatment of the cells with certain proteins channeled into the cells via poly-arginine anchors was sufficient to induce pluripotency.[38] The acronym given for those iPSCs is piPSCs (protein-induced pluripotent stem cells).

Another key strategy for avoiding problems such as tumor genesis and low throughput has been to use alternate forms of vectors: adenovirus, plasmids, and naked DNA and/or protein compounds.

In 2008, Hochedlinger et al. used an adenovirus to transport the requisite four transcription factors into the DNA of skin and liver cells of mice, resulting in cells identical to ESCs. The adenovirus is unique from other vectors like viruses and retroviruses because it does not incorporate any of its own genes into the targeted host and avoids the potential for insertional mutagenesis.[39] In 2009, Freed et al. demonstrated successful reprogramming of human fibroblasts to iPS cells.[40] Another advantage of using adenoviruses is that they only need to present for a brief amount of time in order for effective reprogramming to take place.

Also in 2008, Yamanaka et al. found that they could transfer the four necessary genes with a plasmid.[41] The Yamanaka group successfully reprogrammed mouse cells by transfection with two plasmid constructs carrying the reprogramming factors; the first plasmid expressed c-Myc, while the second expressed the other three factors (Oct4, Klf4, and Sox2). Although the plasmid methods avoid viruses, they still require cancer-promoting genes to accomplish reprogramming. The other main issue with these methods is that they tend to be much less efficient compared to retroviral methods. Furthermore, transfected plasmids have been shown to integrate into the host genome and therefore they still pose the risk of insertional mutagenesis. Because non-retroviral approaches have demonstrated such low efficiency levels, researchers have attempted to effectively rescue the technique with what is known as the PiggyBac Transposon System. Several studies have demonstrated that this system can effectively deliver the key reprogramming factors without leaving footprint mutations in the host cell genome. The PiggyBac Transposon System involves the re-excision of exogenous genes, which eliminates the issue of insertional mutagenesis. [42]

In January 2014, two articles were published claiming that a type of pluripotent stem cell can be generated by subjecting the cells to certain types of stress (bacterial toxin, a low pH of 5.7, or physical squeezing); the resulting cells were called STAP cells, for stimulus-triggered acquisition of pluripotency.[43]

In light of difficulties that other labs had replicating the results of the surprising study, in March 2014, one of the co-authors has called for the articles to be retracted.[44] On 4 June 2014, the lead author, Obokata agreed to retract both the papers [45] after she was found to have committed research misconduct as concluded in an investigation by RIKEN on 1 April 2014.[46]

MicroRNAs are short RNA molecules that bind to complementary sequences on messenger RNA and block expression of a gene. Measuring variations in microRNA expression in iPS cells can be used to predict their differentiation potential.[47] Addition of microRNAs can also be used to enhance iPS potential. Several mechanisms have been proposed.[47] ES cell-specific microRNA molecules (such as miR-291, miR-294 and miR-295) enhance the efficiency of induced pluripotency by acting downstream of c-Myc.[48]microRNAs can also block expression of repressors of Yamanakas four transcription factors, and there may be additional mechanisms induce reprogramming even in the absence of added exogenous transcription factors.[47]

Induced pluripotent stem cells are similar to natural pluripotent stem cells, such as embryonic stem (ES) cells, in many aspects, such as the expression of certain stem cell genes and proteins, chromatin methylation patterns, doubling time, embryoid body formation, teratoma formation, viable chimera formation, and potency and differentiability, but the full extent of their relation to natural pluripotent stem cells is still being assessed.[49]

Gene expression and genome-wide H3K4me3 and H3K27me3 were found to be extremely similar between ES and iPS cells.[50][citation needed] The generated iPSCs were remarkably similar to naturally isolated pluripotent stem cells (such as mouse and human embryonic stem cells, mESCs and hESCs, respectively) in the following respects, thus confirming the identity, authenticity, and pluripotency of iPSCs to naturally isolated pluripotent stem cells:

Recent achievements and future tasks for safe iPSC-based cell therapy are collected in the review of Okano et al.[62]

The task of producing iPS cells continues to be challenging due to the six problems mentioned above. A key tradeoff to overcome is that between efficiency and genomic integration. Most methods that do not rely on the integration of transgenes are inefficient, while those that do rely on the integration of transgenes face the problems of incomplete reprogramming and tumor genesis, although a vast number of techniques and methods have been attempted. Another large set of strategies is to perform a proteomic characterization of iPS cells.[63] Further studies and new strategies should generate optimal solutions to the five main challenges. One approach might attempt to combine the positive attributes of these strategies into an ultimately effective technique for reprogramming cells to iPS cells.

Another approach is the use of iPS cells derived from patients to identify therapeutic drugs able to rescue a phenotype. For instance, iPS cell lines derived from patients affected by ectodermal dysplasia syndrome (EEC), in which the p63 gene is mutated, display abnormal epithelial commitment that could be partially rescued by a small compound[64]

An attractive feature of human iPS cells is the ability to derive them from adult patients to study the cellular basis of human disease. Since iPS cells are self-renewing and pluripotent, they represent a theoretically unlimited source of patient-derived cells which can be turned into any type of cell in the body. This is particularly important because many other types of human cells derived from patients tend to stop growing after a few passages in laboratory culture. iPS cells have been generated for a wide variety of human genetic diseases, including common disorders such as Down syndrome and polycystic kidney disease.[65][66] In many instances, the patient-derived iPS cells exhibit cellular defects not observed in iPS cells from healthy patients, providing insight into the pathophysiology of the disease.[67] An international collaborated project, StemBANCC, was formed in 2012 to build a collection of iPS cell lines for drug screening for a variety of disease. Managed by the University of Oxford, the effort pooled funds and resources from 10 pharmaceutical companies and 23 universities. The goal is to generate a library of 1,500 iPS cell lines which will be used in early drug testing by providing a simulated human disease environment.[68] Furthermore, combining hiPSC technology and genetically-encoded voltage and calcium indicators provided a large-scale and high-throughput platform for cardiovascular drug safety screening.[69]

A proof-of-concept of using induced pluripotent stem cells (iPSCs) to generate human organ for transplantation was reported by researchers from Japan. Human liver buds (iPSC-LBs) were grown from a mixture of three different kinds of stem cells: hepatocytes (for liver function) coaxed from iPSCs; endothelial stem cells (to form lining of blood vessels) from umbilical cord blood; and mesenchymal stem cells (to form connective tissue). This new approach allows different cell types to self-organize into a complex organ, mimicking the process in fetal development. After growing in vitro for a few days, the liver buds were transplanted into mice where the liver quickly connected with the host blood vessels and continued to grow. Most importantly, it performed regular liver functions including metabolizing drugs and producing liver-specific proteins. Further studies will monitor the longevity of the transplanted organ in the host body (ability to integrate or avoid rejection) and whether it will transform into tumors.[70][71] Using this method, cells from one mouse could be used to test 1,000 drug compounds to treat liver disease, and reduce animal use by up to 50,000.[72]

Embryonic cord-blood cells were induced into pluripotent stem cells using plasmid DNA. Using cell surface endothelial/pericytic markers CD31 and CD146, researchers identified 'vascular progenitor', the high-quality, multipotent vascular stem cells. After the iPS cells were injected directly into the vitreous of the damaged retina of mice, the stem cells engrafted into the retina, grew and repaired the vascular vessels.[73][74]

Labelled iPSCs-derived NSCs injected into laboratory animals with brain lesions were shown to migrate to the lesions and some motor function improvement was observed.[75]

Although a pint of donated blood contains about two trillion red blood cells and over 107 million blood donations are collected globally, there is still a critical need for blood for transfusion. In 2014, type O red blood cells were synthesized at the Scottish National Blood Transfusion Service from iPSC. The cells were induced to become a mesoderm and then blood cells and then red blood cells. The final step was to make them eject their nuclei and mature properly. Type O can be transfused into all patients. Human clinical trials were not expected to begin before 2016.[76]

The first human clinical trial using autologous iPSCs was approved by the Japan Ministry Health and was to be conducted in 2014 in Kobe. However the trial was suspended after Japan's new regenerative medicine laws came into effect last November.[77] iPSCs derived from skin cells from six patients suffering from wet age-related macular degeneration were to be reprogrammed to differentiate into retinal pigment epithelial (RPE) cells. The cell sheet would be transplanted into the affected retina where the degenerated RPE tissue was excised. Safety and vision restoration monitoring would last one to three years.[78][79] The benefits of using autologous iPSCs are that there is theoretically no risk of rejection and it eliminates the need to use embryonic stem cells.[79]

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Arthritis Articles – Symptoms, Treatment, and More

Tuesday, November 22nd, 2016

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Rheumatoid Arthritis. Symptoms of Arthritis and … – Patient

Tuesday, November 22nd, 2016

What is rheumatoid arthritis (RA)?

Arthritis means inflammation of joints. RA is a common form of arthritis. (There are various other causes of arthritis and RA is just one cause.) About 1 in 100 people develop RA at some stage in their lives. It can happen to anyone. It is not an hereditary disease. It can develop at any age, but most commonly starts between the ages of 40 and 60. It is about three times more common in women than in men.

A joint is where two bones meet. Joints allow movement and flexibility of various parts of the body. The movement of the bones is caused by muscles which pull on tendons that are attached to bone. Cartilage covers the end of bones. Between the cartilage of two bones that form a joint there is a small amount of thick fluid called synovial fluid. This lubricates the joint, which allows smooth movement between the bones.

The synovium is the tissue that surrounds a joint. Synovial fluid is made by cells of the synovium. The outer part of the synovium is called the capsule. This is tough, gives the joint stability, and stops the bones from moving out of joint. Surrounding ligaments and muscles also help to give support and stability to joints.

RA is thought to be an autoimmune disease. The immune system normally makes antibodies (small proteins) to attack bacteria, viruses, and other germs. In people with autoimmune diseases, the immune system makes antibodies against tissues of the body. It is not clear why this happens. Some people have a tendency to develop autoimmune diseases. In such people, something might trigger the immune system to attack the body's own tissues. The trigger is not known.

In people with RA, antibodies are formed against the tissue that surrounds each joint (the synovium). This causes inflammation in and around affected joints. Over time, the inflammation can damage the joint, the cartilage, and parts of the bone near to the joint.

The most commonly affected joints are the small joints of the fingers, thumbs, wrists, feet, and ankles. However, any joint may be affected. The knees are quite commonly affected. Less commonly, the hips, shoulders, elbows, and neck are involved. It is often symmetrical. So, for example, if a joint is affected in a right arm, the same joint in the left arm is also often affected. In some people, just a few joints are affected. In others, many joints are involved.

The common main symptoms are pain and stiffness of affected joints. The stiffness is usually worse first thing in the morning, or after you have been resting. The inflammation causes swelling around the affected joints.

These are known as extra-articular symptoms of RA (meaning outside of the joints). A variety of symptoms may occur. The cause of some of these is not fully understood:

In most cases the symptoms develop gradually - over several weeks or so. Typically, you may first develop some stiffness in the hands, wrists, or soles of the feet in the morning, which eases by mid-day. This may come and go for a while, but then becomes a regular occurence. You may then notice some pain and swelling in the same joints. More joints such as the knees may then become affected.

In a small number of cases, less common patterns are seen. For example:

The severity of RA can vary greatly from person to person. It is usually a chronic relapsing condition. Chronic means that it is persistent. Relapsing means that at times the disease flares up (relapses), and at other times it settles down. There is usually no apparent reason why the inflammation may flare up for a while, and then settle down.

If untreated, most people with RA have this pattern of flare-ups followed by better spells. In some people, months or even years may go by between flare-ups. Some damage may be done to affected joints during each flare-up. The amount of disability which develops usually depends on how much damage is done over time to the affected joints. In a minority of cases the disease is constantly progressive, and severe joint damage and disability can develop quite quickly.

Inflammation can damage the cartilage which may become eroded or worn. The bone underneath may become thinned. The joint capsule and nearby ligaments and tissues around the joint may also become damaged. Joint damage develops gradually, but the speed at which damage develops varies from person to person. Over time, joint damage can lead to deformities. It may become difficult to use the affected joints. For example, the fingers and wrists are commonly affected, so a good grip and other tasks using the hands may become difficult.

Most people with RA develop some damage to affected joints. The amount of damage can range from mild to severe. At the outset of the disease it is difficult to predict for an individual how badly the disease will progress. However, modern treatments can often limit or even stop the progression of the disease and limit the joint damage (see below).

Hi! Terrified of taking Enbrel...how is anyone else coping with it?

When you first develop joint pains, it may at first be difficult for a doctor to say that you definitely have RA. This is because there are many other causes of joint pains. There is no single test which diagnoses early RA with 100% certainty. However, RA can usually be confidently diagnosed by a doctor based on the following combination of factors:

You may also be advised to have a range of other blood tests to rule out other causes of joint pains.

The risk of developing certain other conditions is higher than average in people with rheumatoid arthritis (RA). These include:

It is not clear why people with RA have a higher-than-average chance of developing these conditions. One possible reason is that, on average, people with RA tend to have more risk factors for developing some of these conditions. For example:

Other complications which may develop include:

If your doctor suspects that you have rheumatoid arthritis (RA), you will usually be referred to a joint specialist (a rheumatologist). This is to confirm the diagnosis and to advise on treatment. It is very important to start treatment as early as possible after symptoms begin. This is because any joint damage done by the disease is permanent. Therefore, it is vital to start treatment as early as possible to minimise or even prevent any permanent joint damage.

There is no cure for RA. However, treatments can make a big difference to reduce symptoms and improve the outlook. The main aims of treatment are:

There are a number of medicines called disease-modifying antirheumatic drugs (DMARDs). These are medicines that ease symptoms but also reduce the damaging effect of the disease on the joints. They work by blocking the way inflammation develops in the joints. They do this by blocking certain chemicals involved in the inflammation process. DMARDs includemethotrexate, sulfasalazine, sodium aurothiomalate, penicillamine, leflunomide, hydroxychloroquine, azathioprine, ciclosporin and mycophenolate mofetil. It is these medicines that have improved the outlook (prognosis) in recent years for many people with RA.

It is usual to start a DMARD as soon as possible after RA has been diagnosed. It is also common practice to use a combination of two or more DMARDs. This is commonly methotrexate plus at least one other DMARD. In general, the earlier you start DMARDs, the more effective they are likely to be.

DMARDs have no immediate effect on pains or inflammation. It can take several weeks, and sometimes several months, before you notice any effect. Therefore, it is important to keep taking DMARDs as prescribed, even if they do not seem to be working at first. Whilst on treatment, you are likely to have a blood test called a C-reactive protein (CRP) test every now and then. This test detects inflammation in the body. As the disease activity reduces, so should the blood level of CRP. The CRP test, in conjunction with assessing your symptoms, is a good way of monitoring disease activity and the effect of treatment in controlling the disease. If DMARDs work well, it is usual to take one or more DMARDs indefinitely. However, when a satisfactory level of disease control has been achieved, your doctor may advise a cautious reduction in doses, but not to a dose less than that required to continue to maintain disease control.

Each DMARD has different possible side-effects. If one does not suit, a different one may be fine. Some people try several DMARDs before one or more can be found to suit. Some side-effects can be serious. These are rare and include damage to the liver and blood-producing cells. Therefore, it is usual to have regular tests - usually blood tests - whilst you take DMARDs. The tests look for some possible side-effects before they become serious.

Biological medicines have been introduced more recently and also have a disease-modifying effect against RA. They are sometimes called cytokine modulators or monoclonal antibodies. Biological therapies include adalimumab, certolizumab pegol, etanercept, golimumab, infliximab, anakinra, abatacept, rituximab and tocilizumab.

They are called biological medicines because they mimic substances produced by the human body such as antibodies. Also, they are made by living organisms such as cloned human white blood cells. This is unlike most medicines that are made by chemical processes.

Biological medicines work in RA by blocking chemicals that are involved in inflammation. For example, some of these biological medicines block a chemical called TNF-alpha which plays an important role in causing inflammation in joints in RA.

One problem with biological medicines is that they need to be given by injection. They are also expensive. Recent guidelines state that two trials of six months of traditional DMARD monotherapy or combination therapy (at least one including methotrexate) should fail to control symptoms or prevent disease progression before one of these newer biological medicines may be recommended. Biological medicines may also be used in combination with methotrexate (a DMARD).

There seems to be an association between gum disease and the activity of RA. (Gum disease is very common.) One recent research trial looked at 40 people with RA who also had gum disease. The trial compared 20 people who had treatment for their gum disease with 20 people who did not. It found that the disease activity of RA seemed to decrease when gum disease was treated. The treatment for the gum disease was scaling/root planing and oral hygiene instructions. That is, basically, good dental care and oral hygiene such as tooth brushing and flossing.

Gum disease causes an ongoing inflammation in the gums. The theory is that this inflammation may in some way add to the immune mechanisms involved in the inflammation of RA. Further research is needed to confirm this association. But, in the meantime, it seems sensible to make sure your oral hygiene is good, as it may have a beneficial effect. See separate leaflet called Dental Plaque and Gum Disease for details.

DMARDs and biological medicines mentioned earlier control the activity of the disease and will ease symptoms when they take effect. However, whilst waiting for them to take effect, or if they do not work so well, you may need treatment to treat symptoms.

During a flare-up of inflammation, if you rest the affected joint(s) it helps to ease pain. Special wrist splints, footwear, gentle massage, or applying heat may also help. Medication is also helpful. Medicines which may be advised by your doctor to ease pain and stiffness include the following:

These are sometimes just called anti-inflammatories and are good at easing pain and stiffness, and also help to reduce inflammation. There are many types and brands. Each is slightly different to the others, and side-effects may vary between brands. To decide on the right brand to use, a doctor has to balance how powerful the effect is against possible side-effects and other factors. Usually one can be found to suit. However, it is not unusual to try two or more brands before finding one that suits you best.

The leaflet which comes with the tablets gives a full list of possible side-effects. The most common side-effect is stomach pain (dyspepsia). An uncommon but serious side-effect is bleeding from the stomach. Therefore, your doctor will usually prescribe another medicine to protect the stomach from these possible problems. Stop taking the tablets and see a doctor urgently if you:

After starting a DMARD (discussed earlier), many people take an anti-inflammatory tablet for several weeks until the DMARD starts to work. Once a DMARD is found to help, the dose of the anti-inflammatory tablet can be reduced or even stopped.

Paracetamol often helps. This does not have any anti-inflammatory action, but is useful for pain relief in addition to, or instead of, an anti-inflammatory tablet. Codeine is another stonger painkiller that is sometimes used.

Note: NSAIDs and painkillers ease the symptoms of RA. However, they do not alter the progression of the disease or prevent joint damage. You do not need to take them if symptoms settle with the use of disease-modifying medicines.

Steroids are good at reducing inflammation. It is common practice to advise a short course of steroids to damp down a flare-up of symptoms which has not been helped much by an NSAID. Also, when RA is first diagnosed, a short course of steroids is commonly used to control symptoms whilst waiting for DMARDs to take effect. Sometimes a steroid is used for a longer period of time in combination with a DMARD. An injection of steroid directly into a joint is sometimes used to treat a bad flare-up in one particular joint.

The main side-effects from steroids occur when they are used for more than a few weeks. The higher the dose, the more likely that side-effects become a problem. Serious side-effects that may occur if you take steroids for more than a few weeks, or if you have injections frequently, include:

As mentioned earlier, sometimes people with RA develop inflammation in other parts of the body such as the lungs, heart, blood vessels, or eyes. Also, anaemia may develop. Various treatments may be needed to treat these problems if they occur.

As mentioned earlier, if you have RA you have an increased risk of developing cardiovascular diseases (for example, angina, heart attack, and stroke), osteoporosis, and infections. Therefore, you should consider doing what you can to reduce the risk of these conditions by other means.

For example, if possible:

See separate leaflets called Preventing Cardiovascular Diseasesand Osteoporosis for more details.

To prevent certain infections, you should have:

Some people try complementary therapies such as special diets, bracelets, acupuncture, etc. There is little research evidence to say how effective such treatments are for RA. In particular, beware of paying a lot of money to people who make extravagant claims of success. For advice on the value of any treatment it is best to consult a doctor, or contact one of the groups below.

The prognosis regarding joint damage is perhaps better than many people imagine:

However, these figures are probably becoming out-of-date, as treatment has improved in recent years. Symptoms can often be well controlled with medication. Also, the outlook for a person who is diagnosed with RA these days is likely to be much better than it was a few years ago. This is because of the newer and better medicines - in particular the newer disease-modifying medicines. Follow-up studies of people being treated with the newer medicines should give a clearer idea of prognosis over the next few years.

Another factor to bear in mind is the increased risk of developing associated diseases such as cardiovascular disease (see above). Because of this, the average life expectancy of people with RA is a little reduced compared with the general population. This is why it is important to tackle any factors that you can modify such as smoking, diet, weight, etc.

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Rheumatoid Arthritis. Symptoms of Arthritis and ... - Patient

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Google Health Google

Saturday, November 12th, 2016

Google Health has been permanently discontinued. All data remaining in Google Health user accounts as of January 2, 2013 has been systematically destroyed, and Google is no longer able to recover any Google Health data for any user. To learn more about this announcement, see our blog post, or answers to frequently-asked questions below.

Is there any way to retrieve my Google Health data from Google?

No -- all remaining user data has been permanently and irrevocably deleted from the Google Health system starting on January 2, 2013. Google is no longer able to recover any Google Health data for any user.

What happened to my Google Health data after January 1, 2013?

All Google Health user accounts have been deactivated, and all data stored in them has been systematically deleted from Google's systems.

I want to keep tracking my health online. What can I use to do this?

There are a number of options available. For example, you can continue tracking your health data via another personal health record provider such as Microsoft(R) HealthVault(TM).

Why was Google Health discontinued?

Please see our blog post for more information on this decision.

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Google Health Google

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Enbrel (etanercept)

Tuesday, November 8th, 2016

IMPORTANT SAFETY INFORMATION

What is the most important information I should know about ENBREL?

ENBREL is a medicine that affects your immune system. ENBREL can lower the ability of your immune system to fight infections. Serious infections have happened in patients taking ENBREL. These infections include tuberculosis (TB) and infections caused by viruses, fungi, or bacteria that have spread throughout the body. Some patients have died from these infections. Your healthcare provider should test you for TB before you take ENBREL and monitor you closely for TB before, during, and after ENBREL treatment, even if you have tested negative for TB.

There have been some cases of unusual cancers reported in children and teenage patients who started using tumor necrosis factor (TNF) blockers before 18 years of age. Also, for children, teenagers, and adults taking TNF blockers, including ENBREL, the chances of getting lymphoma or other cancers may increase. Patients with RA may be more likely to get lymphoma.

Before starting ENBREL, tell your healthcare provider if you:

What are the possible side effects of ENBREL?

ENBREL can cause serious side effects including: New infections or worsening of infections you already have; hepatitis B can become active if you already have had it; nervous system problems, such as multiple sclerosis, seizures, or inflammation of the nerves of the eyes; blood problems (some fatal); new or worsening heart failure; new or worsening psoriasis; allergic reactions; autoimmune reactions, including a lupus-like syndrome and autoimmune hepatitis.

Common side effects include: Injection site reactions and upper respiratory infections (sinus infections).

In general, side effects in children were similar in frequency and type as those seen in adult patients. The types of infections reported were generally mild and similar to those usually seen in children.

These are not all the side effects with ENBREL. Tell your healthcare provider about any side effect that bothers you or does not go away.

If you have any questions about this information, be sure to discuss them with your healthcare provider. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit http://www.fda.gov/medwatch, or call 1-800-FDA-1088.

Please see Prescribing Information and Medication Guide.

INDICATIONS

Moderate to Severe Rheumatoid Arthritis (RA)

ENBREL is indicated for reducing signs and symptoms, keeping joint damage from getting worse, and improving physical function in patients with moderately to severely active rheumatoid arthritis. ENBREL can be taken with methotrexate or used alone.

Moderately to Severely Active Polyarticular Juvenile Idiopathic Arthritis (JIA)

ENBREL is indicated for reducing signs and symptoms of moderately to severely active polyarticular juvenile idiopathic arthritis (JIA) in children ages 2 years and older.

Psoriatic Arthritis

ENBREL is indicated for reducing signs and symptoms, keeping joint damage from getting worse, and improving physical function in patients with psoriatic arthritis. ENBREL can be used with or without methotrexate.

Ankylosing Spondylitis (AS)

ENBREL is indicated for reducing signs and symptoms in patients with active ankylosing spondylitis.

Moderate to Severe Plaque Psoriasis

ENBREL is indicated for chronic moderate to severe plaque psoriasis (PsO) in children 4 years and older and adults who may benefit from taking injections or pills (systemic therapy) or phototherapy (ultraviolet light).

IMPORTANT SAFETY INFORMATION: What is the most important information I should know about Enbrel (etanercept)?

ENBREL is a medicine that affects your immune system. ENBREL can lower the ability of your immune system to fight infections. Serious infections have happened in patients taking ENBREL. These infections include tuberculosis(TB) and infections caused by viruses, fungi, or bacteria that have spread throughout the body. Some patients have died from these infections. Your healthcare provider should test you for TB before you take ENBREL and monitor you closely for TB before, during, and after ENBREL treatment, even if you have tested negative for TB.

There have been some cases of unusual cancers reported in children and teenage patients who started using tumor necrosis factor (TNF) blockers before 18 years of age. Also, for children, teenagers, and adults taking TNF blockers, including ENBREL, the chances of getting lymphoma or other cancers may increase. Patients with RA may be more likely to get lymphoma.

Before starting ENBREL, tell your healthcare provider if you:

What are the possible side effects of ENBREL?

ENBREL can cause serious side effects including: New infections or worsening of infections you already have; hepatitis B can become active if you already have had it; nervous system problems, such as multiple sclerosis, seizures, or inflammation of the nerves of the eyes; blood problems (some fatal); new or worsening heart failure; new or worsening psoriasis; allergic reactions; autoimmune reactions, including a lupus-like syndrome and autoimmune hepatitis.

Common side effects include: Injection site reactions, upper respiratory infections (sinus infections), and headache.

In general, side effects in children were similar in frequency and type as those seen in adult patients. The types of infections reported were generally mild and similar to those usually seen in children.

These are not all the side effects with ENBREL. Tell your healthcare provider about any side effect that bothers you or does not go away.

If you have any questions about this information, be sure to discuss them with your healthcare provider. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit http://www.fda.gov/medwatch, or call 1-800-FDA-1088.

Please see Prescribing Information and Medication Guide.

INDICATIONS

Moderate to Severe Rheumatoid Arthritis (RA)

ENBREL is indicated for reducing signs and symptoms, keeping joint damage from getting worse, and improving physical function in patients with moderately to severely active rheumatoid arthritis. ENBREL can be taken with methotrexate or used alone.

Moderately to Severely Active Polyarticular Juvenile Idiopathic Arthritis (JIA)

ENBREL is indicated for reducing signs and symptoms of moderately to severely active polyarticular juvenile idiopathic arthritis (JIA) in children ages 2 years and older.

Psoriatic Arthritis

ENBREL is indicated for reducing signs and symptoms, keeping joint damage from getting worse, and improving physical function in patients with psoriatic arthritis. ENBREL can be used with or without methotrexate.

Ankylosing Spondylitis(AS)

ENBREL is indicated for reducing signs and symptoms in patients with active ankylosing spondylitis.

Moderate to Severe Plaque Psoriasis

ENBREL is indicated for the treatment of adult patients (18 years or older) with chronic moderate to severe plaque psoriasis who are candidates for systemic therapy or phototherapy.

At Enbrel.com, you can learn about Enbrel (etanercept), a self-injected biologic medicine used to treat inflammatory diseases with long-term effects. You can find information about moderate to severe rheumatoid arthritis(RA), moderate to severe plaque psoriasis, psoriatic arthritis, moderately to severely active polyarticular juvenile idiopathic arthritis(JIA), and ankylosing spondylitis(AS). You can learn about symptoms, treatment, how Enbrel (etanercept) works for each condition, results for each condition, results for each condition, and safety information.

Enbrel.com supports you and your loved ones from diagnosis to treatment. You can find resources like injection demonstrations, patient testimonial videos, questions to ask your doctor, and even help with finding a rheumatologist or dermatologist near you.

Enbrel.com also provices ongoing assistance with ENBREL SupportTM, a patient support program to help with out-of-pocket costs and connect you with registered nurses and ENBREL Nurse Partners. The resources available will help you get started. Resources include the ENBREL Starter Kit, injection and medicine refill reminders, free needle disposal containers, travel packs, and ongoing education.

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Arthritis – Wikipedia

Wednesday, October 19th, 2016

Arthritis is a term often used to mean any disorder that affects joints.[1] Symptoms generally include joint pain and stiffness.[1] Other symptoms may include redness, warmth, swelling, and decreased range of motion of the affected joints.[1][2] In some types other organs are also affected.[3] Onset can be gradual or sudden.[4]

There are over 100 types of arthritis.[5][4] The most common forms are osteoarthritis (degenerative joint disease) and rheumatoid arthritis. Osteoarthritis usually occurs with age and affects the fingers, knees, and hips. Rheumatoid arthritis is an autoimmune disorder that often affects the hands and feet.[3] Other types include gout, lupus, fibromyalgia, and septic arthritis.[3][6] They are all types of rheumatic disease.[1]

Treatment may include resting the joint and alternating between applying ice and heat. Weight loss and exercise may also be useful.[3] Pain medications such as ibuprofen and acetaminophen (paracetamol) may be used.[7] In some a joint replacement may be useful.[3]

Osteoarthritis affects more than 3.8% of people while rheumatoid arthritis affects about 0.24% of people.[8] Gout affects about 1 to 2% of the Western population at some point in their lives.[9] In Australia and the United States more than 20% of people have a type of arthritis.[6][10] Overall the disease becomes more common with age.[6] Arthritis is a common reason that people miss work and can result in a decreased quality of life.[7] The term is from Greek arthro- meaning joint and -itis meaning inflammation.[11]

There are several diseases where joint pain is primary, and is considered the main feature. Generally when a person has "arthritis" it means that they have one of these diseases, which include:

Joint pain can also be a symptom of other diseases. In this case, the arthritis is considered to be secondary to the main disease; these include:

An undifferentiated arthritis is an arthritis that does not fit into well-known clinical disease categories, possibly being an early stage of a definite rheumatic disease.[16]

Disability due to musculoskeletal disorders increased by 45% from 1990 to 2010. Of these, osteoarthritis is the fastest increasing major health condition.[17] Among the many reports on the increased prevalence of musculoskeletal conditions, data from Africa are lacking and underestimated. A systematic review assessed the prevalence of arthritis in Africa and included twenty population-based and seven hospital-based studies.[18] The majority of studies, twelve, were from South Africa. Nine studies were well-conducted, eleven studies were of moderate quality, and seven studies were conducted poorly. The results of the systematic review were as follows:

Pain, which can vary in severity, is a common symptom in virtually all types of arthritis. Other symptoms include swelling, joint stiffness and aching around the joint(s). Arthritic disorders like lupus and rheumatoid arthritis can affect other organs in the body, leading to a variety of symptoms.[20] Symptoms may include:

It is common in advanced arthritis for significant secondary changes to occur. For example, arthritic symptoms might make it difficult for a person to move around and/or exercise, which can lead to secondary effects, such as:

These changes, in addition to the primary symptoms, can have a huge impact on quality of life.

Arthritis is the most common cause of disability in the USA. More than 20 million individuals with arthritis have severe limitations in function on a daily basis.[21]Absenteeism and frequent visits to the physician are common in individuals who have arthritis. Arthritis can make it very difficult for individuals to be physically active and some become home bound.

It is estimated that the total cost of arthritis cases is close to $100 billion of which almost 50% is from lost earnings. Each year, arthritis results in nearly 1 million hospitalizations and close to 45 million outpatient visits to health care centers.[22]

Decreased mobility, in combination with the above symptoms, can make it difficult for an individual to remain physically active, contributing to an increased risk of obesity, high cholesterol or vulnerability to heart disease.[23] People with arthritis are also at increased risk of depression, which may be a response to numerous factors, including fear of worsening symptoms.[24]

Diagnosis is made by clinical examination from an appropriate health professional, and may be supported by other tests such as radiology and blood tests, depending on the type of suspected arthritis.[25] All arthritides potentially feature pain. Pain patterns may differ depending on the arthritides and the location. Rheumatoid arthritis is generally worse in the morning and associated with stiffness; in the early stages, patients often have no symptoms after a morning shower. Osteoarthritis, on the other hand, tends to be worse after exercise. In the aged and children, pain might not be the main presenting feature; the aged patient simply moves less, the infantile patient refuses to use the affected limb.[citation needed]

Elements of the history of the disorder guide diagnosis. Important features are speed and time of onset, pattern of joint involvement, symmetry of symptoms, early morning stiffness, tenderness, gelling or locking with inactivity, aggravating and relieving factors, and other systemic symptoms. Physical examination may confirm the diagnosis, or may indicate systemic disease. Radiographs are often used to follow progression or help assess severity.

Blood tests and X-rays of the affected joints often are performed to make the diagnosis. Screening blood tests are indicated if certain arthritides are suspected. These might include: rheumatoid factor, antinuclear factor (ANF), extractable nuclear antigen, and specific antibodies.

Osteoarthritis is the most common form of arthritis.[26] It can affect both the larger and the smaller joints of the body, including the hands, wrists, feet, back, hip, and knee. The disease is essentially one acquired from daily wear and tear of the joint; however, osteoarthritis can also occur as a result of injury. In recent years, some joint or limb deformities, such as knock-knee or acetabular overcoverage or dysplasia, have also been considered as a predisposing factor for knee or hip osteoarthritis. Osteoarthritis begins in the cartilage and eventually causes the two opposing bones to erode into each other. The condition starts with minor pain during physical activity, but soon the pain can be continuous and even occur while in a state of rest. The pain can be debilitating and prevent one from doing some activities. Osteoarthritis typically affects the weight-bearing joints, such as the back, knee and hip. Unlike rheumatoid arthritis, osteoarthritis is most commonly a disease of the elderly. More than 30 percent of women have some degree of osteoarthritis by age 65. Risk factors for osteoarthritis include prior joint trauma, obesity, and a sedentary lifestyle.

Rheumatoid arthritis (RA) is a disorder in which the body's own immune system starts to attack body tissues. The attack is not only directed at the joint but to many other parts of the body. In rheumatoid arthritis, most damage occurs to the joint lining and cartilage which eventually results in erosion of two opposing bones. RA often affects joints in the fingers, wrists, knees and elbows, is symmetrical (appears on both sides of the body), and can lead to severe deformity in a few years if not treated. RA occurs mostly in people aged 20 and above. In children, the disorder can present with a skin rash, fever, pain, disability, and limitations in daily activities. With earlier diagnosis and aggressive treatment, many individuals can lead a better quality of life than if going undiagnosed for long after RA's onset. The drugs to treat RA range from corticosteroids to monoclonal antibodies given intravenously. Treatments also include analgesics such as NSAIDs and disease-modifying antirheumatic drugs (DMARDs), while in rare cases, surgery may be required to replace joints, but there is no cure for the disease.[27]

Treatment with DMARDs is designed to initiate an adaptive immune response, in part by CD4+ T helper (Th) cells, specifically Th17 cells.[28] Th17 cells are present in higher quantities at the site of bone destruction in joints and produce inflammatory cytokines associated with inflammation, such as interleukin-17 (IL-17).[29]

Bone erosion is a central feature of rheumatoid arthritis. Bone continuously undergoes remodeling by actions of bone resorbing osteoclasts and bone forming osteoblasts. One of the main triggers of bone erosion in the joints in rheumatoid arthritis is inflammation of the synovium, caused in part by the production of pro-inflammatory cytokines and receptor activator of nuclear factor kappa B ligand (RANKL), a cell surface protein present in Th17 cells and osteoblasts.[29] Osteoclast activity can be directly induced by osteoblasts through the RANK/RANKL mechanism.[30]

Lupus is a common collagen vascular disorder that can be present with severe arthritis. Other features of lupus include a skin rash, extreme photosensitivity, hair loss, kidney problems, lung fibrosis and constant joint pain.[31]

Gout is caused by deposition of uric acid crystals in the joint, causing inflammation. There is also an uncommon form of gouty arthritis caused by the formation of rhomboid crystals of calcium pyrophosphate known as pseudogout. In the early stages, the gouty arthritis usually occurs in one joint, but with time, it can occur in many joints and be quite crippling. The joints in gout can often become swollen and lose function. Gouty arthritis can become particularly painful and potentially debilitating when gout cannot successfully be treated.[32] When uric acid levels and gout symptoms cannot be controlled with standard gout medicines that decrease the production of uric acid (e.g., allopurinol, febuxostat) or increase uric acid elimination from the body through the kidneys (e.g., probenecid), this can be referred to as refractory chronic gout or RCG.[33]

Infectious arthritis is another severe form of arthritis. It presents with sudden onset of chills, fever and joint pain. The condition is caused by bacteria elsewhere in the body. Infectious arthritis must be rapidly diagnosed and treated promptly to prevent irreversible joint damage.[37]

Psoriasis can develop into psoriatic arthritis. With psoriatic arthritis, most individuals develop the skin problem first and then the arthritis. The typical features are of continuous joint pains, stiffness and swelling. The disease does recur with periods of remission but there is no cure for the disorder. A small percentage develop a severe painful and destructive form of arthritis which destroys the small joints in the hands and can lead to permanent disability and loss of hand function.[38]

There is no known cure for either rheumatoid or osteoarthritis. Treatment options vary depending on the type of arthritis and include physical therapy, lifestyle changes (including exercise and weight control), orthopedic bracing, and medications. Joint replacement surgery may be required in eroding forms of arthritis. Medications can help reduce inflammation in the joint which decreases pain. Moreover, by decreasing inflammation, the joint damage may be slowed.

In general, studies have shown that physical exercise of the affected joint can noticeably improve long-term pain relief. Furthermore, exercise of the arthritic joint is encouraged to maintain the health of the particular joint and the overall body of the person.[39]

Individuals with arthritis can benefit from both physical and occupational therapy. In arthritis the joints become stiff and the range of movement can be limited. Physical therapy has been shown to significantly improve function, decrease pain, and delay need for surgical intervention in advanced cases.[40] Exercise prescribed by a physical therapist has been shown to be more effective than medications in treating osteoarthritis of the knee. Exercise often focuses on improving muscle strength, endurance and flexibility. In some cases, exercises may be designed to train balance. Occupational therapy can provide assistance with activities as well as equipment.

There are several types of medications that are used for the treatment of arthritis. Treatment typically begins with medications that have the fewest side effects with further medications being added if insufficiently effective.[41]

Depending on the type of arthritis, the medications that are given may be different. For example, the first-line treatment for osteoarthritis is acetaminophen (paracetamol) while for inflammatory arthritis it involves non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen. Opioids and NSAIDs are less well tolerated.[42]

Rheumatoid arthritis (RA) is autoimmune so in addition to using pain medications and anti-inflammatory drugs, this type uses another category of drug called disease modifying anti-rheumatic drugs (DMARDS). An example of this type of drug is Methotrexate. These types of drugs act on the immune system and slow down the progression of RA.

A number of rheumasurgical interventions have been incorporated in the treatment of arthritis since the 1950s. Arthroscopic surgery for osteoarthritis of the knee provides no additional benefit to optimized physical and medical therapy.[43]

A Cochrane review in 2000 concluded that transcutaneous electrical nerve stimulation (TENS) for knee osteoarthritis was more effective in pain control than placebo.[44][needs update]Low level laser therapy may be considered for relief of pain and stiffness associated with arthritis.[45] Evidence of benefit is tentative.[46][47]

Pulsed electromagnetic field therapy has tentative evidence supporting improved functioning but no evidence of improved pain in osteoarthritis.[48] The FDA has not approved PEMF for the treatment of arthritis. In Canada, PEMF devices are legally licensed by Health Canada for the treatment of pain associated with arthritic conditions.

Arthritis is predominantly a disease of the elderly, but children can also be affected by the disease. More than 70% of individuals in North America affected by arthritis are over the age of 65.[citation needed] Arthritis is more common in women than men at all ages and affects all races, ethnic groups and cultures. In the United States a CDC survey based on data from 20072009 showed 22.2% (49.9 million) of adults aged 18 years had self-reported doctor-diagnosed arthritis, and 9.4% (21.1 million or 42.4% of those with arthritis) had arthritis-attributable activity limitation (AAAL). With an aging population, this number is expected to increase.[49]

While evidence of primary ankle osteoarthritis has been discovered in dinosaurs,[50] the first known traces of human arthritis date back as far as 4500 BC. In early reports, arthritis was frequently referred to as the most common ailment of prehistoric peoples.[51] It was noted in skeletal remains of Native Americans found in Tennessee and parts of what is now Olathe, Kansas. Evidence of arthritis has been found throughout history, from tzi, a mummy (circa 3000 BC) found along the border of modern Italy and Austria, to the Egyptian mummies circa 2590 BC.[52]

In 1715, William Musgrave published the second edition of his most important medical work, De arthritide symptomatica, which concerned arthritis and its effects.[53]

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Chamomile: A herbal medicine of the past with bright future

Monday, October 3rd, 2016

Abstract

Chamomile is one of the most ancient medicinal herbs known to mankind. It is a member of Asteraceae/Compositae family and represented by two common varieties viz. German Chamomile (Chamomilla recutita) and Roman Chamomile (Chamaemelum nobile). The dried flowers of chamomile contain many terpenoids and flavonoids contributing to its medicinal properties. Chamomile preparations are commonly used for many human ailments such as hay fever, inflammation, muscle spasms, menstrual disorders, insomnia, ulcers, wounds, gastrointestinal disorders, rheumatic pain, and hemorrhoids. Essential oils of chamomile are used extensively in cosmetics and aromatherapy. Many different preparations of chamomile have been developed, the most popular of which is in the form of herbal tea consumed more than one million cups per day. In this review we describe the use of chamomile in traditional medicine with regard to evaluating its curative and preventive properties, highlight recent findings for its development as a therapeutic agent promoting human health.

Keywords: chamomile, dietary agents, flavonoids, polyphenols, human health

The interplay of plants and human health has been documented for thousands of years (13). Herbs have been integral to both traditional and non-traditional forms of medicine dating back at least 5000 years (2, 46). The enduring popularity of herbal medicines may be explained by the tendency of herbs to work slowly, usually with minimal toxic side effects. One of the most common herbs used for medicinal purposes is chamomile whose standardized tea and herbal extracts are prepared from dried flowers of Matricaria species. Chamomile is one of the oldest, most widely used and well documented medicinal plants in the world and has been recommended for a variety of healing applications (7). Chamomile is a native of the old World and is a member of the daisy family (Asteraceae or Compositae). The hollow, bright gold cones of the flowers are packed with disc or tubular florets and are ringed with about fifteen white ray or ligulate florets, widely represented by two known varieties viz. German chamomile (Matricaria chamomilla) and Roman chamomile (Chamaemelum nobile) (8) . In this review we will discuss the use and possible merits of chamomile, examining its historical use and recent scientific and clinical evaluations of its potential use in the management of various human ailments.

Different classes of bioactive constituents are present in chamomile, which have been isolated and used as medicinal preparations and cosmetics (9). The plant contains 0.24%1.9% volatile oil, composed of a variety of separate oils. When exposed to steam distillation, the oil ranges in color from brilliant blue to deep green when fresh but turns to dark yellow after storage. Despite fading, the oil does not lose its potency. Approximately 120 secondary metabolites have been identified in chamomile, including 28 terpenoids and 36 flavonoids (10, 11). The principal components of the essential oil extracted from the German chamomile flowers are the terpenoids -bisabolol and its oxide azulenes including chamazulene and acetylene derivatives. Chamazulene and bisabolol are very unstable and are best preserved in an alcoholic tincture. The essential oil of Roman chamomile contains less chamazulene and is mainly constituted from esters of angelic acid and tiglic acid. It also contains farnesene and -pinene. Roman chamomile contains up to 0.6% of sesquiterpene lactones of the germacranolide type, mainly nobilin and 3-epinobilin. Both -bisabolol, bisabolol oxides A and B and chamazulene or azulenesse, farnesene and spiro-ether quiterpene lactones, glycosides, hydroxycoumarins, flavanoids (apigenin, luteolin, patuletin, and quercetin), coumarins (herniarin and umbelliferone), terpenoids, and mucilage are considered to be the major bio-active ingredients (12, 13). Other major constituents of the flowers include several phenolic compounds, primarily the flavonoids apigenin, quercetin, patuletin as glucosides and various acetylated derivatives. Among flavonoids, apigenin is the most promising compound. It is present in very small quantities as free apigenin, but predominantly exists in the form of various glycosides (1418).

Chamomile is known to be used in various forms of its preparations. Dry powder of chamomile flower is recommended and used by many people for traditionally established health problems. Medicinal ingredients are normally extracted from the dry flowers of chamomile by using water, ethanol or methanol as solvents and corresponding extracts are known as aqueous, ethanolic (alcoholic) and/or methanolic extracts. Optimum chamomile extracts contain about 50 percent alcohol. Normally standardized extracts contain 1.2% of apigenin which is one of the most effective bioactive agents. Aqueous extracts, such as in the form of tea, contain quite low concentrations of free apigenin but include high levels of apigenin-7-O-glucoside. Oral infusion of chamomile is recommended by the German Commission E (19, 20).Chamomile tea is one of the worlds most popular herbal teas and about a million cups are consumed every day. Tea bags of chamomile are also available in the market, containing chamomile flower powder, either pure or blended with other popular medicinal herbs. Chamomile tincture may also be prepared as one part chamomile flower in four parts of water having 12% grain alcohol, which is used to correct summer diarrhea in children and also used with purgatives to prevent cramping. Chamomile flowers are extensively used alone, or combined with crushed poppy-heads, as a poultice or hot foment for inflammatory pain or congestive neuralgia, and in cases of external swelling, such as facial swelling associated with underlying infection or abscess. Chamomile whole plant is used for making herb beers, and also for a lotion, for external application in toothache, earache, neuralgia and in cases of external swelling (20). It is also known to be used as bath additive, recommended for soothing ano-genital inflammation (21). The tea infusion is used as a wash or gargle for inflammation of the mucous membranes of the mouth and throat (22, 23). Inhalation of the vaporized essential oils derived from chamomile flowers is recommended to relieve anxiety, general depression. Chamomile oil is a popular ingredient of aromatherapy and hair care (24, 25). Roman chamomile is widely used in cosmetic preparations and in soothing and softening effect on the skin (26, 27).

Traditionally, chamomile has been used for centuries as an anti-inflammatory, antioxidant, mild astringent and healing medicine (28). As a traditional medicine, it is used to treat wounds, ulcers, eczema, gout, skin irritations, bruises, burns, canker sores, neuralgia, sciatica, rheumatic pain, hemorrhoids, mastitis and other ailments (29, 30). Externally, chamomile has been used to treat diaper rash, cracked nipples, chicken pox, ear and eye infections, disorders of the eyes including blocked tear ducts, conjunctivitis, nasal inflammation and poison ivy (31, 32). Chamomile is widely used to treat inflammations of the skin and mucous membranes, and for various bacterial infections of the skin, oral cavity and gums, and respiratory tract. Chamomile in the form of an aqueous extract has been frequently used as a mild sedative to calm nerves and reduce anxiety, to treat hysteria, nightmares, insomnia and other sleep problems (33). Chamomile has been valued as a digestive relaxant and has been used to treat various gastrointestinal disturbances including flatulence, indigestion, diarrhea, anorexia, motion sickness, nausea, and vomiting (34, 35). Chamomile has also been used to treat colic, croup, and fevers in children (36). It has been used as an emmenagogue and a uterine tonic in women. It is also effective in arthritis, back pain, bedsores and stomach cramps.

The flowers of chamomile contain 12% volatile oils including alpha-bisabolol, alpha-bisabolol oxides A & B, and matricin (usually converted to chamazulene and other flavonoids which possess anti-inflammatory and antiphlogistic properties (12, 19, 35, 36). A study in human volunteers demonstrated that chamomile flavonoids and essential oils penetrate below the skin surface into the deeper skin layers (37). This is important for their use as topical antiphlogistic (anti-inflammatory) agents. One of chamomiles anti-inflammatory activities involve the inhibition of LPS-induced prostaglandin E(2) release and attenuation of cyclooxygenase (COX-2) enzyme activity without affecting the constitutive form, COX-1 (38).

Most evaluations of tumor growth inhibition by chamomile involve studies with apigenin which is one of the bioactive constituents of chamomile. Studies on preclinical models of skin, prostate, breast and ovarian cancer have shown promising growth inhibitory effects (3943). In a recently conducted study, chamomile extracts were shown to cause minimal growth inhibitory effects on normal cells, but showed significant reductions in cell viability in various human cancer cell lines. Chamomile exposure induced apoptosis in cancer cells but not in normal cells at similar doses (18). The efficacy of the novel agent TBS-101, a mixture of seven standardized botanical extracts including chamomile has been recently tested. The results confirm it to have a good safety profile with significant anticancer activities against androgen-refractory human prostrate cancer PC-3 cells, both in vitro and in vivo situation (44).

Common cold (acute viral nasopharyngitis) is the most common human disease. It is a mild viral infectious disease of the upper respiratory system. Typically common cold is not life-threatening, although its complications (such as pneumonia) can lead to death, if not properly treated. Studies indicate that inhaling steam with chamomile extract has been helpful in common cold symptoms (45); however, further research is needed to confirm these findings.

It has been suggested that regular use of flavonoids consumed in food may reduce the risk of death from coronary heart disease in elderly men (46). A study assessed the flavonoid intake of 805 men aged 6584 years who were followed up for 5 years. Flavonoid intake (analyzed in tertiles) was significantly inversely associated with mortality from coronary heart disease and showed an inverse relation with incidence of myocardial infarction. In another study (47), on twelve patients with cardiac disease who underwent cardiac catheterization, hemodynamic measurements obtained prior to and 30 minutes after the oral ingestion of chamomile tea exhibited a small but significant increase in the mean brachial artery pressure. No other significant hemodynamic changes were observed after chamomile consumption. Ten of the twelve patients fell into a deep sleep shortly after drinking the beverage. A large, well-designed randomized controlled trial is needed to assess the potential value of chamomile in improving cardiac health.

An apple pectin-chamomile extract may help shorten the course of diarrhea in children as well as relieve symptoms associated with the condition (47). Two clinical trials have evaluated the efficacy of chamomile for the treatment of colic in children. Chamomile tea was combined with other herbs (German chamomile, vervain, licorice, fennel, balm mint) for administration. In a prospective, randomized, double-blind, placebo-controlled study, 68 healthy term infants who had colic (2 to 8 weeks old) received either herbal tea or placebo (glucose, flavoring). Each infant was offered treatment with every bout of colic, up to 150 mL/dose, no more than three times a day. After 7 days of treatment, parents reported that the tea eliminated the colic in 57% of the infants, whereas placebo was helpful in only 26% (P<0.01). No adverse effects with regard to the number of nighttime awakenings were noted in either group (48). Another study examined the effects of a chamomile extract and apple pectin preparation in 79 children (age 0.55.5 y) with acute, non-complicated diarrhea who received either the chamomile/pectin preparation (n = 39) or a placebo (n = 40) for 3 days. Diarrhea ended sooner in children treated with chamomile and pectin (85%), than in the placebo group (58%) (49). These results provide evidence that chamomile can be used safely to treat infant colic disorders.

Topical applications of chamomile have been shown to be moderately effective in the treatment of atopic eczema (50). It was found to be about 60% as effective as 0.25% hydrocortisone cream (51). Roman chamomile of the Manzana type (Kamillosan (R)) may ease discomfort associated with eczema when applied as a cream containing chamomile extract. The Manzana type of chamomile is rich in active ingredients and does not exhibit chamomile-related allergenic potential. In a partially double-blind, randomized study carried out as a half-side comparison, Kamillosan(R) cream was compared with 0.5% hydrocortisone cream and a placebo consisting only of vehicle cream in patients suffering from medium-degree atopic eczema (52). After 2 weeks of treatment, Kamillosan(R) cream showed a slight superiority over 0.5% hydrocortisone and a marginal difference as compared to placebo. Further research is needed to evaluate the usefulness of topical chamomile in managing eczema.

Chamomile is used traditionally for numerous gastrointestinal conditions, including digestive disorders, "spasm" or colic, upset stomach, flatulence (gas), ulcers, and gastrointestinal irritation (53). Chamomile is especially helpful in dispelling gas, soothing the stomach, and relaxing the muscles that move food through the intestines. The protective effect of a commercial preparation (STW5, Iberogast), containing the extracts of bitter candy tuft, lemon balm leaf, chamomile flower, caraway fruit, peppermint leaf, liquorice root, Angelica root, milk thistle fruit and greater celandine herb, against the development of gastric ulcers has been previously reported (54). STW5 extracts produced a dose dependent anti-ulcerogenic effect associated with a reduced acid output, an increased mucin secretion, an increase in prostaglandin E (2) release and a decrease in leukotrienes. The results obtained demonstrated that STW5 not only lowered gastric acidity as effectively as a commercial antacid, but was more effective in inhibiting secondary hyperacidity (54).

Studies suggest that chamomile ointment may improve hemorrhoids. Tinctures of chamomile can also be used in a sitz bath format. Tincture of Roman chamomile may reduce inflammation associated with hemorrhoids (55, 56).

It has been claimed that consumption of chamomile tea boosts the immune system and helps fight infections associated with colds. The health promoting benefits of chamomile was assessed in a study which involved fourteen volunteers who each drank five cups of the herbal tea daily for two consecutive weeks. Daily urine samples were taken and tested throughout the study, both before and after drinking chamomile tea. Drinking chamomile was associated with a significant increase in urinary levels of hippurate and glycine, which have been associated with increased antibacterial activity (57). In another study, chamomile relieved hypertensive symptoms and decreased the systolic blood pressure significantly, increasing urinary output (58). Additional studies are needed before a more definitive link between chamomile and its alleged health benefits can be established.

Inflammation is associated with many gastrointestinal disorders complaints, such as esophageal reflux, diverticular disease, and inflammatory disease (5961). Studies in preclinical models suggest that chamomile inhibits Helicobacter pylori, the bacteria that can contribute to stomach ulcers (60). Chamomile is believed to be helpful in reducing smooth muscle spasms associated with various gastrointestinal inflammatory disorders. Chamomile is often used to treat mild skin irritations, including sunburn, rashes, sores and even eye inflammations (6265) but its value in treating these conditions has not been shown with evidence-based research.

Mouth ulcers are a common condition with a variety of etiologies (66). Stomatitis is a major dose-limiting toxicity from bolus 5-fluorouracil-based (5-FU) chemotherapy regimens. A double-blind, placebo-controlled clinical trial including 164 patients was conducted (22). Patients were entered into the study at the time of their first cycle of 5-FU-based chemotherapy and were randomized to receive a chamomile or placebo mouthwash thrice daily for 14 days. There was no suggestion of any stomatitis difference between patients randomized to either protocol arm. There was also no suggestion of toxicity. Similar results were obtained with another prospective trial on chamomile in this situation. Data obtained from these clinical trials did not support the pre study hypothesis that chamomile could decrease 5-FU-induced stomatitis. The results remain unclear if chamomile is helpful in this situation.

Osteoporosis is a metabolic bone disease resulting from low bone mass (osteopenia) due to excessive bone resorption. Sufferers are prone to bone fractures from relatively minor trauma. Agents which include selective estrogen receptor modulators or SERMs, biphosphonates, calcitonin are frequently used to prevent bone loss. To prevent bone loss that occurs with increasing age, chamomile extract was evaluated for its ability to stimulate the differentiation and mineralization of osteoblastic cells. Chamomile extract was shown to stimulate osteoblastic cell differentiation and to exhibit an anti-estrogenic effect, suggesting an estrogen receptor-related mechanism (67). However, further studies are needed before it can be considered for clinical use.

Traditionally, chamomile preparations such as tea and essential oil aromatherapy have been used to treat insomnia and to induce sedation (calming effects). Chamomile is widely regarded as a mild tranquillizer and sleep-inducer. Sedative effects may be due to the flavonoid, apigenin that binds to benzodiazepine receptors in the brain (68). Studies in preclinical models have shown anticonvulsant and CNS depressant effects respectively. Clinical trials are notable for their absence, although ten cardiac patients are reported to have immediately fallen into a deep sleep lasting for 90 minutes after drinking chamomile tea (47). Chamomile extracts exhibit benzodiazepine-like hypnotic activity (69). In another study, inhalation of the vapor of chamomile oil reduced a stress-induced increase in plasma adrenocorticotropic hormone (ACTH) levels. Diazepam, co-administered with the chamomile oil vapor, further reduced ACTH levels, while flumazenile, a BDZ antagonist blocked the effect of chamomile oil vapor on ACTH. According to Paladini et al. (70), the separation index (ratio between the maximal anxiolytic dose and the minimal sedative dose) for diazepam is 3 while for apigenin it is 10. Compounds, other than apigenin, present in extracts of chamomile can also bind BDZ and GABA receptors in the brain and might be responsible for some sedative effect; however, many of these compounds are as yet unidentified.

Chamomile has been reported in the treatment of generalized anxiety disorder (GAD). But the reports seem contradictory as an earlier report suggests that German chamomile showed significant inhibition of GAD activity (71). The recent results from the controlled clinical trial on chamomile extract for GAD suggests that it may have modest anxiolytic activity in patients with mild to moderate GAD (72). Extracts of chamomile (M. recutita) possess suitable effects on seizure induced by picrotoxin (73). Furthermore, apigenin has been shown to reduce the latency in the onset of picrotoxin-induced convulsions and reduction in locomotor activity but did not demonstrate any anxiolytic, myorelaxant, or anticonvulsant activities (16).

Studies suggest that chamomile ameliorates hyperglycemia and diabetic complications by suppressing blood sugar levels, increasing liver glycogen storage and inhibition of sorbitol in the human erythrocytes (74). The pharmacological activity of chamomile extract has shown to be independent of insulin secretion (75), and studies further reveal its protective effect on pancreatic beta cells in diminishing hyperglycemia-related oxidative stress (76). Additional studies are required to evaluate the usefulness of chamomile in managing diabetes.

The efficacy of lubrication of the endo-tracheal tube cuff with chamomile before intubation on postoperative sore throat and hoarseness was determined in a randomized double-blind study. 161 patients whose American Society of Anesthesiologists (ASA) physical status was I or II, and undergoing elective surgical, orthopedic, gynecological or urological surgeries were divided in two groups. The study group received 10 puffs of chamomile extract (Kamillosan M spray, total 370 mg of Chamomile extract) at the site of the cuff of the endotracheal tube for lubrication, while the control group did not receive any lubrication before intubations. Standard general anesthesia with tracheal intubations was given in both groups. 41 out of 81 patients (50.6%) in the chamomile group reported no postoperative sore throat in the post-anesthesia care unit compared with 45 out of 80 patients (56.3%) in the control group. Postoperative sore throat and hoarseness both in the post-anesthesia care unit and at 24 h post-operation were not statistically different. Lubrication of endo-tracheal tube cuff with chamomile extract spray before intubations can not prevent post operative sore throat and hoarseness (77). Similar results were obtained in another double blind study (78).

Vaginal inflammation is common in women of all ages. Vaginitis is associated with itching, vaginal discharge, or pain with urination. Atrophic vaginitis most commonly occurs in menopausal and postmenopausal women, and its occurrence is often associated with reduced levels of estrogen. Chamomile douche may improve symptoms of vaginitis with few side effects (79). There is insufficient research data to allow conclusions concerning possible potential benefits of chamomile for this condition.

The efficacy of topical use of chamomile to enhance wound healing was evaluated in a double-blind trial on 14 patients who underwent dermabrasion of tattoos. The effects on drying and epithelialization were observed, and chamomile was judged to be statistically efficacious in producing wound drying and in speeding epithelialization (80). Antimicrobial activity of the extract against various microorganisms was also assessed. The test group, on day 15, exhibited a greater reduction in the wound area when compared with the controls (61 % versus 48%), faster epithelialization and a significantly higher wound-breaking strength. In addition, wet and dry granulation tissue weight and hydroxyproline content were significantly higher. The increased rate of wound contraction, together with the increased wound-breaking strength, hydroxyproline content and histological observations, support the use of M. recutita in wound management (81). Recent studies suggest that chamomile caused complete wound healing faster than corticosteroids (82). However, further studies are needed before it can be considered for clinical use.

Essential oils obtained from Roman chamomile are the basic ingredients of aromatherapy. Clinical trials of aromatherapy in cancer patients have shown no statistically significant differences between treated and untreated patients (83). Another pilot study investigated the effects of aromatherapy massage on the anxiety and self-esteem experience in Korean elderly women. A quasi-experimental, control group, pretest-posttest design used 36 elderly females: 16 in the experimental group and 20 in the control group. Aromatherapy massage using lavender, chamomile, rosemary, and lemon was given to the experimental group only. Each massage session lasted 20 min, and was performed 3 times per week for two 3-week periods with an intervening 1-week break. The intervention produced significant differences in the anxiety and self-esteem. These results suggest that aromatherapy massage exerts positive effects on anxiety and self-esteem (8486). However, more objective, clinical measures should be applied in a future study with a randomized placebo-controlled design.

A relatively low percentage of people are sensitive to chamomile and develop allergic reactions (87). People sensitive to ragweed and chrysanthemums or other members of the Compositae family are more prone to develop contact allergies to chamomile, especially if they take other drugs that help to trigger the sensitization. A large-scale clinical trial was conducted in Hamburg, Germany, between 1985 and 1991 to study the development of contact dermatitis secondary to exposure to a mixture of components derived from the Compositae family. Twelve species of the Compositae family, including German chamomile, were selected and tested individually when the mixture induced allergic reactions. During the study, 3,851 individuals were tested using a patch with the plant extract (88). Of these patients, 118 (3.1%) experienced an allergic reaction. Further tests revealed that feverfew elicited the most allergic reactions (70.1% of patients) followed by chrysanthemums (63.6%) and tansy (60.8%). Chamomile fell in the middle range (56.5%). A study involving 686 subjects exposed either to a sesquiterpene lactone mixture or a mixture of Compositae extracts led to allergic reactions in 4.5% of subjects (89). In another study it was shown that eye washing with chamomile tea in hay fever patients who have conjunctivitis exacerbates the eye inflammation, whereas no worsening of eye inflammation was noted when chamomile tea was ingested orally (90). Chamomile is listed on the FDA's GRAS (generally recognized as safe) list. It is possible that some reports of allergic reactions to chamomile may be due to contamination of chamomile by "dog chamomile," a highly allergenic and bad-tasting plant of similar appearance. Evidence of cross-reactivity of chamomile with other drugs is not well documented, and further study of this issue is needed prior to reaching conclusions. Safety in young children, pregnant or nursing women, or those with liver or kidney disease has not been established, although there have not been any credible reports of toxicity caused by this common beverage tea.

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Eastern Pennsylvania | About Us | Arthritis Foundation

Friday, September 16th, 2016

The Arthritis Foundation is the largest and most trusted nonprofit organization dedicated to conquering the challenges of people with arthritis, the nations leading cause of disability.

The Arthritis Foundation is the Champion of Yes. We lead the fight for the arthritis community and help conquer everyday battles through life-changing information and resources, access to optimal care, advancements in science and community connections. Our goal is to chart a winning course, guiding families in developing personalized plans for living a full life and making each day another stride towards a cure.

Reach

The Arthritis Foundation, NortheastRegion serves New York, New Jersey, and portions of Pennsylvania.

Prevalence

Arthritis is a serious and growing health crisis, striking 50 million Americans (one in every five adults) and about 300,000 children. In the Northeast Region, 7 million adults and 32,000 children are diagnosed with arthritis. It is a complex and incurable condition; two major types of arthritis alone osteoarthritis and rheumatoid arthritis cost the U.S. economy more than $156 billion annually in lost wages and medical expenses.

Core Areas

Help & Support Our goal is to help those with arthritis live life to its fullest easing their pain and illuminating a path toward wellness. Through personalized information and support, we expertly guide individuals affected by arthritis in developing a customized plan for how to say Yes and make every step another victory.

Advocacy & Access We are the authority on arthritis and have a strong voice at the state and federal levels. In telling the untold stories of those with arthritis to insurers and regulators, we work to make sure that all people with arthritis have access to optimal care and game-changing medicine. Through the Arthritis Foundations effective and committed nationwide advocacy network now more than 100,000 members strong we are working to address key issues on both the state and federal levels with lawmakers, insurers, employers and providers.

Scientific Discovery Finding a cure for arthritis is, and always will be, a priority for the Arthritis Foundation. Science and technology is advancing every day, and the optimism and energy we pour into research and scientific discovery are helping pave the path toward progress. Last year, more than $1.8 million was provided in funding to local researchers within the New England Region.

Juvenile Arthritis The needs of families living with juvenile arthritis (JA) are unique and urgent. In the United States, an estimated 300,000 children have JA or other rheumatic conditions. Multiply that by their parents, siblings, extended family and others, and the number of people affected is astronomical. For almost seven decades, the Arthritis Foundation has upheld our unwavering promise to assist them and their caregivers. Were boldly leading the JA fight, ensuring easy access to life-changing resources, community and care.

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Osteoarthritis Symptoms and Causes | Information about …

Wednesday, September 7th, 2016

Often called "wear and tear" arthritis, osteoarthritis (OA) is the most common form of arthritis in the U.S. In most cases, over time, cartilage in joints breaks down, and OA symptoms begin to occur. OA is most commonly found in the:

Wrists, elbows, shoulders, and ankles can also be affected by OA, but this occurs less frequently. When OA is found in these joints, there may have been a history of injury or stress to that joint.

Typically, OA comes on slowly. For many, the first signs are joints that ache after physical work or exercise. As the disease progresses, other most common symptoms include:

If you are experiencing any of these symptoms, it's important to talk to your doctor to find out if you have OA.

OA most often occurs in the following areas:

Knees Because knees are primarily weight-bearing joints, they are very commonly affected by OA. If you have OA in your knees, you may feel that these joints are stiff, swollen, and painful, making it hard to walk, climb, and get in and out of chairs and bathtubs.

Hips OA in the hip can cause pain, stiffness, and severe disability. Hips both support the weight of the body and enable movement of your lower body. When you have OA in your hips, you may also feel the pain in your groin, inner thigh, or knees. OA in the hip can lead to difficulty moving, bending, and walking.

Fingers and Hands When OA occurs in hands and fingers, the base of the thumb joint is commonly affected and people experience stiffness, numbness, and aching. Other symptoms of hand and finger OA include:

Spine If you have OA of the spine, you may experience stiffness and pain in the neck or in the lower back. Sometimes arthritis-related changes in the spine can put pressure on the nerves, causing weakness or numbness in your arms or legs.

While the exact cause of OA is unknown, joint damage can be due to repetitive movement (also known as "wear and tear"). It can also begin as the result of an injury. Either way, with OA there's erosion of the cartilage, the part of the joint that covers the ends of the bones.

Here are some factors that may increase your risk of developing OA:

Age Age is the strongest risk factor for OA. Although OA can start in young adulthood, in these cases, it is often due to joint injury.

Gender OA affects both men and women. However, before age 45, OA occurs more frequently in men; after age 45, OA is more common in women.

Joint injury or overuse caused by physical labor or sports Traumatic injury to a joint increases your risk of developing OA in that joint. Joints that are used repeatedly in certain jobs may be more likely to develop OA because of injury or overuse.

Obesity The chances of getting OA generally increase with the amount of weight the bodys joints have to bear. The knee is particularly affected because it is a major weight-bearing joint.

Joint Alignment People with joints that dont move or fit together correctly, like bowlegs, dislocated hips, or double-jointedness, are more likely to develop OA in those joints.

Heredity An inherited defect in one of the genes responsible for manufacturing cartilage may be a contributing factor in developing OA.

If you experience joint pain, stiffness, and/or swelling that won't go away, you should make an appointment to see your doctor. Your doctor will be able to determine if you have arthritis and, if so, what type.

When you see your doctor about your symptoms, he or she may ask questions about when and how you started experiencing them. The doctor will probably give you a physical examination to check your general health, and examine the joints that are bothering you.

You may also need other tests to help confirm the diagnosis of OA and determine the extent and severity of joint damage. Some of these may include:

If you are experiencing some of these symptoms, the sooner you talk to your doctor, the sooner you may get diagnosed and get treatment.

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Arthritis Symptoms, Treatment, Causes – Is there an arthritis …

Wednesday, September 7th, 2016

Is there an arthritis diet?

For most forms of arthritis, diets play little or no role in precipitating or exacerbating the condition. However, in general, oils of fish have been shown to have anti-inflammatory properties. Some arthritis suffers benefit from omega-3 fatty acid supplements. Some feel they benefit from the curcumin that is present in curry foods.

Gout is a particular type of arthritis that is clearly diet-related. Foods that are high in purines, especially red meats and shellfish, can worsen the condition. Moreover, certain foods elevate the levels of uric acid, including alcohol (especially beer) and those foods containing high amounts of fructose (such as the corn syrup found in soft drinks). For people with celiac disease, gluten-containing foods (wheat, barley, rye) can worsen joint pains.

With the exception of the unique metabolic form of arthritis in gout and celiac disease, there are no universally accepted foods that must be avoided by people with arthritis. Gout can be promoted and precipitated by dehydration as well as fructose-containing foods (corn syrup, etc.), high-purine foods (seafood, shellfish, organ meats), and alcoholic beverages (particularly beer). People with gout should avoid these foods. The arthritis of celiac disease can be worsened by intake of gluten-containing foods (wheat, barley, rye).

Medically Reviewed by a Doctor on 5/17/2016

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What is Rheumatoid Arthritis?

Wednesday, September 7th, 2016

Rheumatoid arthritis (RA) is an autoimmune disease where the body's immune system attacks normal joint tissues, causing inflammation of the joint lining.

This inflammation of the joint lining (called the synovium) can cause pain, stiffness, swelling, warmth, and redness. The affected joint may also lose its shape, resulting in loss of normal movement. RA is an ongoing disease, with active periods of pain and inflammation, known as flares, alternating with periods of remission, when pain and inflammation disappear.

RA can affect many different joints. In some people, it can even affect parts of the body other than the joints, including the eyes, blood, the lungs, and the heart.

Although RA is often a chronic disease, the severity and duration of symptoms may unpredictably come and go. With RA, people experience periods of increased disease activity, called flare-ups or flares, alternating with periods when the symptoms fade or disappear, called remission.

If you experience some of these symptoms, you may want to talk to your doctor:

As RA progresses, about 25% of people with the disease develop small lumps of tissue under the skin, called rheumatoid nodules, which can vary in size. Usually, they are not painful.

If you are experiencing any of the symptoms described above, it is important to find out from a doctor if you have RA.

The exact causes of RA are unknown. But research has shown that several factors may contribute to the development of RA:

Rheumatoid arthritis can cause joint inflammation, which can affect the ability to go about your daily activities. If left untreated, RA can worsen and destroy joints. After the onset of the disease, some of the effects of RA are as follows:

If you have persistent discomfort and swelling in multiple joints on both sides of your body, make an appointment to see your doctor. Early diagnosis and treatment can help slow disease progression.

When you see your doctor about your symptoms, he or she may ask questions about your medical history and examine the joints that are bothering you. Your doctor will also decide if you need other tests to help confirm the diagnosis of RA and determine the extent and severity of joint damage. These may include:

Blood Tests

X-rays

If you have joint pain, stiffness, and/or swelling that won't go away, you may have arthritis. Talk with your doctor about your symptoms.

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Arthritis Symptoms, Treatment, Causes – MedicineNet

Wednesday, September 7th, 2016

What is the treatment for arthritis?

The treatment of arthritis is very dependent on the precise type of arthritis present. An accurate diagnosis increases the chances for successful treatment. Treatments available include physical therapy, home remedies, splinting, cold-pack application, paraffin wax dips, anti-inflammatory medications, pain medications (ranging from acetaminophen [Tylenol] to narcotics), immune-altering medications, biologic medications, and surgical operations. For treatments of particular forms of arthritis, see the corresponding articles for the form of arthritis of interest.

The outlook for patients with arthritis depends on its severity, complications, and whether or not there are non-joint manifestations of the disease. For example, rheumatoid arthritis can affect the lungs, kidneys, eyes, etc. Chronic joint inflammation can lead to permanent damage to the joint and loss of joint function, making movement difficult or impossible.

Since most forms of arthritis are inherited to some degree, there is no real way to prevent them. Arthritis that follows joint injury could be prevented by adhering to safety regulations and trying to avoid becoming injured. Arthritis related to infection (for examples, septic arthritis, reactive arthritis, Whipple's disease) could be prevented by not becoming infected with the causative organism. The extent to which this is possible varies depending upon the individual condition.

Medically Reviewed by a Doctor on 5/17/2016

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9 Ways to Get Relief from Arthritis Pain Naturally

Wednesday, September 7th, 2016

Arthritis Pain

Arthritis is a painful and degenerative condition marked by inflammation in the joints that causes stiffness and pain. Osteoarthritis, the most common type of arthritis, gets worse with age and is caused by wear and tear over the years.

Doctors traditionally treat arthritis with anti-inflammatory medications and painkillers. However, some medications cause side effects, and a natural approach to pain relief is becoming more popular. Remember to consult your doctor before trying these natural remedies.

Your weight can make a big impact on the amount of pain you experience from arthritis. Extra weight puts more pressure on your jointsespecially your knees, hips, and feet.

Reducing the stress on your joints by losing weight will improve your mobility, decrease pain, and prevent future damage to your joints.

There are more benefits to exercise than just weight loss. Regular movement helps to maintain flexibility in your joints. Weight-bearing exercises like running and walking can be damaging. Instead, try low-impact exercises like water aerobics or swimming to flex your joints without adding further stress.

Simple hot and cold treatments can make a world of difference when it comes to arthritis pain. Long, warm showers or bathsespecially in the morninghelp ease stiffness in your joints. Use an electric blanket or heating pad at night to keep your joints loose and use moist heating pads.

Cold treatments are best for relieving joint pain. Wrap a gel ice pack or a bag of frozen vegetables in a towel and apply it to painful joints for quick relief.

Injections for knee pain. Compare your options

Acupuncture is an ancient Chinese medical treatment that involves inserting thin needles into specific points on your body. This is supposed to re-route energies and restore balance in your body.

It is thought that acupuncture has the ability to reduce arthritis pain. If you want to try this treatment method, be sure to find an experienced acupuncturist with good references.

Meditation and relaxation techniques may be able to help you reduce pain from arthritis by reducing stress and enabling you to cope with it better. According to the National Institutes of Health (NIH), studies have found that the practice of mindfulness meditation is helpful for some people with painful joints. Researchers also found that those with depression and arthritis benefitted the most from meditation.

Everyone needs omega-3 fatty acids in their diets for optimum health. However, these fats may also help your arthritis. Fish oil supplements, which are high in omega-3s, may help reduce joint stiffness and pain.

Another fatty acid that can help is gamma-linolenic acid, or GLA. Its found in the seeds of certain plants like evening primrose, borage, hemp, and black currants. You can also buy the oils of the seeds as a supplement. However, be sure to check with your doctor before taking them.

Turmeric, the yellow spice common in Indian dishes, contains a chemical called curcumin that may be able to reduce arthritis pain. The secret is its anti-inflammatory properties.

The NIH reports that turmeric given to lab rats reduced inflammation in their joints. Research on humans is scarce, but it cant hurt to add this tasty spice to your dinners.

According to the Arthritis Foundation, regular massaging of arthritic joints can help reduce pain and stiffness, and improve your range of motion. Work with a physical therapist to learn self-massage, or schedule appointments with a massage therapist regularly.

Hear from real patients who treated their knee pain with injectables

Your massage therapist should be experienced with working on people who have arthritis. Check with your doctor for a recommendation.

There are many kinds of herbal supplements on the market that claim to be able to reduce joint pain. Some of the herbs touted for arthritis pain include boswellia, bromelain, devils claw, ginkgo, stinging nettle, and thunder god vine.

Always talk to your doctor before trying a new supplement to avoid side effects and dangerous drug interactions.

Were unable to offer personal health advice, but weve partnered with trusted telehealth provider Amwell, who can connect you with a doctor. Try Amwell telehealth for $1 by using the code HEALTHLINE.

If you're facing a medical emergency, call your local emergency services immediately, or visit the nearest emergency room or urgent care center.

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Arthritis | University of Maryland Medical Center

Thursday, August 4th, 2016

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Arthritis is inflammation of one or more joints. A joint is the area where two bones meet. There are over 100 different types of arthritis.

Joint inflammation; Joint degeneration

Arthritis involves the breakdown of cartilage. Normal cartilage protects a joint and allows it to move smoothly. Cartilage also absorbs shock when pressure is placed on the joint, such as when you walk. Without the normal amount of cartilage, the bones rub together. This causes, swelling (inflammation), and stiffness.

Joint inflammation may result from:

In most cases, the joint inflammation goes away after the cause goes away or is treated. Sometimes it does not. When this happens, you have chronic arthritis. Arthritis may occur in men or women. Osteoarthritis is the most common type.

Other, more common types of arthritis include:

Arthritis causes joint pain, swelling, stiffness, and limited movement. Symptoms can include:

The health care provider will perform a physical exam and ask questions about your medical history.

The physical exam may show:

Some types of arthritis may cause joint deformity. This may be a sign of severe, untreated rheumatoid arthritis.

Blood tests and joint x-rays are often done to check for infection and other causes of arthritis.

Your doctor may also remove a sample of joint fluid with a needle and send it to a lab to be checked.

The goal of treatment is to reduce pain, improve function, and prevent further joint damage. The underlying cause often cannot be cured.

LIFESTYLE CHANGES

Lifestyle changes are the preferred treatment for osteoarthritis and other types of joint swelling. Exercise can help relieve stiffness, reduce pain and fatigue, and improve muscle and bone strength. Your health care team can help you design an exercise program that is best for you.

Exercise programs may include:

Your health care provider may suggest physical therapy. This might include:

Other things you can do include:

Apply capsaicin cream over your painful joints. You may feel improvement after applying the cream for 3 to 7 days.

Lose weight, if you are overweight. Weight loss can greatly improve joint pain in the legs and feet.

MEDICINES

Medicines may be prescribed along with lifestyle changes. All medicines have some risks. You should be closely followed by a doctor when taking arthritis medicines.

Over-the-counter medicines:

Prescription medicines:

It is very important to take your medicines as directed by your doctor. If you are having problems doing so (for example, because of side effects), you should talk to your doctor. Also make sure your doctor knows about all the medicines you are taking, including vitamins and supplements bought without a prescription.

SURGERY AND OTHER TREATMENTS

In some cases, surgery may be done if other treatments have not worked. This may include:

A few arthritis-related disorders can be completely cured with proper treatment.

Most forms of arthritis however are long-term (chronic) conditions.

Complications of arthritis include:

Call your doctor if:

Your joint pain persists beyond 3 days.

You have severe unexplained joint pain.

The affected joint is significantly swollen.

You have a hard time moving the joint.

Your skin around the joint is red or hot to the touch.

You have a fever or have lost weight unintentionally.

Early diagnosis and treatment can help prevent joint damage. If you have a family history of arthritis, tell your doctor, even if you do not have joint pain.

Avoiding excessive, repeated motions may help protect you against osteoarthritis.

Hunter DJ, Lo GH. The management of osteoarthritis: an overview and call to appropriate conservative treatment. Med Clin North Am. 2009;93:127-43, xi.

Huizinga TW, Pincus T. In the clinic. Rheumatoid arthritis. Ann Intern Med. 2010 Jul 6;153(1):ITC1-1-ITC1-15.

Neustadt DH. Osteoarthritis. In: Bope ET, Kellerman RD, eds. Conn's Current Therapy 2013. 1st ed. Philadelphia, Pa: Saunders Elsevier; 2012:chap 9.

ODell JR. Treatment of Rheumatoid Arthritis. In: Firestein GS, Budd RC, Gabriel SE, et al, eds. Kelley's Textbook of Rheumatology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2012:chap 71.

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Arthritis – Lab Tests Online

Thursday, August 4th, 2016

Arthritis is the of one or more . Classic symptoms of arthritis include joint pain, swelling, stiffness, and redness. However, there are over 100 types of arthritis with varying manifestations.

Arthritis may be due to gradual wear and tear on the joints or result from an autoimmune disorder. It may be triggered by injury (such as a fracture) or infection (, , or ). A person may have more than one type of arthritis.

Arthritis affects both sexes and all ethnicities. Most types are more common in adults, but arthritis can occur at any age and can affect joints in many different parts of the body. Some specific types of arthritis include:

Some organizations classify fibromyalgia, Sjogren syndrome, scleroderma, and lupus (SLE) as types of arthritis as well.

Laboratory tests can be useful in diagnosing these forms of arthritis and/or ruling out other conditions that may cause similar symptoms. For more detailed information on these, click on the linked condition name to go to that article.

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An Overview of Arthritis

Thursday, August 4th, 2016

Hero Images/Digital Vision/Getty Images

Updated December 10, 2014.

Certain arthritic conditions can affect parts of the body other than the joints. For example, tendons, muscles, and skin can become inflamed and painful.

Some rheumatic conditions can affect internal organs and result in debilitating or even life-threatening complications.

The two most common types of arthritis are osteoarthritis and rheumatoid arthritis. While they are both classified as arthritis, osteoarthritis and rheumatoid arthritis are very different and must be distinguished.

Many people believe arthritis is a disease that only affects old people. In fact, arthritis can affect anyone at any age, including children. The incidence of arthritis increases with age, but nearly 3 out of 5 people with arthritis are under age 65.

If left undiagnosed and untreated, many types of arthritis can cause irreversible damage to the joints, bones, organs, and skin. It is essential to be diagnosed early in the course of the disease and treated appropriately. Knowing your type of arthritis is essential.

Osteoarthritis, also known as degenerative joint disease, results from wear and tear on the joint. Cartilage damage develops which can lead to decreased joint function. The first signs of osteoarthritis are:

Usually, osteoarthritis onset is subtle and gradual, involving one or only a few joints. The joints most often affected are the:

The risk of developing osteoarthritis increases with age. Other risk factors include: joint injury, obesity, and repetitive use of the joint.

Rheumatoid arthritis is an autoimmune disease which occurs when the body's own immune system mistakenly attacks the synovium (cell lining inside the joint). Rheumatoid arthritis is an inflammatory type of arthritis, chronic and potentially disabling. The first signs of the disease are:

While the cause remains elusive, doctors suspect that genetic factors play some role in predisposition to the disease. But there is more than genetic predisposition. It is thought that there are also environmental triggers for rheumatoid arthritis.

Juvenile arthritis is a general term for all types of arthritis that occur in children, 16 years old or younger. Juvenile rheumatoid arthritis is the most prevalent type of arthritis in children. There are three major types of JRA:

Signs and symptoms of juvenile rheumatoid arthritis vary from child to child. No single test can conclusively establish a diagnosis. Juvenile arthritis must be present consistently for six or more consecutive weeks before a correct diagnosis can be made.

Psoriatic arthritis is similar to rheumatoid arthritis. About 5% of people with psoriasis (a chronic skin disease) also develop psoriatic arthritis. In psoriatic arthritis, there is inflammation of the joints and sometimes the spine.

Fibromyalgia syndrome is a painful condition characterized by:

Fibromyalgia is characterized by pain in the muscles, ligaments and tendons. Fibromyalgia is a type of soft tissue or muscular rheumatism and does not cause joint deformities.

Gout is a painful type of arthritis that causes sudden, severe attacks of pain, tenderness, redness, warmth, and swelling in the joints, especially the big toe. The pain and swelling associated with gout are caused by uric acid crystals that precipitate out of the blood and are deposited in the joint.

Pseudogout, which is also known as Calcium Pyrophosphate Dihydrate Deposition Disease (CPPD), is caused by deposits of calcium phosphate crystals (not uric acid) in the joints. CPPD is often mistaken for gouty arthritis. Since CPPD is a different disease than gout, treatment is not the same.

Scleroderma is a disease of the body's connective tissue that causes thickening and hardening of the skin. It can also affect the:

There are two types of scleroderma: localized and generalized (systemic).

Systemic lupus erythematosus (SLE) is an autoimmune disease that can involve the:

Symptoms vary, but may include skin rash, arthritis, fever, anemia, fatigue, hair loss, mouth ulcers, and kidney problems. Symptoms usually first appear in women of childbearing age, but, can occur in children or older people. About 90% of people affected are women.

Carpal tunnel syndrome is caused by pressure on the median nerve at the wrist which causes tingling and numbness in the fingers. It can begin suddenly or gradually and can be associated with other diseases, such as rheumatoid arthritis -- or it may be unrelated to other disorders.

Ankylosing spondylitis, a chronic inflammatory disease of the spine, can cause the vertebrae to fuse, producing a rigid spine. Other joints, besides the spine, may become involved.

Spondylitis is a result of inflammation which usually starts in tissue outside the joint. Common, early symptoms of spondylitis involve low back pain and stiffness which may continue for months.

The exact cause is still unknown, but, most people with spondylitis have a genetic marker known as HLA-B27. Having this genetic marker does not mean a person will develop spondylitis, but people with the marker are more likely to develop the disease. Ankylosing spondylitis usually affects men between the ages of 16 and 35, but it can also affect women.

Bursitis is a condition caused by inflammation of the bursa sacs. Bursae are the fluid-filled sacs located in the areas where muscles and tendons glide over the bones. Tendinitis, also spelled tendonitis, is characterized by inflammation of a tendon. Tendons connect muscles to bones.

Infectious arthritis is a form of joint inflammation caused by bacteria, viruses or fungi. Diagnosis is made by culturing the organism from the joint.

Reactive arthritis, also called Reiter's syndrome, involves inflammation in the joints, and sometimes where ligaments and tendons attach to bones.

Sjogren's syndrome is characterized by dysfunction of the moisture-producing glands causing dryness of the mouth and eyes. Other parts of the body may also be affected, resulting in a wide range of symptoms.

Osteoporosis results in loss of bone tissue, leaving bones less dense and prone to fracture. Osteoporosis is a silent disease that can often be prevented.

Sources:

Arthritis: Timely Treatments for An Ageless Disease, FDA Consumer, May-June 2000

Do I Have Arthritis? NIAMS. March 2010.

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Richardson TX Rheumatologist Doctors – Arthritis: Facts on …

Thursday, August 4th, 2016

2

Allan D. Duby North Texas Rheumatology Associates 7920 Belt Line Rd Ste 540 Dallas, TX 75254 (972) 239-2301

3

Marian E. Sackler Arthritis Centers Of Texas 712 N Washington Ave Ste 300 Dallas, TX 75246 (214) 823-6503

4

Alex Limanni Arthritis Centers Of Texas 712 N Washington Ave Ste 300 Dallas, TX 75246 (214) 823-6503

5

Himanshu R. Patel Arthritis Centers Of Texas 712 N Washington Ave Ste 300 Dallas, TX 75246 (214) 823-6503

6

Priya K. Nair Arthritis Centers Of Texas 712 N Washington Ave Ste 300 Dallas, TX 75246 (214) 823-6503

7

Dianne L. Petrone Arthritis Centers Of Texas 712 N Washington Ave Ste 300 Dallas, TX 75246 (214) 823-6503

8

John J. Willis Arthritis Centers Of Texas 712 N Washington Ave Ste 300 Dallas, TX 75246 (214) 823-6503

9

Leyka M. Barbosa North Texas Joint Care 7777 Forest Ln Ste C610 Dallas, TX 75230 (972) 566-6599

10

Robert J. Meador Jr Health Texas Provider Ntwk 601 Clara Barton Blvd Ste 300 Garland, TX 75042 (972) 494-6235

11

Kasturi Inaganti Health Texas Provider Ntwk 601 Clara Barton Blvd Ste 300 Garland, TX 75042 (972) 494-6235

12

Supriya Sehgal North Texas Urology 2821 E President George Bush Hwy Ste 305 Richardson, TX 75082 (972) 235-3248

13

Yijun Fan Texas Medical & Surgical Assocs 8440 Walnut Hill Ln Ste 400 Dallas, TX 75231 (214) 345-1400

14

Riteesha G. Reddy Arthritis Care & Diagnostic Center 8440 Walnut Hill Ln Ste 340 Dallas, TX 75231 (214) 696-1600

15

Alan L. Brodsky Arthritis Care & Diagnostic Center 8440 Walnut Hill Ln Ste 340 Dallas, TX 75231 (214) 696-1600

16

Don E. Cheatum Texas Medical & Surgical Assocs 8440 Walnut Hill Ln Ste 400 Dallas, TX 75231 (214) 345-1400

17

Scott J. Zashin Scott J Zashin MD 8230 Walnut Hill Ln Ste 614 Dallas, TX 75231 (214) 363-2812

18

Lige B. Rushing Jr Lige B Rushing Jr MD MS PA 8210 Walnut Hill Ln Ste 120 Dallas, TX 75231 (214) 368-3611

19

Pooja Banerjee North Texas Rheumatology 8220 Walnut Hill Ln Ste 414 Dallas, TX 75231 (469) 916-0677

20

Janine Shinn Rheumatology Associates 8144 Walnut Hill Ln Ste 800 Dallas, TX 75231 (214) 540-0700

21

Richard L. Stern Rheumatology Associates 3200 N Macarthur Blvd Ste 104 Irving, TX 75062 (214) 540-0700

22

Janet E. Maffei Rheumatology Associates 8144 Walnut Hill Ln Ste 800 Dallas, TX 75231 (214) 540-0700

23

Robert N. Jenkins Rheumatology Associates 3200 N Macarthur Blvd Ste 104 Irving, TX 75062 (214) 540-0700

24

Imran Iqbal Rheumatology Associates 1200 Medical Ave Ste 103 Plano, TX 75075 (214) 540-0700

25

Roy M. Fleischmann Rheumatology Associates 3200 N Macarthur Blvd Ste 104 Irving, TX 75062 (214) 540-0700

26

Talat J. Kheshgi Rheumatology Associates 1200 Medical Ave Ste 103 Plano, TX 75075 (214) 540-0700

27

Sharad Lakhanpal Rheumatology Associates 3200 N Macarthur Blvd Ste 104 Irving, TX 75062 (214) 540-0700

28

Thomas D. Geppert Rheumatology Associates 3200 N Macarthur Blvd Ste 104 Irving, TX 75062 (214) 540-0700

29

Margarita Fallena Rheumatology Associates 8144 Walnut Hill Ln Ste 800 Dallas, TX 75231 (214) 540-0700

30

Jasmine E. McElhany Rheumatology Associates 1200 Medical Ave Ste 103 Plano, TX 75075 (214) 540-0700

31

Susan K. Chrostowski Rheumatology Associates 1200 Medical Ave Ste 103 Plano, TX 75075 (214) 540-0700

32

Stanley B. Cohen Rheumatology Associates 3200 N Macarthur Blvd Ste 104 Irving, TX 75062 (214) 540-0700

33

Virginia Reddy Rheumatology Associates 901 W Wall St Ste 103 Grapevine, TX 76051 (214) 540-0700

34

Catalina Orozco Rheumatology Associates 3200 N Macarthur Blvd Ste 104 Irving, TX 75062 (214) 540-0700

35

Mary B. Decardenas Rheumatology Associates 8144 Walnut Hill Ln Ste 800 Dallas, TX 75231 (214) 540-0700

36

Jack B. Vine Rheumatology Associates 3200 N Macarthur Blvd Ste 104 Irving, TX 75062 (214) 540-0700

37

Zoran Kurepa Rheumatology Associates 3200 N Macarthur Blvd Ste 104 Irving, TX 75062 (214) 540-0700

38

Kathryn H. Dao Arthritis Care & Research Center 9900 N Central Expy Ste 550 Dallas, TX 75231 (214) 373-4321

39

John J. Cush Arthritis Care & Research Center 9900 N Central Expy Ste 550 Dallas, TX 75231 (214) 373-4321

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Dannette S. Johnson Arthritis Care & Research Center 9900 N Central Expy Ste 550 Dallas, TX 75231 (214) 373-4321

41

Leilani D. Law Arthritis Care & Research Center 9900 N Central Expy Ste 550 Dallas, TX 75231 (214) 373-4321

42

Mary Cardenas Rheumatology Associates 1200 Medical Ave Ste 103 Plano, TX 75075 (214) 540-0700

43

Jean A. Clark Rheumatology Associates 1200 Medical Ave Ste 103 Plano, TX 75075 (214) 540-0700

44

Wassila Amari Dallas Diagnostic Association Park Cities 9101 N Central Expy Ste 300 Dallas, TX 75231 (214) 319-0000

45

Su Yin Health Texas Provider Ntwk 4716 Alliance Blvd Ste 500 Plano, TX 75093 (469) 800-6000

46

Armine Tumyan Health Texas Provider Ntwk 4716 Alliance Blvd Ste 500 Plano, TX 75093 (469) 800-6000

47

Andrea G. Landon Texas Rheumatology Care 6300 Stonewood Dr Ste 412 Plano, TX 75024 (469) 467-2478

48

Fehmida Zahabi Texas Rheumatology Care 6300 Stonewood Dr Ste 412 Plano, TX 75024 (469) 467-2478

49

Ziaullah Virk Ochsner Clinic 9001 Summa Ave Baton Rouge, LA 70809 (225) 761-5200

50

Mohan Penmetcha Mohan Penmetcha MD 4217 Marsh Ridge Rd Ste 110 Carrollton, TX 75010 (972) 307-3456

51

Ghufran Ahmed AIM For Wellness 2100 Hedgcoxe Rd Ste 100 Plano, TX 75025 (972) 801-3600

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