Archive for the ‘valium’ Category
Sunday, February 15th, 2009
Generally, gout progresses through four stages. During the first stage, a patient has elevated levels of uric acid in the blood (hyperuricemia) but no other signs or symptoms. At this stage, called asymptomatic hyperuricemia, patients seldom require treatment. In addition, not all people with hyperuricemia go on to develop gout.
The second stage of gout is called acute gouty arthritis. It occurs when the patient suddenly experiences a hot, red, swollen joint, caused by the formation of uric acid crystals between the joints. In most cases, the big toe (a condition once known as podagra) or the knee is affected.
The attack often occurs at night and in a single joint, with the pain becoming more severe. When a single joint is involved, the condition is called monoarticular gout. The pain may grow so intense that even a bed sheet on the joint can cause pain. Chills and a mild fever along with a general feeling of malaise may also accompany the severe pain and inflammation.
Monoarticular gout occurs more often in middle-aged patients and usually involves one joint in the lower limbs, especially the big toe (hallux).
Even without treatment, the first episode often disappears spontaneously within three to 10 days, but prompt treatment can abort the attack in a few hours. Although the pain and swelling disappear, gouty arthritis almost always returns in the same joint or in another one.
A patient is usually symptom-free for a period of time. During this third stage, called interval or intercritical gout, a patient does not have any symptoms and has normal function of the joints. The next attack usually occurs within two years, followed by additional attacks thereafter.
If left untreated, the interval between attacks may shorten and they may become increasingly severe and prolonged. Over time, the attacks can begin to involve multiple joints at once – called polyarticular gout – and may be accompanied by a joint infection (e.g., septic arthritis). Polyarticular gout occurs more often in elderly patients and usually involves the joints in the upper extremities, especially the fingers.
In addition, episodes of acute gouty arthritis can be triggered by circumstances that affect blood levels of uric acid, such as certain chronic illnesses (e.g., diabetes, high blood pressure), injury, surgery, fasting, drinking alcohol, overeating (especially foods rich in purines, such as liver) and taking certain medications (e.g., diuretics, aspirin, immunosuppressives).
People who experience sudden, intense joint pain with fever should see their physician as soon as possible. If gout is left untreated, it can lead to worsening of the pain and permanent joint damage.
When gout goes untreated for several years, it can progress to a condition called chronic tophaceous gout. During this last phase, patients experience chronic pain and inflammation and there is permanent joint damage due to the formation of large masses of uric acid crystals, which also collect in bone and cartilage, such as in the ears. These masses or nodules of crystals are called tophi. They can form near the knuckles and small joints of the fingers and can cause disfigurement. These large masses or lumps may drain and ooze a chalky substance.
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Saturday, February 14th, 2009
Gout, one of the most painful types of arthritis, is often caused by excessive blood levels (above 7 milligrams/deciliter in females and 8 milligrams/deciliter in males) of uric acid (hyperuricemia). But not all people with hyperuricemia will develop gout, and not all people with gout have hyperuricemia. In many cases, the cause of gout is unknown (idiopathic).
Many common conditions are strongly associated with gout, including diabetes, high blood pressure, heart disease, obesity, kidney disease and dyslipidemia (unhealthy levels of cholesterol and other blood fats). In addition, episodes of acute gouty arthritis can be triggered by a number of factors, including stress, minor trauma, infection, heavy consumption of alcohol and surgery. Research suggests that hot, humid weather and dehydration may also trigger attacks.
Physicians have identified the following risk factors for gout:
* Family history. Some people are born with an enzyme defect that makes it hard for the body to break down purines. According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, about 18 percent of gout patients have a family history of the disease.
* Sex and age. Gout occurs more often in men than in women, mostly because women tend to have lower levels of uric acid than men. However, after menopause, women’s levels of uric acid are similar to those of men.
In addition, men are more likely to develop gout earlier, usually between the ages of 30 and 50. Women who develop gout generally do so after menopause. This may be especially true if women are prescribed certain medications, such as diuretics for high blood pressure, heart failure, kidney disease or other conditions.
* Excessive consumption of alcohol. Drinking too much alcohol, especially beer, can interfere with the body’s ability to eliminate uric acid, as well as introduce more purines (which break down into uric acid) into the diet. Some research has also linked heavy consumption of sugary soft drinks to increased risk of gout.
* Excessive consumption of foods rich in purines (e.g., organ meats, meats, seafood). Eating too much of these foods may cause high blood levels of uric acid.
* Long-term use of certain medications. Many medications have been shown to interfere with the body’s ability to eliminate uric acid, often because they affect kidney function, including diuretics, aspirin, levodopa (a treatment for Parkinson’s disease) and immunuosuppressives, such as those taken after an organ transplant.
In addition, chemotherapy for cancer increases the break down of abnormal cells, releasing large amounts of purines into the body that can cause accumulation of uric acid in the blood.
* Genetics. Researchers in 2008 identified three genes that together may increase the risk of gout by up to 40 times: SCLA29, ABCG2 and SLC17A3.
* Anemia. A condition in which the number and volume of red blood cells and the amount of hemoglobin in the blood are lower than normal.
* Lymphoproliferative disorders. Conditions in which cells of the lymphatic system grow excessively, such as leukemia or lymphoma.
* Paget’s disease. A chronic disorder that may result in enlarged or deformed bones.
* Psoriasis. A common skin inflammation characterized by redness, itching, and thick, dry, silvery scales on the skin.
* Exposure to lead. Some studies have linked environmental exposure to lead with gout.
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Friday, February 13th, 2009
Gout is one of the most painful forms of arthritis. It usually develops when there are chronically high levels of uric acid in the blood. Uric acid is the waste product formed from the breakdown of purines. Purines are substances found in all of the body’s tissues as well as in many foods, such as organ meats and seafood.
The uric acid can form into sharp, needle-like crystals that accumulate in the body’s connective tissues, particularly in the joint space between the bones. These deposits of uric acid crystals (called monosodium urate crystals or MSU) produce swelling, redness, heat, pain and stiffness in the joints. The joints are the most commonly affected part of the body, but crystals can also form beneath the skin (called tophi) and in the kidneys (kidney stones) or other parts of the urinary system.
Uric acid normally dissolves in the blood and passes through the kidneys before being eliminated in the urine. People with gout either produce excessive levels of uric acid or their kidneys have a problem eliminating it. This condition is called hyperuricemia and occurs when uric acid reaches or exceeds 7 milligrams/deciliter in the blood. Not all people with hyperuricemia develop gout, and some patients who do develop gout have normal blood levels of uric acid. The reason for this is not thoroughly understood.
Elevated levels of uric acid also increase the risk of fatal heart disease, according to long-term research using data from the National Health and Nutrition Examination Survey (NHANES).
Gout can be primary or secondary. Primary gout occurs on its own and is due to the body’s overproduction of purines in the liver or an inherent inability to eliminate purines in the urine. Primary gout is uncommon.
Secondary gout, which is much more common, is due to an underlying medical condition or the therapy to treat a medical condition. For instance, diuretics (medications used to treat high blood pressure and other conditions) help flush water from the body. These medications can retain uric acid, thus causing levels of uric acid to rise.
Gout is sometimes confused with another form of arthritis called pseudogout because it produces similar symptoms of inflammation and swelling. However, in the latter condition, deposits are made up of calcium phosphate crystals rather than uric acid.
Up to 3 million Americans have gout, according to the American College of Rheumatology. Gout is rare in children and young adults. It is more prevalent in men than women.
Gout is highly treatable. If left untreated, however, it can erode the joints and bones and cause disfigurement. In addition, patients with gout have an increased risk for developing kidney stones because uric acid crystals can also collect in the urinary tract and kidneys, which can impair kidney function.
If gout is properly diagnosed and treated early, most patients experience relief from their symptoms. Patients are advised to seek medical treatment with a rheumatologist because these physicians specialize in the management of gout and other forms of arthritis.
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Thursday, February 12th, 2009
Gout is a very painful form of arthritis that can develop when blood levels of uric acid are chronically high. Uric acid is a substance that normally forms when the body breaks down substances called purines, which are found in the body and consumed in foods.
People with gout either produce too much uric acid or their body has a problem removing it. Gout can occur on its own but it is more often associated with other medical conditions or medications that may interfere with the body’s ability to remove uric acid.
This buildup of uric acid (hyperuricemia) can lead to the development of sharp, needle-like crystals, which can accumulate in the body’s connective tissues. These deposits of uric acid crystals produce swelling, redness, heat, pain and stiffness in the joints.
Joints are most often affected, but uric acid crystals can also accumulate under the skin and in the kidneys and urinary tract. The symptoms of gout are usually severe and can occur without warning, often at night. Such occurrences are called acute gouty arthritis. Symptoms include inflammation, redness and severe joint pain. The large joint of the big toe is usually affected first.
Symptoms may initially disappear within three to 10 days, but if left untreated, gout can lead to increasing pain and joint damage. In some cases, the function of the kidneys and the urinary tract can be affected. People with gout are also more likely to develop kidney stones and other complications.
However, not everyone with high levels of uric acid will develop gout. Although it is not known why some people develop gout and not others, risk factors include family history of gout, excessive consumption of alcohol, diet, frequent use of some medications, and medical conditions including obesity, heart disease, kidney disease and diabetes. In addition, men are much more likely than women to develop gout. Some people may develop gout even with normal levels of uric acid in the blood.
Treatment focuses on reducing joint inflammation, preventing further episodes of acute gouty arthritis and decreasing the high blood levels of uric acid with medication and lifestyle changes (e.g., maintaining a healthy weight, avoiding alcohol and foods high in purines such as organ meats and sardines).
Gout is highly treatable. Most patients who receive prompt treatment and follow guidelines can relieve attacks and sometimes avoid an impending attack. But repetitive attacks can permanently damage joints.
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Wednesday, February 11th, 2009
Preparing questions in advance can help patients have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions about osteoarthritis (OA):
1. Do I have OA or another form of arthritis?
2. What tests might I need to undergo, and what do they involve?
3. What do my test results show?
4. Will my joint pain spread to other joints?
5. What will alleviate my osteoarthritis pain?
6. What forms of exercise are safe for me?
7. Can glucosamine, chondroitin or other supplements help my osteoarthritis? Are there any supplements I should avoid?
8. Can heat therapy, hydrotherapy, electrotherapy, acupuncture or other such treatments help my pain?
9. Will physical therapy or occupational therapy prevent further deterioration?
10. Should I get assistive devices to help my mobility or adaptive equipment to help protect my joints during daily tasks?
11. Am I a candidate for surgery?
12. Is there anything I can do to prevent OA or slow its progression?
13. If I have OA, are my children more likely to get it?
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Tuesday, February 10th, 2009
Weight control and regular exercise as approved by a physician may help prevent osteoarthritis (OA). Practicing good posture and ergonomics and reducing the risk of trauma with safety precautions such as seat belts and athletic equipment may also help.
Some evidence suggests that diet can play a preventive role in OA. In North Carolina, the Johnson County Osteoarthritis Project, described as the largest and longest-term investigation of its kind, found that participants with high amounts of the mineral selenium had less knee OA than people lacking selenium. Selenium is found naturally in soil and in foods grown in soil but varies widely by location. It is also found in seafood, chicken and other meats and is available in supplements.
A deficiency of vitamin K has also been found in people suffering OA. Sources of vitamin K include leafy green vegetables, canola oil, soybean oil and olive oil.
It may also help not to use tobacco. It may also help not to use tobacco. Some research has linked smoking to increased severity of OA.
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Monday, February 9th, 2009
Because osteoarthritis (OA) cannot be cured, treatment concentrates on controlling pain, improving function and slowing the degeneration of joints. Knowledge about the likely course of OA may help people preserve or improve function of joints and learn ways to manage the condition.
Many OA treatment methods may also be used to slow the progress of joint degeneration or prevent further damage. For instance, many lifestyle factors can be adjusted for OA, including getting adequate amounts of sleep, resting when experiencing fatigue, avoiding activities that place stress on the joints and wearing appropriate shoes and clothing.
Regular exercise can help maintain muscle tone and improve flexibility and range of motion for joints. Research indicates that exercise may slow progression of OA and strengthen cartilage in the joints.
Although it is uncertain whether weight loss slows the progression of OA in affected joints, it can alleviate joint stress and pain. One recent study of overweight people with knee OA indicated that every pound shed yielded a four-pound reduction in force on the knees during every step, which could slow the progression of the disease. An analysis of several studies concluded that overweight people with OA could reduce disability by losing only 5 percent of their weight.
OA patients may also benefit from physical therapy or occupational therapy. Physical therapy can improve flexibility, strength, endurance and range of motion. All of these factors may help reduce the symptoms of OA and prevent further deterioration. Physical therapists can also evaluate and provide assistive devices to help with joint stability and movement. These devices can include braces or splints, canes, walkers and electric power lifts.
Occupational therapy can help OA patients with their activities of daily living (ADLs). Occupational therapists (OTs) can evaluate the patient and provide exercises and recommendations on ways to execute tasks such as dressing, bathing and household chores. OTs can provide the patient with adaptive equipment to make activities easier, especially for arthritic hands. Examples of this equipment include reachers, jar openers, adapters to make dressing easier and larger grips for utensils. In addition, an OT can conduct a home assessment to recommend changes (e.g., grab bars in the shower, raised toilet seats) that will make everyday activities easier for individuals with OA.
The following OA treatment methods may also be used for symptomatic relief:
* Heat, cold and water therapies. A physician, physical therapist or occupational therapist can indicate which kind of therapy should be used for treatment. Heat (thermotherapy), such as ultrasound therapy, relieves pain, muscle spasm and stiffness. Cold (cryotherapy) relieves pain and may reduce swelling. Water therapy (hydrotherapy) is often combined with thermotherapy or exercise therapy. People with some medical conditions, such as poor circulation, should not use cold therapy, and conditions such as impaired sensation may rule out use of heat therapy.
* Medication. Many prescription and nonprescription medications are used for OA pain. Some of these include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs). These drugs are used to reduce pain and inflammation. They come in prescription and nonprescription forms and include gels that have demonstrated effectiveness in relieving OA pain in the knees.
- Acetaminophen. This over-the-counter analgesic may relieve mild pain associated with OA.
- Injection therapy. Hyaluronic acid is a synthetic version of the fluid in the joint capsule. A physician may inject it into joints of a patient who does not receive pain relief from noninvasive treatments. Corticosteroids may be injected in cases where OA is confined to a few joints and pain cannot be relieved with NSAIDs. The use of corticosteroid injections for OA is somewhat controversial. Physicians recommend no more than three or four injections a year for weight-bearing joints.
- Topical analgesics. Capsaicin cream, which has the same active substance as hot chili pepper, can lessen the pain for OA patients. A newer kind of NSAID patches are available and may be of some use for pain relief if applied locally.
* Electrical therapy, such as transcutaneous electrical nerve stimulation (TENS). This treatment delivers mild electric current to the skin and stimulates nerves to interfere with transmission of pain signals. It can alleviate pain or modify the perception of pain for OA patients, especially those with knee pain.
* Supplements. Many people use supplements such as glucosamine and chondroitin as complementary and alternative therapies to help relieve the chronic pain of OA. These supplements are not medications and are not regulated by the U.S. Food and Drug Administration (FDA). The studies of their effectiveness have not been conclusive, although most evidence indicates the supplements cause no harm. A study of knee OA sponsored by the National Institutes of Health (NIH) indicated that glucosamine and chondroitin can help relieve moderate to severe pain but in general may be no more effective than a placebo (sugar pill).
* Acupuncture and acupressure. These alternative treatment methods are based on traditional Chinese practices about specific body points that control pain. Acupuncture uses needles inserted at these points. Acupressure applies pressure to the same points but does not involve needles. Studies differ on the value of acupuncture and acupressure for OA pain. Some patients with soft-tissue pain experience relief, but others report no change.
* Surgery. Several types of surgery can correct OA damage. Surgery is usually reserved for the most debilitating cases of OA after other treatments have proven ineffective. Types of surgery include:
- Arthroscopy. A flexible lighted tube is inserted in a joint to remove fragments of bone or cartilage from the joint capsule. It may also be used to remove the lining of the joint capsule (synovectomy). Arthroscopy may not provide much pain relief to OA patients.
- Corrective surgery. May be used on deformed joints and to realign bones (osteotomy).
- Fusion (arthrodesis). Vertebral fusion involves implanting small pieces of the hipbone between the injured vertebrae. Surgeons may fuse bones, usually in the spine, or in other areas where the joints are damaged but joint replacement is not an option (fingers, toes or ankle). A fused joint can bear weight but is no longer flexible.
- Joint replacement surgery (arthroplasty). Damaged joints may be partially or completely replaced. When a joint is completely degenerated, surgeons can replace the entire joint. This is most commonly performed for the knees and hips but can also be used to treat shoulders and some other joints.
Researchers are studying many potential treatments to slow the progression of OA or reduce pain and disability. These include bioengineered implants of a patient’s own cartilage, osteoporosis treatments such as bisphosphonates and the hormone calcitonin, and injections of botulinum toxin type A (Botox).
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Thursday, February 5th, 2009
Diagnosis of osteoarthritis (OA) begins with a review of the patient’s medical history. Focus will be placed on any familial arthritic conditions, previous injuries or surgeries and general use of the joints. A pain assessment may also be used to help identify the nature and severity of the condition. A physical examination that concentrates on the areas of complaint may be completed by a rheumatologist (specialist in arthritis and other inflammatory diseases) or other physician.
The physician will examine the joints and surrounding areas for:
* Pain or tenderness
* Swelling or stiffness
* Reduced range of motion or flexibility
* Instability or difficulty bearing weight
* Crepitus (grating or crackling sound or feeling)
* Bony lumps, nodes or growths
Most diagnostic examinations where OA is suspected will include imaging studies, such as x-rays, MRI (magnetic resonance imaging) or a bone scan. right
Although x-rays and MRI are good indicators of damage to joints, the degree of damage may be unrelated to the intensity of a patient’s symptoms. Physicians use the studies to look for:
* Bony outgrowths (osteophytes)
* Narrowing of the joint capsule
* Hardening or formation of cysts
Laboratory tests cannot diagnose OA. However, blood tests may be used to rule out other forms of arthritis and diseases if needed. These tests may include:
* Rheumatoid factor (RF) test. May indicate rheumatoid arthritis (RA) or other autoimmune conditions.
* Erythrocyte rate (ESR or sed rate). An elevated level in this blood test indicates inflammation, but can be caused by many forms of inflammation or infection. It may be combined with the physician’s clinical findings to confirm conditions such as polymyalgia rheumatica.
* C reactive protein test. An elevated level of this protein produced by the liver suggests an inflammatory disease, such as RA.
Other blood tests may indicate the presence of uric acid, a sign of gout, or the presence of a genetic marker that is seen with some other forms of arthritis.
In some cases, a biopsy or synovial fluid analysis may be completed. These tests may identify or rule out other conditions but cannot diagnose OA.
The combination of findings from lab tests, x-rays and a physical examination may provide a physician with enough information to diagnose OA.
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Wednesday, February 4th, 2009
Most people who experience symptoms of osteoarthritis (OA) have joint pain, limited mobility and stiffness. Many experience stiffness when they wake in the morning, which usually lasts no more than 30 minutes. Stiffness that lasts an hour may be a symptom of rheumatoid arthritis (RA). Joints may become sore when used after periods of inactivity or after exercise. Pain that occurs during activity or exercise usually is relieved by rest.
Patients may experience crepitus, a grating, grinding or crackling sound or sensation in joints affected by OA. Crepitus can be painless or painful.
Symptoms of OA vary, depending on the joints affected. Some of the main symptoms, grouped according to joints, include:
* Fingers. May include pain, swelling or enlargement of finger joints. Bone spurs called Heberden’s nodes (in end joints) and Bouchard’s nodes (in middle joints) may also appear. People may experience difficulty with fine-motor movements such as picking up items or gripping a pen.
* Spine. In the spine, growths on or around the intervertebral discs may cause pain or pressure on Anatomy of the spine includes the cervical spine, thoracic spine, lumbar spine and sacral region.nerves. This may be experienced as pain or stiffness in the neck, arms, lower back or legs. Pinched nerves may produce numbness in the arms or legs. As OA affects the spine, it may lead to other complications such as spinal stenosis, a narrowing of spinal canal.
* Hips. May cause pain in the groin, buttocks or thighs. Hip pain may also cause limping. OA in the hip may cause referred pain, which originates in the hip but is felt in the knee, thigh or lower back.
* Knees. May cause knee pain while moving, walking, using stairs or rising from a chair. OA in the knee may produce a slipping sensation, as if there is no support in the leg. It can also produce creaking or grating sounds when the knee moves.
* Feet and ankles. May cause pain and swelling in the feet, especially the joint at the base of the big toe. It may also cause foot pain while wearing high heel or tight shoes that was not previously experienced with those types of shoes.
For thousands of years, people have perceived a connection between the onset of arthritic pain and changes in weather (usually approaching rain). Such changes were noted as early as 400 B.C. by the ancient Greek physician Hippocrates. Although many people acknowledge a connection, the studies conducted on the phenomenon have not yielded definitive results. These studies may not be representative because they had small groups of subjects and relied on self-reporting methods. Still, many individuals with OA report an increase amount of pain and stiffness before or during a change in weather.
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Tuesday, February 3rd, 2009
Some people consider osteoarthritis (OA) a normal part of aging. The most common cause is the normal “wear and tear” of a joint. Mechanical stress on a joint over time may affect the enzymes (proteins that stimulate chemical reactions) in cartilage, but the exact relationship is unclear.
Some risk factors for OA have been identified. Risk factors make an individual more likely to develop a condition but do not mean the person will get the disease. In addition, people with no risk factors can still develop the disease.
The most common risk factors associated with OA include:
* Age. OA usually develops after age 45 and is most common after age 65.
* Weight. Overweight or obese people are more likely to develop OA.
* Heredity. People with a family member with OA are more likely to develop the disease. Inherited bone abnormalities, such as a malformed joint or defective cartilage, may also increase the likelihood of developing OA. Even a minor difference in leg lengths, a common condition, may increase the risk of knee and hip OA, research has indicated.
* Sex. Although OA is less common before age 55, it occurs equally in both sexes in this age group. After age 55, it is more common in women than men.
* Lifestyle factors. People are more likely to develop OA when they have repetitive motion or stress on a joint from exercise or work conditions. Also, individuals who have long periods of immobilization are at risk for OA.
* Injury. Having a sports injury, such as a torn knee cartilage (meniscus injury) or a fracture near the joint, makes an individual more susceptible to OA. Knee surgeries, such as repair of a torn anterieror cruciate ligament, may increase risk of early OA. Weak muscles in the thighs may lead to the OA in the knees.
* Medical conditions. Diseases that cause a change in the structure or function of joints also increase the likelihood of OA. These include other forms of arthritis, such as rheumatoid arthritis and gout, and hemochromatosis, a condition in which excess iron can get deposited within cartilage causing destruction.
* Nerve disorders. Peripheral neuropathy, a condition that affects the nerves in limbs, may increase the likelihood of OA. Causes of neuropathy include diabetes and alcoholism.
Some research has contradicted the popular notion that cracking the knuckles or other joints contributes to osteoarthritis.
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