ArthritisPedia™ - The Arthritis Encyclopedia

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Arthritis:
Arthritis (from Greek arthro-, joint + -itis, inflammation; plural: arthritides) is a group of conditions involving damage to the joints of the body. Arthritis is the leading cause of disability in people older than fifty-five years.

There are different forms of arthritis; each has a different cause. The most common form of arthritis, osteoarthritis (degenerative joint disease) is a result of trauma to the joint, infection of the joint, or age. Emerging evidence suggests that abnormal anatomy might contribute to the early development of osteoarthritis. Other arthritis forms are rheumatoid arthritis and psoriatic arthritis, autoimmune diseases in which the body attacks itself. Septic arthritis is caused by joint infection. Gouty arthritis is caused by deposition of uric acid crystals in the joint, causing inflammation. There is also an uncommon form of gout caused by the formation of rhomboid crystals of calcium pyrophosphate. This gout is known as pseudogout.

History and Physical Examination:
All arthritides 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. 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.

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 assess severity in a more quantitative manner.

Extra-Articular Features of Joint Disease:
Cutaneous Nodules
Cutaneous Vasculitic Lesions
Lymphadenopathy
Oedema
Ocular Inflammation
Urethritis
Tenosynovitis (Tendon Sheath Effusions)
Bursitis (swollen bursa)
Diarrhea
Orogenital Ulceration

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.

Types of Arthritis:
Primary Forms of Arthritis:
Osteoarthritis - Osteoarthritis (OA, also known as degenerative arthritis, degenerative joint disease), is a clinical syndrome in which low-grade inflammation results in pain in the joints, caused by abnormal wearing of the cartilage that covers and acts as a cushion inside joints and destruction or decrease of synovial fluid that lubricates those joints. As the bone surfaces become less well protected by cartilage, the patient experiences pain upon weight bearing, including walking and standing. Due to decreased movement because of the pain, regional muscles may atrophy, and ligaments may become more lax. OA is the most common form of arthritis, and the leading cause of chronic disability in the United States.

"Osteoarthritis" is derived from the Greek word "osteo", meaning "of the bone", "arthro", meaning "joint", and "itis", meaning inflammation, although many sufferers have little or no inflammation. A common misconception is that OA is due solely to wear and tear, since OA typically is not present in younger people. However, while age is correlated with OA incidence, this correlation merely illustrates that OA is a process that takes time to develop. There is usually an underlying cause for OA, in which case it is described as secondary OA. If no underlying cause can be identified it is described as primary OA. "Degenerative arthritis" is often used as a synonym for OA, but the latter involves both degenerative and regenerative changes.

OA affects nearly 21 million people in the United States, accounting for 25% of visits to primary care physicians, and half of all NSAID (Non-Steroidal Anti-Inflammatory Drugs) prescriptions. It is estimated that 80% of the population will have radiographic evidence of OA by age 65, although only 60% of those will show symptoms. In the United States, hospitalizations for osteoarthritis soared from about 322,000 in 1993 to 735,000 in 2006.

Rheumatoid Arthritis - Rheumatoid arthritis (RA) is a chronic, systemic autoimmune disorder that most commonly causes inflammation and tissue damage in joints (arthritis) and tendon sheaths, together with anemia. It can also produce diffuse inflammation in the lungs, pericardium, pleura, and the sclera of the eye, and also nodular lesions, most common in subcutaneous tissue under the skin. It can be a disabling and painful condition, which can lead to substantial loss of functioning and mobility. It is diagnosed chiefly on symptoms and signs, but also with blood tests (especially a test called rheumatoid factor) and X-rays. Diagnosis and long-term management are typically performed by a rheumatologist, an expert in the diseases of joints and connective tissues.

Various treatments are available. Non-pharmacological treatment includes physical therapy and occupational therapy. Analgesia (painkillers) and anti-inflammatory drugs, as well as steroids, are used to suppress the symptoms, while disease-modifying antirheumatic drugs (DMARDs) are often required to inhibit or halt the underlying immune process and prevent long-term damage. In recent times, the newer group of biologics has increased treatment options.

The name is based on the term "rheumatic fever", an illness which includes joint pain and is derived from the Greek word rheumatos ("flowing"). The suffix -oid ("resembling") gives the translation as joint inflammation that resembles rheumatic fever. The first recognized description of rheumatoid arthritis was made in 1800 by Dr Augustin Jacob Landré-Beauvais (1772-1840) of Paris.

Septic Arthritis - Septic arthritis is the purulent invasion of a joint by an infectious agent which produces arthritis.

The term "suppurative arthritis" is a near synonym for septic arthritis. ("Suppurative" refers to the production of pus, without necessarily implying sepsis.)

ICD-10 uses the term "pyogenic arthritis". Pyogenic also refers to the production of pus.

Reactive arthritis refers to arthritis caused by an immune consequence of an infection, but not directly attributable to the infection itself.

The usual etiology of septic arthritis is bacterial, but viral, mycobacterial, and fungal arthritis occur occasionally. A broader term is "infectious arthritis", which describes arthritis caused by any infectious organism. Viruses can cause arthritis, but it can be hard to determine if the arthritis is directly due to the virus or if the arthritis is reactive.

Septic/suppurative arthritis and "bacterial arthritis" are sometimes considered equivalent, but there are exceptions. For example, Borrelia burgdorferi can cause infectious arthritis, but is not associated with suppurative arthritis.

Gout - Gout (metabolic arthritis) is a disease created by a buildup of uric acid. In this condition, crystals of monosodium urate or uric acid are deposited on the articular cartilage of joints, tendons and surrounding tissues. These crystals cause inflammation and pain, both severe. If untreated, the crystals form tophi, which can cause significant tissue damage. Gout results from a combination of elevated concentrations of uric acid and overall acidity in the bloodstream. In isolation, neither elevated uric acid (hyperuricemia) nor acidity is normally sufficient to cause gout.

Pseudogout - Calcium pyrophosphate deposition disease (CPPD) is a rheumatologic disorder with varied clinical manifestations due to precipitation of calcium pyrophosphate dihydrate crystals in the connective tissues. It is more commonly known by alternative names that specify certain clinical or radiographic findings, although neither is synonymous with CPPD. Pseudogout refers to the clinically evident acute synovitis with red, tender, and swollen joints that may resemble gouty arthritis (a similar condition with joint deposition of monosodium urate crystals). Chondrocalcinosis, on the other hand, refers to the radiographic evidence of calcification in hyaline and/or fibrocartilage. Pyrophosphate arthropathy is a term that may refer to either of the above. Statistically, the interphalangeal joints are the most commonly affected.

Juvenile Idiopathic Arthritis - (JIA) is the most common form of persistent arthritis in children. (Juvenile in this context refers to an onset before age 16, idiopathic refers to a condition with no defined cause, and arthritis is the inflammation of the synovium of a joint.)

JIA is a subset of arthritis seen in childhood, which may be transient and self-limited or chronic. It differs significantly from arthritis commonly seen in adults (osteoarthritis, rheumatoid arthritis), and other types of arthritis that can present in childhood which are chronic conditions (e.g. psoriatic arthritis and ankylosing spondylitis).

Still's Disease - can be one of these:
1. Juvenile Idiopathic Arthritis (JIA) is the most common form of persistent arthritis in children. (Juvenile in this context refers to an onset before age 16, idiopathic refers to a condition with no defined cause, and arthritis is the inflammation of the synovium of a joint.)

The "Still" is for English physician Sir George Frederic Still (1861-1941).

The condition "juvenile-onset still disease" is now usually grouped under juvenile rheumatoid arthritis. However, there is some evidence that the two conditions are closely related.

The diagnosis is clinical, not based upon serology.

Ankylosing Spondylitis - (AS; previously known as Bechterew's disease, Bechterew syndrome, Marie Strümpell disease and a form of Spondyloarthritis) is a chronic, painful, degenerative inflammatory arthritis primarily affecting spine and sacroiliac joints, causing eventual fusion of the spine; it is a member of the group of the autoimmune spondyloarthropathies with a strong genetic predisposition. Complete fusion results in a complete rigidity of the spine, a condition known as bamboo spine.

Secondary to Other Diseases:
Lupus Erythematosus - Lupus erythematosus may manifest as a systemic disease or in purely cutaneous forms, categorized into the following types:
Chronic Cutaneous Lupus Erythematosus
Discoid Lupus Erythematosus - Generalized discoid lupus erythematosus is less common than localized discoid lupus erythematosus, with all degrees of severity being encountered, most often affecting the thorax and upper exemities in addition to the head and neck.
Localized Discoid Lupus Erythematosus - typically presents with lesions localized above the neck, with favored sites being the scalp, bridge of nose, malar areas, lower lip, and ears.
Generalized Discoid Lupus Erythematosus - is less common than localized discoid lupus erythematosus, with all degrees of severity being encountered, most often affecting the thorax and upper exemities in addition to the head and neck.
Childhood Discoid Lupus Erythematosus - lacks a female predominace, low frequency of photosensitivity, and higher progression to systemic lupus erythematosus, but in most other respects, the clinical presentation and course is similar to those in adults.
Verrucous Lupus Erythematosus (Hypertrophic Lupus Erythematosus) - (also known as "Hypertrophic lupus erythematosus") presents with non-puritic papulonodular lesions on the arms and hands, resembling keratoacanthoma or hypertropic lichen planus.
Lupus Erythematosus-Lichen Planus Overlap Syndrome - is a true overlap syndrome with features of both lupus erythematosus and lichen planus, with skin lesions usually large, atropic, hypopigmented, red or pink patches and plaques.
Chilblain Lupus Erythematosus (Hutchinson) - is a chronic, unremitting form of lupus erythematosus with the fingertips, rims of ears, claves, and heels affected, especially in women.
Tumid Lupus Erythematosus - is a rare, but distinctive entity in which patients present with edematous erythematous plaques, usually on the trunk.
Lupus Erythematosus Panniculitis (Lupus Erythematosus Profundus) - Lupus erythematosus panniculitis (also known as "Lupus erythematosus profundus") presents with subcutaneous nodules that are commonly firm, sharply defined, and nontender.
Subacute Cutaneous Lupus Erythematosus - is a clinically distinct subset of cases of lupus erythematosus that is most often present in white women aged 15 to 40, consisting of skin lesions that are scaly and evolve as polycylic annular lesions or psoriasiform plaques.
Neonatal Lupus Erythematosus - Neonatal lupus erythematosus presents in infants, most often girls, born to mothers who carry the Ro/SSA antibody. The infants have no skin lesions at birth, but develop them during the first weeks of life.
Complement Deficiency Syndromes - Complement deficiency syndromes are often associated with lupus erythematosus-like conditions, and although deficiency of many complement components may cause LE-like conditions, they are most commonly caused by C2 and C4 deficiencies.
Systemic Lupus Erythematosus - or lupus, is a chronic autoimmune disease that can be fatal, although with recent medical advances, fatalities are becoming increasingly rare. As occurs in other autoimmune diseases, the immune system attacks the body’s cells and tissue, resulting in inflammation and tissue damage. SLE can affect any part of the body, but most often harms the heart, joints, skin, lungs, blood vessels, liver, kidneys, and nervous system. The course of the disease is unpredictable, with periods of illness (called flares) alternating with remissions. Lupus can occur at any age, and is most common in women, particularly of non-European descent; 90% of people diagnosed with SLE are women. Lupus is treatable through addressing its symptoms, mainly with corticosteroids and immunosuppressants; there is currently no cure. Survival in patients with SLE in the United States, Canada, and Europe is approximately 95% at five years, 90% at 10 years, and 78% at 20 years.
Drug-Induced Lupus Erythematosus - Drug-induced lupus erythematosus (DIL or DILE) is an autoimmune disorder, similar to systemic lupus erythematosus (SLE), which is induced by chronic use of certain drugs. These drugs cause an autoimmune response (the body attacks its own cells) producing symptoms similar to those of SLE. There are 38 known medications to cause DIL but there are three that report the highest number of cases: hydralazine, procainamide, and isoniazid. While the criteria for diagnosing DIL has not been thoroughly established, symptoms of DIL include fever, elevated blood pressure, skin lesions, and arthritis. Generally, the symptoms recede after discontinuing use of the drugs, but there are reported cases of DIL that do not go away completely after the offending drug is removed.

While this may not be a prevailing illness in this age of heritable and non-transmittable diseases, research on drug-induced lupus could lead to a greater understanding on the immune system. This greater understanding of our immune systems could lead to breakthroughs in many other diseases such as HIV, influenza, and other communicable diseases. Research on this topic also has pharmaceutical implications as to avoid immune reactions from future drugs.

Henoch-Schönlein Purpura - Henoch-Schönlein purpura, also known as allergic purpura or anaphylactoid purpura and commonly abbreviated to HSP, is a systemic vasculitis (inflammation of blood vessels) characterized by deposition of immune complexes containing the antibody IgA in the skin and kidney. It occurs mainly in young children.

Typical symptoms include palpable purpura (small hemorrhages in the skin), joint pains and abdominal pain. Most cases are self-limiting and require no treatment apart from symptom control, but the disease may relapse in a third of the cases and cause irreversible kidney damage in about one in a hundred cases. The exact cause of Henoch-Schönlein purpura is unknown, although it may occur after certain viral and bacterial infections, as well as an adverse drug reaction to some medications.

Psoriatic Arthritis - Psoriatic arthritis (also arthritis psoriatica, arthropathic psoriasis or psoriatic arthropathy) is a type of inflammatory arthritis that, according to the National Psoriasis Foundation, affects around 10-30% of people suffering from the chronic skin condition psoriasis. Psoriatic arthritis is said to be a seronegative spondyloarthropathy and therefore occurs more commonly in patients with tissue type HLA-B27. Treatment of psoriatic arthritis is similar to that of rheumatoid arthritis. More than 80% of patients with psoriatic arthritis will have psoriatic nail lesions characterised by pitting of the nails, or more extremely, loss of the nail itself (onycholysis).

Psoriatic arthritis can develop at any age, however on average it 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 50, but it can also affect children. Men and women are equally affected by this condition. In about one in seven cases the arthritis symptoms may occur before any skin involvement.

Reactive Arthritis - Reactive arthritis (ReA) is an autoimmune condition that develops in response to an infection in another part of the body. Coming into contact with bacteria and developing an infection can trigger reactive arthritis. It has symptoms similar to various other conditions collectively known as "arthritis," such as rheumatism. It is caused by another infection and is thus "reactive", i.e., dependent on the other condition. The "trigger" infection has often been cured or is in remission in chronic cases, thus making determination of the initial cause difficult.

The symptoms of reactive arthritis very often include a combination of three seemingly unlinked symptoms—an inflammatory arthritis of large joints, inflammation of the eyes (conjunctivitis and uveitis), and urethritis. A useful mnemonic is "the patient can't see, can't pee and can't bend the knee". Also known as Reiter’s syndrome, after German physician Hans Reiter, it is also known as arthritis urethritica, venereal arthritis and polyarteritis enterica. It is a type of seronegative spondyloarthropathy.

Reactive arthritis is an RF-seronegative, HLA-B27-linked spondyloarthropathy[citation needed] (autoimmune damage to the cartilages of joints) often precipitated by genitourinary or gastrointestinal infections, some of which can be transmitted through sexual activities.

It most commonly strikes individuals aged 20-40, is more common in men than in women, and is more common in white men than in black men. This is owing to white individuals' being more likely to have tissue type HLA-B27 than black individuals. People with HIV have an increased risk of developing reactive arthritis as well. Food poisoning is a common cause.

Haemochromatosis - Haemochromatosis, also spelled hemochromatosis (see spelling differences), also called hereditary haemochromatosis, siderophilia and bronze diabetes, is a hereditary disease characterized by excessive absorption of dietary iron resulting in a pathological increase in total body iron stores. Humans, like virtually all animals, have no means to excrete excess iron. Excess iron accumulates in tissues and organs disrupting their normal function. The most susceptible organs include the liver, adrenal glands, the heart and the pancreas; patients can present with cirrhosis, adrenal insufficiency, heart failure or diabetes. The hereditary form of the disease is most common among those of Northern European ancestry, in particular those of British or Irish descent.

Haemochromatosis less often refers to the condition of iron overload as a consequence of multiple transfusions. More preferred terms in the United States include for transfusional iron overload or hemosiderosis used synonymously. Those with hereditary anemias such as beta-thalassemia major, sickle cell anemia, and Diamond-Blackfan anemia who require regular transfusions of red blood cells are all at risk for developing life-threatening iron overload. Older patients with various forms of bone marrow failure such as with myelodysplastic syndrome who become transfusion-dependent are also at risk for iron overload.

Hepatitis - Hepatitis (plural hepatitides) implies injury to the liver characterized by the presence of inflammatory cells in the tissue of the organ. The name is from ancient Greek hepar or hepato-, meaning liver, and suffix -itis, meaning "inflammation" (c. 1727). The condition can be self-limiting, healing on its own, or can progress to scarring of the liver. Hepatitis is acute when it lasts less than six months and chronic when it persists longer. A group of viruses known as the hepatitis viruses cause most cases of liver damage worldwide. Hepatitis can also be due to toxins (notably alcohol), other infections or from autoimmune process. It may run a subclinical course when the affected person may not feel ill. The patient becomes unwell and symptomatic when the disease impairs liver functions that include, among other things, removal of harmful substances, regulation of blood composition, and production of bile to help digestion.

Wegener's Granulomatosis (and Many Other Vasculitis Syndromes) - Wegener's granulomatosis is a form of vasculitis that affects the lungs, kidneys and other organs. Due to its end-organ damage, it can be a serious disease that requires long-term immune suppression. It is named after Dr. Friedrich Wegener, who described the disease in 1936.

Wegener's granulomatosis is part of a larger group of vasculitic syndromes, all of which feature the presence of an abnormal type of circulating antibody termed ANCAs (antineutrophil cytoplasmic antibodies) and affect small and medium-size blood vessels. Apart from Wegener's, this category includes Churg-Strauss syndrome and microscopic polyangiitis.

Lyme Disease - Lyme disease, or borreliosis, is an emerging infectious disease caused by at least three species of bacteria belonging to the genus Borrelia. Borrelia burgdorferi is the predominant cause of Lyme disease in the United States, whereas Borrelia afzelii and Borrelia garinii are implicated in most European cases.

Lyme disease is the most common tick-borne disease in the Northern Hemisphere. Borrelia is transmitted to humans by the bite of infected hard ticks belonging to several species of the genus Ixodes. Early manifestations of infection may include fever, headache, fatigue, depression, and a characteristic skin rash called erythema migrans. Left untreated, late manifestations involving the joints, heart, and nervous system can occur. In most cases, the infection and its symptoms are eliminated with antibiotics, especially if diagnosis and treatment occur early in the course of illness. Late, delayed, or inadequate treatment can lead to late manifestations of Lyme disease which can be disabling and difficult to treat.

Some Lyme disease patients who have completed a course of antibiotic treatment continue to have symptoms such as severe fatigue, sleep disturbance, and cognitive difficulties. Some groups have argued that "chronic" Lyme disease is responsible for a range of medically unexplained symptoms beyond the objectively recognized manifestations of late Lyme disease, and that additional, long-term antibiotic treatment is warranted in such cases. Of four randomized controlled trials of long-term antibiotic courses in patients with ongoing symptoms, two found no benefit, and two found inconsistent benefits and significant side effects and risks from further antibiotic treatment. Most expert groups including the Infectious Diseases Society of America and the American Academy of Neurology have found that existing scientific evidence does not support a role for Borrelia nor ongoing antibiotic treatment in such cases.

Familial Mediterranean Fever - Familial Mediterranean Fever (FMF) is a hereditary inflammatory disorder that affects groups of people originating from around the Mediterranean Sea (hence its name). It is prominently present in the Armenian people, Sephardi Jews (and, to a much lesser extent, Ashkenazi Jews), people from Turkey, and the Arab countries.

Hyperimmunoglobulinemia D with Recurrent Fever - Hyperimmunoglobulinemia D with recurrent fever (commonly abbreviated as HIDS) is a periodic fever syndrome originally described in 1984 by the internist Prof. Jos van der Meer, then at Leiden University Medical Centre. No more than 300 cases have been described worldwide.

TNF Receptor Associated Periodic Syndrome - TNF receptor associated periodic syndrome (also known as TRAPS or familial Hibernian fever) is a periodic fever syndrome associated with mutations in a receptor for the molecule tumor necrosis factor (TNF) that is inheritable in an autosomal dominant manner. Individuals with TRAPS have episodic symptoms such as recurrent high fevers, rash, abdominal pain, joint/muscle aches and puffy eyes. TRAPS was first described in 1982 in a boy of Scottish-Irish origin. At that time, it was named familial Hibernian fever.

The main source of TNF (tumor necrosis factor) is cells in the immune system called macrophages which produce it in response to infection and other stimuli. TNF helps activate other immune cells and plays a major role in initiation of inflammation. Individuals with TRAPS have a mutation in the tumor necrosis factor receptor-1 (TNFR1) gene. The mechanisms by which mutations in TNFR1 lead to the TRAPS phenotype are still under investigation.

Several medications have been studied for the treatment of TRAPS including etanercept, infliximab, tacrolimus and Il-1Ra (anakinra). Studies on treatment efficacy in a larger group of patients affected with TRAPS are however lacking to date.

Inflammatory Bowel Disease (Including Crohn's Disease and Ulcerative Colitis) - In medicine, inflammatory bowel disease (IBD) is a group of inflammatory conditions of the large intestine and small intestine. The major types of IBD are Crohn's disease and ulcerative colitis.

The main difference between Crohn's disease and UC is the location and nature of the inflammatory changes. Crohn's can affect any part of the gastrointestinal tract, from mouth to anus (skip lesions), although a majority of the cases start in the terminal ileum. Ulcerative colitis, in contrast, is restricted to the colon and the rectum.

Microscopically, ulcerative colitis is restricted to the mucosa (epithelial lining of the gut), while Crohn's disease affects the whole bowel wall.

Finally, Crohn's disease and ulcerative colitis present with extra-intestinal manifestations (such as liver problems, arthritis, skin manifestations and eye problems) in different proportions.

Rarely, a definitive diagnosis of neither Crohn's disease nor ulcerative colitis can be made because of idiosyncrases in the presentation. In this case, a diagnosis of indeterminate colitis may be made. Although a recognised definition, not all centres refer to this.

Diseases That Can Mimic Arthritis Include:
Hypertrophic Osteoarthropathy - In medicine, clubbing, finger clubbing, or digital clubbing is a deformity of the fingers and fingernails that is associated with a number of diseases, mostly of the heart and lungs. Idiopathic clubbing can also occur. Hippocrates was probably the first to document clubbing as a sign of disease, and the phenomenon is therefore occasionally called Hippocratic fingers.
Multiple Myeloma - (also known as MM, myeloma, plasma cell myeloma, or as Kahler's disease after Otto Kahler) is a type of cancer of plasma cells which are immune system cells in bone marrow that produce antibodies. Myeloma is regarded as incurable, but remissions may be induced with steroids, chemotherapy, thalidomide and stem cell transplants. Myeloma is part of the broad group of diseases called hematological malignancies.
Osteoporosis - is a disease of bone that leads to an increased risk of fracture. In osteoporosis the bone mineral density (BMD) is reduced, bone microarchitecture is disrupted, and the amount and variety of non-collagenous proteins in bone is altered. Osteoporosis is defined by the World Health Organization (WHO) in women as a bone mineral density 2.5 standard deviations below peak bone mass (20-year-old healthy female average) as measured by DXA; the term "established osteoporosis" includes the presence of a fragility fracture. Osteoporosis is most common in women after menopause, when it is called postmenopausal osteoporosis, but may also develop in men, and may occur in anyone in the presence of particular hormonal disorders and other chronic diseases or as a result of medications, specifically glucocorticoids, when the disease is called steroid- or glucocorticoid-induced osteoporosis (SIOP or GIOP). Given its influence on the risk of fragility fracture, osteoporosis may significantly affect life expectancy and quality of life.
Osteoporosis can be prevented with lifestyle changes and sometimes medication; in people with osteoporosis, treatment may involve both. Lifestyle change includes preventing falls and exercise; medication includes calcium, vitamin D, bisphosphonates and several others. Fall-prevention advice includes exercise to tone deambulatory muscles, proprioception-improvement exercises; equilibrium therapies may be included. Exercise with its anabolic effect, may at the same time stop or reverse osteoporosis.
Fifth Disease (parvovirus infection) - Fifth disease is one of several possible manifestations of infection by erythrovirus previously called parvovirus B19. The disease is also referred to as erythema infectiosum (meaning infectious redness) and as slapped cheek syndrome, slapcheek, slap face or slapped face. In Japan the disease is called 'apple sickness' or 'ringo-byou' in reference to the symptom of facial redness. The name "fifth disease" derives from its historical classification as the fifth of the classical childhood skin rashes or exanthems.

Treatment:
Treatment options vary depending on the type of arthritis and include physical and occupational therapy, lifestyle changes (including exercise and weight control), medications and dietary supplements (symptomatic or targeted at the disease process causing the arthritis). Arthroplasty (joint replacement surgery) may be required in eroding forms of arthritis.

In general, studies have shown that physical exercising of the affected joint can have noticeable improvement in terms of long-term pain relief. Furthermore, exercising of the arthritic joint is encouraged to maintain the health of the particular joint and the overall body of the person.

Another form of non-drug treatment that does have a body of proper research to support its efficacy is marine oil, from both fish and the New Zealand green-lipped mussel (Perna canaliculus). Diets high in marine oils from cold-water fish such as salmon, mackerel, and tuna have been shown to reduce the inflammation of joint conditions such as arthritis. Massage on joints with neem oil has reported improvement in chronic and acute cases.

History:
While evidence of primary ankle (kaki) osteoarthritis has been discovered in dinosaurs, the first known traces of human arthritis date back as far as 4500 BC. 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 Ötzi, a mummy (circa 3000 BC) found along the border of modern Italy and Austria, to the Egyptian mummies circa 2590 BC.

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

Arthritis Care in the UK:
Arthritis Care is the UK's largest charity dedicated to supporting people with arthritis (registered charity nos: 206563, SC038693). It is a user led organisation which means people with arthritis are at the heart of its work – they form its membership, are involved in its activities and are well represented on its staff and board of trustees. It provides information and support on a range of issues related to living with arthritis. Arthritis Care campaigns locally and nationally to make sure people with arthritis have access to treatments and services. Arthritis Care has three national offices (Scotland, Northern Ireland and Wales) and three regional offices in England (North England, Central England, South England). All activities are co-ordinated by an office in London.

Osteoimmunology is the study of the interface between the skeletal system and the immune system, comprising the “osteo-immune system”. It is also the study of shared components and mechanisms between the two systems in vertebrates, including ligands, receptors, signaling molecules and transcription factors. Some medical conditions in which this field is particularly relevant are bone metastases, rheumatoid arthritis, osteoporosis, osteopetrosis, and periodontitis. Studies in osteoimmunology reveal relationships between molecular communication among blood cells and structural pathologies in the body.

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