http://newsinhealth.nih.gov/issue/Nov2011/Feature2


http://newsinhealth.nih.gov/issue/Nov2011/Feature2.

Looking at Lupus
An Attack from Within

 Cartoon of a woman rubbing her own shoulder.

Lupus is a complex and mysterious disorder. It arises when the cells that are supposed to protect your body from disease mistakenly assault your own healthy cells and tissues. This attack from within can damage your joints, skin and most other parts of your body. NIH-funded scientists are working to uncover the causes of lupus and find better ways to diagnose and treat the disease.

“Just about anyone can get lupus, but it mostly affects young women. It can rob them of the prime years of their lives,” says NIH’s Dr. Mark Gourley, an expert on lupus and related disorders. The disease often strikes between the ages of 15 and 44. Lupus afflicts about 9 times more women than men. For unknown reasons, African American women are at especially high risk.

No one knows what causes lupus. But researchers suspect that a combination ofgenes and the environment is to blame.

Lupus comes in different forms. The most common and serious type is called systemic lupus erythematosus. It can cause severe problems throughout the body. Other types can cause temporary skin sores after sun exposure or long-term rashes that may lead to scarring.

Lupus can be difficult to diagnose because its symptoms vary so widely. People with mild lupus may have just a few symptoms, such as skin rashes or achy joints. In other cases, lupus can harm essential organs, including the kidneys and brain.

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Myths and Facts About Fibromyalgia


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Myth:  Fibromyalgia is rare

Fact:

Fibromyalgia is one of the most common types of chronic pain.  It affects over 5 million patients in the United States alone.

Myth: Fibromyalgia is “ALL IN THE HEAD”

Fact:

Fibromyalgia has been described for centuries.  But it wasn’t until 1981 that the first scientific study actually confirmed fibromyalgia symptoms and tender points in the body.

Since then, researchers have done more testing on the pain reactions of people with fibromyalgia.  Imaging studies show that the brains of people with fibromyalgia have more activity in reaction to pain.  Studies also have shown that people with fibromyalgia feel pain more intensely at lower levels than people without the condition.

Fibromyalgia is thought to be the result of overactive nerves that cause chronic widespread muscle pain. Although, fibromyalgia is not just “in the head,” it is important to understand that the condition is stressful—especially when it goes without being diagnosed.  Stress can also make fibromyalgia worse.

 Myth: Doctors diagnose  Fibromyalgia when they can’t find a “REAL” diagnosis

Fact:

Diagnosis of fibromyalgia can take time and there isn’t any specific lab test for it. Your doctor isn’t able to see it on an x-ray or do a blood test to confirm it. Instead, he or she has to listen to what you are telling them about your symptoms and a physical exam. What’s really bad is that the symptoms can mimic the symptoms of several other conditions.  Your doctor will want to test for these other conditions also.

Fibromyalgia is a real condition.  In 1990, the American College of Rheumatology developed guidelines for diagnosing fibromyalgia.  Today, these guidelines are widely used.

Something else, there are now thousands of studies validating this form of chronic widespread pain.  In 1990, there were only about 200 published studies on fibromyalgia.  Today there are more than 4,000 published fibromyalgia studies.

Myth: Fibromyalgia is  a “Women’s Disease”

Fact:

The majority of people with fibromyalgia are women (about 80%).  Fibromyalgia is a common condition and that means men are also diagnosed.

Studies have shown that women with fibromyalgia tend to have a lower pain tolerance and more symptoms than men.  But both genders responded about the same to fibromyalgia treatment and other non-drug treatments like exercise.

Fibromyalgia knows no age group, teenagers and the old can be affected.  But the symptoms are more likely to begin in someone in their 30s.  Fibromyalgia occurs in all ethnic groups and cultures.  It knows no borders.

Myth: The pain of Fibromyalgia is mild

Fact:

You may only experience mild symptoms, especially if you’re getting the right treatment.  For others, the pain can be very severe.  It can impact on your quality of life significantly. The simplest of things you once took for granted, like working, going for a walk, the everyday chores of your household, and taking care of your family can become difficult.  Symptoms will often get worse under stress or even under certain weather conditions.

More information about fibromyalgia and chronic widespread pain can be found at http://www.Fibrocenter.com

Myth:  There is nothing that can be done to treat Fibromyalgia

Fact:

Although fibromyalgia can’t be cured,  just getting a diagnosis can be a great relief.  It can, however, signify the beginning of a new and possibly a long  journey toward relief of some of your symptoms.  With lifestyle changes and prescription treatments as well as alternative treatments, you may be able to reduce your fibromyalgia symptoms.  Not long ago there was no FDA-approved treatment for fibromyalgia, there are medication in existence now to help relieve the unique pain of this condition.

Myth:  Fibromyalgia damages my joints

Fact:

Though fibromyalgia pain can be severe at times, it doesn’t damage your bones, joints or muscles.  You may worry that when pain worsens, it means that fibromyalgia is progressing.  But that isn’t the case.  While increasing fibromyalgia pain can make it difficult to go about your daily activities, it isn’t damaging your body.

Myth:  You look fine, so there’s nothing wrong with you

Fact:

You know this isn’t true, but your friends, family and co-workers who don’t understand fibromyalgia will hang on to this belief.  It can cause tension when others wonder if you’re faking your pain because they think you don’t look sick. Resist the urge to get angry and withdraw rather than explain how you’re feeling.

Try to be as open and honest as you can be when you talk so you can help others better understand fibromyalgia.  Be honest about how you feel and let others know that if they have questions, you’re willing to listen and explain.

Myth:  Fibromyalgia is a form of Arthritis

Fact:

It was first believed that fibromyalgia might be a form of arthritis, although research over the past 10+ years has proven that to be not true.  Arthritis is inflammation of the joints, but there isn’t any inflammation with FM, and there isn’t any damage to your joints.   You might have some type of arthritis (like osteoarthritis or rheumatoid arthritis) along with FM, but it’s a completely different disorder.  Research is showing, with new brain-imaging techniques and scientific studies, that fibromyalgia can be described as a central nervous system disorder that results in your brain not being able to process the pain signals your body is sending.

Myth:  Fibromyalgia affects the muscles, joints, connective tissues.

 Fact:  There is no damage to the muscles, joints or connective tissue of people with fibromyalgia. 

In the past fibromyalgia was said to be a musculoskeletal disorder because the pain you have feels like it is coming from the muscles, joints and connective tissues.  But years of testing haven’t shown any actual damage to the muscles, joints and connective tissues.  What the research has shown is that there is a malfunction in your central nervous system causing  the signals being sent to the brain causing your pain to be magnified.   In other words, a stimulus that would not even be noticed by most people can be extremely painful to someone with fibromyalgia.

Speak to your doctor to learn more.

Research:

http://www.fibrocenter.com

http://www.fibrocheck.com

http://www.cidpusa.org/fibromyalgia_myths.htm

http://www.healthcentral.com/chronic-pain/fibromyalgia-160180-5.html

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Thank You One and All!!


I have tried to reply to each of your comments but they keep bouncing back to me, so, I decided to say thank you in an article.

I want to thank each and every one of you for your fabulous comments about my blog and content.

I get a lot of questions about how I get my blog to load so fast.  I have no idea except that I would have to give the credit to wordpress for their excellent format.  They make it so easy for you to pick a design and format.

As for the content that I provide, my goal is to help as many people as I can to understand their arthritis.  It’s not easy to understand why you have so much pain and since I have had arthritis for nearly 14 years now, and I’ve been doing research into the why’s and what for’s for nearly that long, I just want to share what I’ve found.  It’s been my experience that the doctors, not all doctors, and the drug companies would like to not give us all the information we need to make wise health decisions so that we keep coming back and paying more to get answers.  There are answers to our pain.  We just have to dig a little deeper and that’s what my business is all about.  I do the digging for you.

I am glad to hear that I am helping so many people.   Thank you so much for all your replies!!

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Arthritis: Cytotoxic Drugs


Cytotoxic drugs are very powerful medications that work by affecting the growth and action of some cells that cause the joint pain, swelling, warmth and damage of arthritis.  They also work over a long time and you may not notice any effects from the drugs for the first several weeks or months of your treatment.

The three cytotoxic drugs commonly used to treat arthritis and it’s related conditions are:

GENERIC NAME                                                      BRAND NAME

Azathioprine                                                                Imuran

Cyclophosphamide                                                    Cytoxan

Methotrexate                                                                Rheumatrex

These drugs are often given in the pill form, but some may be given intravenously or by injection.

Their ability to help the signs and symptoms of diseases such as rheumatoid arthritislupus may, however, be due to their anti-inflammatory effects as opposed to their ability to kill cells.  As a matter of fact, the low dosage of methotrexate used to treat these conditions is actually anti-inflammatory and not cytotoxic.

Taking Cytotoxic Drugs:  The Benefits and Risks

Cytoxan

Of these three drugs, Cytoxan has the most potential side effects and is typically limited to treating moderate to severe cases of lupus, vasculitis, or lung disease that are sometimes associated with rheumatoid arthritismyositis, and scleroderma.

The major concern with Cytoxan is the risk of bone marrow depression that may increase the risk of infection or bleeding, also, there is a small but definite increased risk of cancer of the skin and bladder.  You may develop a very painful condition of the bladder called interstitial cystitis, but if the drug is given orally, drinking water often and frequent urination may help prevent this problem. Cytoxan is often given by monthly intravenous infusions which may also help.

This drug may cause birth defects if taken during pregnancy and should be avoided if you are not using effective birth control or may be pregnant.  Last, but no least, you might  have an increased risk for serious infection with Cytoxan.

Imuran

Imuran is FDA-approved for rheumatoid arthritis and is used to treat lupus and other connective tissue diseases. It’s also associated with a risk of bone marrow depression and you might be at a slight increase of risk for some cancers and have a risk of serious infection when taking this drug.

Methotrexate

Methotrexate is FDA-approved for rheumatoid arthritis and may also be helpful for other connective tissue diseases such as lupus, myositis, and vasculitis.

While methotrexate can have the same potential side effects as the other two drugs, it seems to be safer.  It’s also like Cytoxan, in that it shouldn’t be used if you’re not using effective birth control or if there’s a chance of you getting pregnant.  Also, the drug has shown to have  a small risk of lung disease (intersitial pneumonitis) that can be life-threatening if you don’t stop the drug and get treatment for the lung disease.  The common symptoms of this problem include shortness of breath, dry cough, and fever and like the other two medications, there may be an increased risk of serious infection.

Answers provided by Scott J. Zashin, M.D., clinical assistant professor at University of Texas Southwestern Medical School, Division of Rheumatology, in Dallas, Texas. Dr. Zashin is also an attending physician at Presbyterian Hospitals of Dallas and Plano. He is a fellow of the American College of Physicians and the American College of Rheumatology and a member of the American Medical Association. Dr. Zashin is author of Arthritis Without Pain – The Miracle of TNF Blockers. The book is useful for anyone on one of the biologic drugs (Enbrel, Remicade, Humira) or considering the biologic drugs. Read my review of the book and visit Dr. Zashin’s website.

The information in this article shouldn’t be used to replace the advice and guidance given by your doctor and if you have questions about these or other medications, please contact your doctor or pharmacist.

Resources of information:

University of Washington orthopaedic

http://arthritis.about.com/od/arthritismedications/f/cytotoxic_drugs.htm

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Arthritis: Using Corticosteroids Part 7


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Corticosteroids are often used to treat arthritis and related conditions because of their overall effectiveness in reducing inflammation, the process that causes the joint pain, warmth, and swelling of arthritis and related conditions.  Cortisone, prednisone, and methylprednisolone are just a few examples of corticosteroids.  All of these medications are related to a natural hormone that our bodies produces that controls many of our important body functions, called cortisol.  You can’t live without this hormone.

Corticosteroids are also hormones, but they’re not sex hormones.  Sex hormones regulate sexual and reproductive function, corticosteroids don’t do that.  Doctors will sometimes refer to corticosteroids as steroids, but they aren’t the same as the anabolic steroids drugs that you hear about being abused by some athletes.

Synthetic glucocorticoids are used in the treatment of joint pain or inflammation (arthritis), temporal arteritisdermatitisallergic reactions, asthmahepatitissystemic lupus erythematosusinflammatory bowel disease (ulcerative colitis and Crohn’s disease), sarcoidosis and for glucocorticoid replacement in Addison’s disease or other forms of adrenal insufficiency.

The typical side effects of glucocorticoids are drug-induced Cushing’s syndrome.   There may also be impaired wound healing or ulcer formation because of the immunosuppressive effects.

Long-term corticosteroids use has several severe side-effects for example: hyperglycemiainsulin resistancediabetes mellitusosteoporosiscataractanxietydepressioncolitishypertensionictuserectile dysfunctionhypogonadismhypothyroidismamenorrhea, and retinopathy.

Research:

University of Washington Orthopaedics

Wikipedia

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Arthritis: Taking Aspirin and Other Related Drugs Part 6


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As you know aspirin is used to treat most forms of arthritis.  Aspirin is important, however, medication is only part of the total treatment program for arthritis.  You can talk to your doctor to find out what else you can do for your disease, but a typical program includes medication therapy as well as exercise, rest, and joint protection.

Salicylates are a family of related drugs that reduce the effects of inflammation, a reaction of the body that causes pain, swelling, redness, and heat.  The word salicylate refers to the active ingredient in the drugs.  Aspirin (acetylsalicylic acid or ASA) is one of these drugs.

There are many other drugs that are chemically related to aspirin and even though salicylates differ from each other slightly in chemical structure, they have similar effects in the body.  Salicylate is a chemical that is found in the bark of willow trees and in certain plants, and this is what these drugs break down into.  You can take small amounts of salicylate to relieve headaches, mild pain, and fever, larger amounts taken regularly over a time to relieve some of the pain, heat, redness, and swelling associated with inflammation found in many forms of arthritis.  If you take more than it can cause toxicity or poisoning that could be mild or severe.

Research:

University of Washington Orthopaedics

Arthritis Foundation

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Arthritis: Using Your Medications Wisely, Tips For Storage Part 5


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It’s important that you store your medications correctly.

Here are a few tips for storing your medications.

  1. Check the label or ask your pharmacist how to store your medications.
  2. Don’t put medications into another container other than the one it came in because you may confuse the dosage information and forget which drug you’re taking.
  3. Don’t keep prescription medications or OTC (over-the-counter) drugs beyond their expiration dates.  Dispose of old medications by flushing them down the toilet so they can’t be found by children.  Below you will find the FDA’s guidelines for disposal of your expired medication.
  4. Don’t store medicines in a humid area of the home or where there is excessive heat and cold.

Guidelines for Drug Disposal

The FDA worked with the White House Office of National Drug Control Policy (ONDCP) to develop the first consumer guidance for proper disposal of prescription drugs.  Issued by ONDCP in February 2007 and updated in October 2009, the federal guidelines are summarized here:

  • Follow any specific disposal instructions on the drug label or patient information that accompanies the medication.  Do not flush prescription drugs down the toilet unless this information specifically instructs you to do so.
  • Take advantage of community drug take-back programs that allow the public to bring unused drugs to a central place for proper disposal. Call your city or county government’s household trash and recycling service (see blue pages in phone book) to see if a take-back program is available in your community. The Drug Enforcement Administration, working with state and local law enforcement agencies, is sponsoring National Prescription Drug Take Back Days throughout the United States.
  • If no instructions are given on the drug label and no take-back program is available in your area, throw the drugs in the household trash, but first:
    • Take them out of their original containers and mix them with an undesirable substance, such as used coffee grounds or kitty litter. The medication will be less appealing to children and pets, and unrecognizable to people who may intentionally go through your trash.
    • Put them in a sealable bag, empty can, or other container to prevent the medication from leaking or breaking out of a garbage bag.
      • Before throwing out a medicine container, scratch out all identifying information on the prescription label to make it unreadable. This will help protect your identity and the privacy of your personal health information.
      • Do not give medications to friends. Doctors prescribe drugs based on a person’s specific symptoms and medical history. A drug that works for you could be dangerous for someone else.
      • When in doubt about proper disposal, talk to your pharmacist.

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Arthritis: Using Your Medications Wisely, Reducing Costs Part 4


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The costs of medications is ridiculous.  It’s sad when we have to choose between eating and getting our medications.

Here are a few ways to reduce your cost:

  1. Ask your doctor about taking the generic form of the drug.  My doctor would do this with some but not all the drugs I was taking.  He refused to give me the generic form of Synthroid because he said that the drug companies used inferior substitutes for the main ingredient and that they were not effective.
  2. Ask your doctor about switching to a less expensive drug.  This is something the insurance companies are really pushing.
  3. Take your medications as prescribed.  You aren’t going to save anything by taking less than what you are prescribed, in fact you could actually increase your cost.  If you don’t take enough, then the drug won’t be as effective and your doctor will end up increasing your dose and it will be more costly.
  4. Try to reduce the number of narcotic pain relievers and tranquilizers you take.  Although they may dull the pain, some of these drugs can actually make you feel “down.”  You might find it necessary to use these drugs for your most severe pain.  Try using other forms of pain relief, such as relaxation techniques, hot packs, hot baths, cold packs, joint protection, energy conservation, mental distraction, or exercise.  I use Brain Wave Entertainment and managed to reduce my Tramadol to 3 tablets at 50 mg each from 6 tablets a day.  I was also on Lyrica for my pain and was taken off of it after only three days of Brain Wave Entertainment.  You can download the mp3  free at http://www.mentallion.com
  5. Carefully check labels on over-the-counter drugs.  Brand-name drugs are usually more costly than generic equivalents and be sure you’re not paying for any extra ingredients like caffeine.
  6. Shop around for the best prices.  Check your local pharmacies for the best prices on the medications you take.

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Arthritis: Using Your Medications Wisely Part 3


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All drugs, whether bought with a prescription or over the counter, have side effects.  These can be due to an allergic reaction or to an unusual susceptibility to a particular effect of the drug.

Here are some general steps you can take to reduce your side effects:

  • Take your medicine as prescribed.  Follow your doctor’s advice about how much and when to take your medicine.  If you’re having problems with the drug, call your doctor and he or she may be able to change your dosage schedule or the type of drug to better suit your needs.  Some drug labels warn: “Do not take on an empty stomach,” or “Do not take with food,” take these warnings seriously.  It really is necessary to take some drugs with food to reduce stomach upset, and NSAIDs be taken with meals.  Spicy and acidic foods may cause more stomach upset, and food in the stomach and intestines can make a drug less effective.  Food can also slow down or speed up the medicine‘s effect on the body so be sure to ask your doctor or pharmacist whether or not to take your medicine with food.
  • Be real careful about drinking alcohol with your medications because it can increase or decrease a drug’s effects.  If the medication causes stomach upset, adding alcohol can increase this upset and it may be best to reduce your alcohol intake or stop altogether.
  • Monitor yourself and know what benefits to expect and when they are likely to occur.  Find out the side effects of your drugs and what to do if they occur.  Be aware of how your body is reacting to the drug.  I have always done this and the doctors don’t worry about me because they know that if I have a problem I’m going to let them know and this is the reason most of my medications, especially the pain medications I take, are taken as I need them.
Never give your medications to others, and never take medicine belonging to someone else.  Although you both may have the same type of arthritis, a drug that works for someone else may not work for you.  It’s possible the drug you take may be harmful to someone else and it could interact with another drug they are taking.  Each person should see a doctor for a specific treatment.
Follow your doctor’s advice when you consider using over-the-counter drugs.  These drugs may seem harmless because they can be bought easily but if they are abused, they can cause serious side effects.  All drugs, prescription or over-the-counter, can interact with each other inside your body.  The interaction between drugs can cause serious side effects.
Many over-the-counter medications, such as cough medicines or cold tablets, contain aspirin or ibuprofen and if you take these in addition to prescribed aspirin or another NSAID, you might experience harmful side effects.  So, before buying an over-the-counter drug, be sure to read the label carefully and ask your doctor or the pharmacist before you take an over-the-count drug with your prescribed medications.
Always ask your doctor before you substitute an over-the-counter medication for a prescription medication.  If you have had a drug prescribed for your arthritis and the drug is now available over-the-counter, you certainly may buy it.  Although, sometimes it costs less, it can be in a much lower dosage then your prescription drug and you’ll have to take extra tablets just to meet your prescribed dosage.  There isn’t any danger in doing this as long as you get the proper amount needed to keep your arthritis under control.  Ask your doctor to be sure.

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Arthritis: Using Your Medications Wisely Part 2


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This article gives you some basic questions to ask you doctor and/or pharmacist about the medications you’re taking or ones that they want you to take.  Be sure to write the answers down so you can remember them.  For me it was easier to carry a tape recorder with me and I just recorded what the doctor or pharmacist said.

  1. What is the name of the medicine?
  2. When should I take it?  For example:  before, after, or with meals.
  3. How long should I take it?
  4. How often should I take it?
  5. Can this drug be taken with other medications?  (Be sure to tell your doctors and the pharmacist about all the medication and over the counter medications and supplements you are taking.)  Don’t assume they already know this, because they don’t.  I ran into way too many times when the doctor had no clue that the drug he was about to give would interact with something else I was I taking until I asked him.  They see far too many patients to keep track of your record and they don’t read your records before they see you, either.
  6. Is there a generic form available, and if so, can I take it?
  7. Are there other less expensive alternatives?  These two questions are good to ask but it’s been my experience that when the doctor doesn’t prescribe the generic or less expensive one it’s because he feels that it won’t work in your situation but it never hurts to ask.
  8. What benefits will I notice, and how soon will these become clear?
  9. What side effects could I experience, and what should I do if I notice them?
  10. If I feel better, can I stop taking the medicine?  If I feel no effects or feel worse, can I stop on my own?  You need to remember that most medicines are a cumulative effect, in other words they take up to 30 days to see results because they have to build up in your body.  I always give medications at least 30 days unless it gets so bad I can’t stand it.
  11. When and how will this drug be assessed for benefits and/or toxicity?
  12. What should I do if I miss a dose?  I have several friends who would stop taking their medications after they had missed a dosed because they thought they had messed up and they would have to start over again.
  13. Under what conditions can I increase or decrease the total daily dose of my medication?  I take Tramadol for my pain and for restless leg syndrome, and I’ve taken it for 13 years and my doctors have, from the beginning, given me permission to take it as needed.  I have never abused this and taken more than I needed because I never wanted to run out when my pain got unbearable.

Get the answers to these questions before you take any of your medicine because this may help you avoid serious side effects.

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