Back Clinic Arthropathies Chiropractic and Physical Therapy Team. Charcot’s is degeneration of a weight-bearing joint and arthrogryposis which means, “curving of joints.” this is a general term that describes any disease of the joints. A group of disorders can afflict the joints, such as sacroiliitis, which causes inflammation in the sacroiliac joint. Doctors use arthropathy interchangeably with arthritis, which means “joint inflammation.”The forms that are distinct from arthritis are Neuropathic arthropathy, nerve damage from diabetes, or other nerve conditions resulting in slow damage to joints.
In diabetic people, arthropathy usually affects the foot and ankle. Hypertrophic pulmonary osteoarthropathy is where the bone ends of the ankles, knees, wrists, and elbows start to grow abnormally and painfully. Fingertips start to become rounded, called “clubbing.” This form of arthropathy usually happens to people with lung cancer. And Hemarthrosis is when blood leaks into a joint like the knee. This occurs after injuries or medical procedures and is a problem in people with hemophilia.
The body has a defensive response known as the immune system that comes to the rescue when traumatic events or injuries impact certain areas of the body. The immune system releases inflammatory cytokines to the affected area and begins the healing process to repair the damage while also getting rid of the foreign intruders in the body. Inflammation can be potentially beneficial and harmful to the body, depending on how severe the injury has potentially impacted the area. When inflammation begins to cause an impact on the surrounding muscles, ligaments, and joints, it can lead to chronic issues associated with pain. To that point, it causes the body to be dysfunctional while mimicking other symptoms. Today’s article examines how chronic inflammatory responses affect the joints, their associated symptoms, and how to manage chronic joint inflammation. We refer patients to certified providers specializing in anti-inflammatory treatments to help many individuals dealing with chronic inflammation of the joints. We also guide our patients by referring to our associated medical providers based on their examination when it’s appropriate. We find that education is the solution to asking our providers insightful questions. Dr. Alex Jimenez DC provides this information as an educational service only. Disclaimer
How Does Chronic Inflammatory Response Affect The Joints?
Have you been experiencing pain in some regions of your body? What about experiencing tenderness in your muscles? Do your joints ache when you are doing everyday activities? If you have been dealing with these issues, it might be due to chronic inflammatory responses affecting your musculoskeletal joints. As stated earlier, inflammation can be both beneficial and harmful to the body, depending on the severity of the impact the body has taken. In its beneficial form, the body activates the immune system and eliminates pathogens from bacteria, viruses, and other environmental triggers to promote healing and tissue repair. This potentially makes the affected area red and inflamed, thus repairing the damaged cells.
However, in its harmful form, studies reveal that chronic inflammatory responses can break down immune tolerance, causing significant alterations to all the tissues, organs, and joints. To that point, the residual effects of high inflammation can cause harm to the joints and cartilage, making them potentially involved with pain and possibly deformity over time. The joints help keep the body moving, surrounded by connective muscle tissue that helps stabilize the body; when chronic inflammatory responses start to affect the joints, they can become a mediator for pain and discomfort while triggering musculoskeletal disorders. Studies reveal that inflammation in the joints can cause damage to the cartilage and result in degenerative changes to the body. This includes functionality loss, joint instability, and other symptoms associated with chronic joint inflammation.
The Symptoms Associated With Chronic Joint Inflammation
When it comes to chronic joint inflammation, it can mimic other chronic conditions that present joint instability while overlapping different chronic disorders. This makes diagnosing difficult, especially if the person is dealing with inflammation on one side of their body, but it affects another part. This is known as referred pain, and studies reveal that most inflammatory forms that affect the joints are sometimes arthritic and have systemic symptoms that may occur in different body areas. Some of the symptoms associated with chronic joint inflammation can include:
The Difference Between Healthy Joints & Inflamed Joints-Video
Have you been dealing with joint pain throughout your life? Do you feel muscle stiffness in certain areas when you move around? Or do you feel muscle tenderness in certain areas? Many of these symptoms are associated with joint inflammation, potentially overlapping with musculoskeletal pain. The video above explains the difference between healthy joints and inflamed joints. Healthy joints are utilized when the surrounding muscles are strong and functional while no pain is inflicted on the body. Inflamed joints may be caused by numerous factors like lifestyle habits, physical inactivity, or previous conditions associated with inflamed joint pain. Studies reveal that inflammatory cytokines may potentially amplify musculoskeletal discomfort that affects the musculoskeletal tissues that surround the joints. To that point, inflammation of the musculoskeletal system may overlap with joint pain, thus directly impacting a person’s quality of life. Fortunately, there are ways to manage chronic joint inflammation and restore a person’s health and wellness.
Managing Chronic Joint Inflammation
Since inflammation is beneficial and harmful to the body, there are different ways to manage chronic inflammatory markers triggering joint pain. Many individuals who want to lower inflammation in their joints will begin to incorporate natural ways to lessen the pain. Eating foods high in fiber may potentially help lower inflammatory markers, including physical activities to improve musculoskeletal and joint stability and utilizing chiropractic care. Studies reveal that chronic joint inflammation associated with pain does affect a person’s ability to sleep and emotional health. To that point, incorporating treatments to manage inflammatory effects may potentially improve a person’s self-efficacy. Now how does chiropractic care help manage chronic joint inflammation? Chiropractic care includes inflammation reduction techniques that help loosen the stiff muscles that surround the inflamed joints. Joint inflammation may also be due to subluxation (spinal misalignment) associated with environmental factors. Utilizing chiropractic care not only alleviates the symptoms caused by joint inflammation but may potentially alleviate the cause of inflammation. Once a person has completed their chiropractic care treatment, they can return to normal activities without the risk of re-injury and re-inflammation.
Inflammation in the body can be beneficial and harmful depending on the impacted area. The body unleashes inflammatory cytokines when a traumatic event or injury has occurred in certain body areas. This is due to the immune system naturally responding to the damaged cells, thus causing the area to be red, hot, and swollen to promote healing. To that point, inflammation can impact the surrounding muscles, ligaments, and joints, which can lead to chronic issues associated with pain. Chronic joint inflammation is residual high inflammatory effects that cause harm to the cartilage and joint structures, thus making them potentially involved with pain and possible deformity. Fortunately, treatments like high fiber and anti-inflammatory foods, getting enough exercise, and chiropractic care may help manage chronic joint inflammation and its associated pain symptoms. This way, many individuals can resume their normal activities.
The hips in the lower extremities of the body help stabilize the weight of the upper half while providing movement to the lower half. The hips also allow the body to twist, turn, and bend back and forth. The hip joints connect to the inside of the pelvic bone, while the pelvic bone is connected to the sacroiliac joint, which connects to the spine. When natural wear and tear affects the joints as the body ages, issues like hip pain and osteoarthritis associated with low back pain occur, causing various symptoms to arise in the body. Today’s article looks at osteoarthritis, how it impacts the hips, and how to manage hip osteoarthritis. We refer patients to certified providers specializing in musculoskeletal therapies to help those with hip pain and osteoarthritis. We also guide our patients by referring to our associated medical providers based on their examination when it’s appropriate. We find that education is the solution to asking our providers insightful questions. Dr. Alex Jimenez DC provides this information as an educational service only. Disclaimer
Have you been experiencing pain in your hips or lower back? How about muscle stiffness near the groin? Do symptoms associated with sciatica seem to flare up near your hips and the back of your leg? Many of these symptoms are signs that you could be at risk of developing osteoarthritis near your hips. While arthritis refers to inflammation of the body’s joints, osteoarthritis is a type of arthritis that causes degeneration of the joint cartilage, triggering joint pain and functionality loss. Even though there are several hundred types of arthritis, osteoarthritis is one of the most common types that many people, especially older adults, are affected by. As the body becomes older naturally through age, the repairs from an injury begin to slow down, and the cartilage (the connective tissue that protects the bones from each other) will start to thin out, triggering bone rubbing together, causing inflammation to occur, bone spurs, and inevitable pain. Osteoarthritis is often associated with old age and is multifactorial as factors that can increase the risk of developing osteoarthritis include:
How Does It Impact The Hips?
Since osteoarthritis affects the joints, how does it cause an impact on the hips? When health issues affect the body, it can cause painful symptoms to gradually worsen and become a risk of developing hip pain. Studies reveal that hip pain is common in all adults and activity levels in the anterior, lateral, or posterior regions near the hips.
Anterior hip pain: Causes referred pain (pain felt in one part of the body but is actually in a different location) associated with internal organ systems.
Lateral hip pain: Causes wear-and-tear pain on the soft muscle tissues on the sides of the hips.
Posterior hip pain: Causes referred pain associated with the lumbar spinal pathology like sciatic nerve entrapment correlating with a deep gluteal syndrome.
All these issues affecting the hips overlap with various issues associated with osteoarthritis. When hip pain originates from osteoarthritis, factors like minimal physical activity or slight movements while resting in bed can worsen due to the hip joints having limited or restricted movement. Studies reveal that hip pain is associated with simple movement impairments that make it difficult to diagnose due to referred pain from the spine, knees, or even the groin area.
How does hip osteoarthritis correlate with groin pain? Studies reveal that when a person is dealing with hip osteoarthritis, groin and buttock pain are slightly more common. The hip joint is behind the groin muscle, which is why groin pain overlaps with hip pain as the root. Hip and groin pain could also be involved with radiating pain down toward the knees in the body.
Exercises For Hip Osteoarthritis- Video
Are you experiencing bladder issues? How about stiffness near or around your hips and groin area? Do issues like low back and sciatica pain? Experiencing these issues could be signs of hip osteoarthritis affecting your lower body. Studies reveal that hip osteoarthritis is a significant source of morbidity, pain, gait abnormalities, and functional impairments potentially involved with other issues. Fortunately, there are ways to manage hip osteoarthritis, as the video above shows eight great exercises for hip osteoarthritis. Certain exercise moves for individuals with hip osteoarthritis can help strengthen the surrounding muscles around the joints while increasing joint mobility to reduce pain and stiffness. Exercising can also be beneficial to the individual as it can provide:
Increase blood circulation
Provides energy boost
Promotes muscle endurance
Other available therapies help manage hip osteoarthritis while alleviating associated symptoms affecting the body.
Managing Hip Osteoarthritis Pain
Many individuals suffering from hip osteoarthritis try to find ways to relieve the pain. While they can’t do anything to prevent wear and tear on the joints completely, there are ways to slow down the process and manage hip osteoarthritis in the body. Small changes like incorporating food can dampen inflammatory effects on the joints while providing nutrients to the body. An exercise regime can help strengthen the weak muscles supporting the joints while increasing mobility and range of motion. Treatments like spinal traction and chiropractic care relieve pain and stiffness from joint disorders like osteoarthritis. Chiropractic care provides spinal manipulation on the back and joints to be adjusted. While spinal traction helps the compressed discs lay off the pressure on the surrounding nerves associated with hip pain. Incorporating any of these can help slow the progression of hip osteoarthritis and bring back mobility to the hips.
The hips provide stability to the upper and lower parts of the body. While supporting the weight of the upper half and movement to the lower half, the hips can succumb to wear and tear in the body. When the hip joints begin to wear and tear slowly, it can lead to the progression of hip osteoarthritis, where the cartilage of the joints begins to cause the bones to rub against each other, triggering inflammation. Hip osteoarthritis makes diagnosing difficult because the referred pain from the spine, knees, or groin area overlaps the symptoms. All is not lost, as there are available treatments to manage hip osteoarthritis that can help slow the progress of this disorder and bring back the mobility of the lower half of the body.
Khan, A M, et al. “Hip Osteoarthritis: Where Is the Pain?” Annals of the Royal College of Surgeons of England, U.S. National Library of Medicine, Mar. 2004, pubmed.ncbi.nlm.nih.gov/15005931/.
Kim, Chan, et al. “Association of Hip Pain with Radiographic Evidence of Hip Osteoarthritis: Diagnostic Test Study.” BMJ (Clinical Research Ed.), BMJ Publishing Group Ltd., 2 Dec. 2015, www.ncbi.nlm.nih.gov/pmc/articles/PMC4667842/.
Sen, Rouhin, and John A Hurley. “Osteoarthritis – Statpearls – NCBI Bookshelf.” In: StatPearls [Internet]. Treasure Island (FL), StatPearls Publishing, 1 May 2022, www.ncbi.nlm.nih.gov/books/NBK482326/.
Many individuals have dealt with issues affecting their lives in some way or form. People with autoimmune diseases must learn to manage their immune system from constantly attacking their bodies to function normally. The immune system’s primary function in the body is to attack environmental factors that harm the cells, muscles, and organs. When a person has an autoimmune disease, either from their family history or environmental factors, their immune system will begin to attack the body’s normal cells because it thinks it is a foreign invader to the body. Some common autoimmune disorders that most people have include lupus, ankylosing spondylitis, and rheumatoid arthritis. Most of these common autoimmune disorders correlate to common symptoms that add to other issues that affect the body. Today’s article looks at rheumatoid arthritis, its symptoms, how it relates to fatigue, and how there are available treatments to manage rheumatoid arthritis as well as fatigue. We refer patients to certified providers specializing in musculoskeletal therapies to help those who suffer from rheumatoid arthritis and fatigue. We also guide our patients by referring to our associated medical providers based on their examination when it’s appropriate. We find that education is the solution to asking our providers insightful questions. Dr. Alex Jimenez DC provides this information as an educational service only. Disclaimer
Have you been feeling stiffness and inflammation around your joints? have you experienced gut issues affecting your life? Or do problems of insomnia or fatigue seem to affect your quality of life? Many of these symptoms are associated with rheumatoid arthritis. Rheumatoid arthritis is an autoimmune disease that causes inflammation and swelling in the joints. The video above explains how to manage rheumatoid arthritis and its associated symptoms. Fatigue is one of the symptoms associated with rheumatoid arthritis as the inflammatory cytokines could be a co-morbidity in altering brain function that can lead to an overlap of pain and fatigue in the body, as studies reveal. While there hasn’t been a cure for rheumatoid arthritis, various treatment approaches can help people manage the symptoms of rheumatoid arthritis.
Some of the most commonly rheumatoid arthritis symptoms do to the body include pain, swelling and inflammation of the joints, joint deformity, and stiffness. Unlike wear and tear damage from different types of common inflammatory issues, rheumatoid arthritis symptoms may come and go that can range from mild, moderate, or even severe. When this happens, rheumatoid arthritis may be the result of making it difficult to perform simple tasks and cause joint alterations. Research shows that rheumatoid arthritis associated with inflammation can damage different body parts like the gut. Gastrointestinal problems like leaky gut, IBS, or SIBO could trigger flare-ups in individuals who have rheumatoid arthritis. This is known as somato-visceral pain, where the muscles affect the vital organs, causing problems for the body.
How Does Fatigue Correlate To RA?
Individuals that have rheumatoid arthritis do suffer from various symptoms that are associated with inflammatory issues. When inflammation begins to affect the body, it can overlap the profiles of fatigue and poorer quality of life in the individual. So how does fatigue correlate to rheumatoid arthritis? Studies reveal that fatigue is considered one of the acute symptoms of rheumatoid arthritis that imposes a burden on individuals, thus being associated with reducing their health and wellness. Fatigue has many dimensions that do impact many individuals. Some people will explain to their primary physicians that they are constantly tired, overworked, and repeatedly stressed from everyday life or disorders affecting their bodies. For rheumatoid arthritis individuals, studies reveal that high inflammatory factors associated with fatigue may cause them to feel exhausted. This is related to individuals who have insomnia from other conditions.
Managing Rheumatoid Arthritis-Video
Have you been feeling stiffness and inflammation around your joints? have you experienced gut issues affecting your life? Or do problems of insomnia or fatigue seem to affect your quality of life? Many of these symptoms are associated with rheumatoid arthritis. Rheumatoid arthritis is a chronic autoimmune disease that causes inflammation and swelling in the joints. The video above explains how to manage rheumatoid arthritis and its associated symptoms. Fatigue is one of the symptoms associated with rheumatoid arthritis as the inflammatory cytokines could be a co-morbidity in altering brain function that can lead to an overlap of pain and fatigue in the body, as studies reveal. While there hasn’t been a cure for rheumatoid arthritis, various treatment approaches can help people manage the symptoms of rheumatoid arthritis.
Treatments For RA & Fatigue
Even though there hasn’t been a cure for rheumatoid arthritis, there are ways to manage the associated symptoms of rheumatoid arthritis. Eating anti-inflammatory riched foods could potentially dampen the effect of inflammation on the joints. One way while exercising can help loosen up stiff joints and bring back muscle strength, thus restoring joint motion. Treatments like chiropractic care can also provide pain relief and management for individuals dealing with rheumatoid arthritis. Chiropractic care comprises passive and active treatment modalities for rheumatoid arthritis and fatigue. Chiropractors utilize spinal adjustments and manual manipulation to reduce misalignment or subluxation of the spine. Chiropractic care may also help with many symptoms like fatigue associated with rheumatoid arthritis without invasive treatments or medication. Chiropractic care could potentially improve the function of the bones, joints, and even the nervous system in the body.
Rheumatoid arthritis is a chronic inflammatory disease that causes joint stiffness and swelling. The causes of this autoimmune disease are unknown. Still, factors like stress, gut issues, and obesity are associated with symptoms like fatigue, leaky gut, muscle stiffness, and poorer quality of life could potentially be involved with rheumatoid arthritis. Treatments like eating anti-inflammatory foods, exercising, and chiropractic care could help manage inflammatory issues triggering rheumatoid arthritis and potentially reduce the effects of fatigue from the body, thus slowing down the progression and bringing back a person’s quality of life.
Korte, S Mechiel, and Rainer H Straub. “Fatigue in Inflammatory Rheumatic Disorders: Pathophysiological Mechanisms.” Rheumatology (Oxford, England), Oxford University Press, 1 Nov. 2019, www.ncbi.nlm.nih.gov/pmc/articles/PMC6827268/.
Santos, Eduardo J F, et al. “The Impact of Fatigue in Rheumatoid Arthritis and the Challenges of Its Assessment.” Rheumatology (Oxford, England), Oxford University Press, 1 Nov. 2019, www.ncbi.nlm.nih.gov/pmc/articles/PMC6827262/.
Spondylitis Anti-Inflammation Diet: Individuals who have a chronic back pain condition can be recommended to have two or more vertebrae fused to correct the problem/s and alleviate the pain. However, a form of inflammatory spinal arthritis can cause the vertebrae to fuse by themselves, known as ankylosing spondylitis. One recommended way to bring pain relief is by eating an anti-inflammatory diet. Studies have shown that a low-inflammatory diet can help improve spondylitis symptoms.
Spondylitis Anti-Inflammation Diet
Ankylosing spondylitis is a progressive inflammatory disease that primarily affects the spine; however, individual symptoms vary. Symptoms include stiffness and pain in the neck, hips, low back, and fatigue. There is no definite pattern meaning:
Symptoms can improve.
Symptoms can worsen or flare up.
Symptoms can stop for a period of time.
Women are affected more often than men with no known cause. There is no cure for ankylosing spondylitis, but treatments and self-care can slow down the disease’s progression and help manage symptoms.
Diet and Inflammation
Diet is not the root cause of inflammatory disease, but eating inflammation-causing foods can worsen symptoms. Reducing inflammation can help alleviate pain.
Eliminating foods that cause or increase inflammation is recommended to help the body become stronger and manage symptoms.
Functional medicine practitioners can help guide individuals on maximizing healthy nutrition and using it to reduce pain and symptoms.
If an individual has a genetic predisposition, their diet can be crucial to calm down the symptoms and help turn the autoimmune disease around.
A spondylitis anti-inflammation diet should be rich in vegetables, fruit, whole grains, and omega-3 fatty acids. Evidence shows that a diet low in starches can lead to less ankylosing spondylitis activity. Low-starch can also help limit the presence of Klebsiella pneumoniae, a bacteria that feeds on starch and is a known trigger for the onset and development of ankylosing spondylitis.
Foods To Eat
These include spinach, kale, Swiss chard, and collard greens containing magnesiumand polyphenols that reduce inflammation.
These can be raw or cooked with garlic and olive oil added to maximize benefits.
These contain sulforaphane, anantioxidantthat includes broccoli cauliflower and can be eaten raw or cooked, roasted with olive oil, sauteed, and stir-fried.
Individuals may not be symptomatic with certain foods, but that doesn’t mean the foods should be consumed. Gluten, dairy, and eggs can cause potential problems as they compromise the gut and the immune system. These can set back the individual’s healing or remission.
What Happens To The Body When Eating Fruit
Fruit is made up of simple sugar called fructose, providing the body with a carbohydrate energy source. The natural sugar the body gets from a piece of fruit is not the same as processed fructose added to processed products like fructose corn syrup. Processed products are typically filled with empty calories and very little nutrition. When the body has fruit, the liver processes fructose before getting absorbed through the small intestine. Research shows that exposing the gut to more fiber-rich foods like fruit helps the gut achieve an anti-obese condition by increasing the good bacteria and reducing the obese bacteria. Essential nutrients from fruit include:
The USDA recommends making half of each meal/plate be fruit and vegetables.
Arthritis can be a debilitating disease that interferes with everyday life. There are over 20% of adults aged 65 and older that have arthritis along with all the symptoms like pain, stiffness, swelling, and decreased range of motion. The most commonly affected joints include the shoulders, hands, spine, hips, and knees. Arthritis results from damage to joint cartilage from various factors such as age, wear and tear, injury, being overweight, and disease. While medication and surgery are the most common treatment options, an arthritis chiropractor can offer a conservative, natural, non-invasive option to manage symptoms.
Arthritis Chiropractor Helps By
While arthritis, either caused by wear and tear – Osteoarthritis or disease – Rheumatoid Arthritis cannot be cured. An arthritis chiropractor can help manage symptoms and prevent progression. Chiropractors are trained to use various techniques to help alleviate pain and tension, including arthritis. Chiropractic treatment aims to alleviate pain by adjusting, massaging, and realigning the musculoskeletal system to relieve stress, stretch the muscles, ligaments, tendons, and restore balance within the body. They open the body to allow proper/optimal nerve energy and blood circulation. This is beneficial for arthritic joints to reduce unnecessary strain, translating to reduced wear on the joints and keeping the body active.
There are significant benefits that regular chiropractic treatment can offer. These include:
Restored range of motion
Joint pain relief
Improved nerve function for optimal tissue healing
Regular adjustments will keep the body optimally aligned and functioning smoothly.
Arthritis chiropractors can recognize the most subtle changes.
Healthy lifestyle adjustments help manage arthritis.
Guidance on healthy habits that include:
Proper sleep habits
The sooner chiropractic care is sought out, the better to prevent symptoms from worsening. Chiropractic can generate great results with less need for medication/s or surgery.
Identifying The Risk of Sarcopenia and Decreased Mobility
As the body ages, it begins to lose muscle mass, and as more sedentary behavior is adopted, the rate of loss increases along with age-related injury. Identifying these age-related changes in muscle and how they relate to frailty risk can be challenging to identify and track. By accurately measuring fat-free mass in each region of the body, Skeletal Muscle Index – SMI quickly specifies muscle mass and frailty risk. Sarcopenia and frailty specifically affect the elderly population, affecting mortality, cognitive function, and quality of life. Loss of muscle in the arms and legs is associated with:
Reductions in mobility
Increased risk of falls
Extended hospital stays
Falls and fractures frequently result in a cycle of muscle deterioration. Analysis tools can help track body composition changes to minimize muscle wasting and the risk of impaired mobility. Assessing skeletal muscle mass in outpatient and hospital settings can decrease debilitating outcomes before they happen. The InBody analysis is quick and easy, providing a calculation for skeletal muscle index and the sum of the lean mass in the arms and legs. The ease of performing the InBody test provides physicians more time to work with and educate individuals on adopting lifestyle changes to help prevent sarcopenia.
Aletaha, Daniel. “Precision medicine and management of rheumatoid arthritis.” Journal of autoimmunity vol. 110 (2020): 102405. doi:10.1016/j.jaut.2020.102405
Beasley, Jeanine. “Osteoarthritis and rheumatoid arthritis: conservative therapeutic management.” Journal of hand therapy: official journal of the American Society of Hand Therapists vol. 25,2 (2012): 163-71; quiz 172. doi:10.1016/j.jht.2011.11.001
Demoruelle, M Kristen, and Kevin D Deane. “Treatment strategies in early rheumatoid arthritis and prevention of rheumatoid arthritis.” Current rheumatology reports vol. 14,5 (2012): 472-80. doi:10.1007/s11926-012-0275-1
Kavuncu, Vural, and Deniz Evcik. “Physiotherapy in rheumatoid arthritis.” MedGenMed: Medscape general medicine vol. 6,2 3. 17 May. 2004
Moon, Jeong Jae et al. “New Skeletal Muscle Mass Index in Diagnosis of Sarcopenia.” Journal of bone metabolism vol. 25,1 (2018): 15-21. doi:10.11005/jbm.2018.25.1.15
Psoriatic arthritis can develop in individuals who have psoriasis, affecting various joints, especially the knees. Psoriasis is a skin condition that causes skin cells to build up and form patches of itchy, dry skin known as plaques. Psoriatic arthritis is a long-term inflammatory disease that can cause inflammation, stiffness, and pain. Symptoms can progressively worsen over time without treatment. Early diagnosis is vital to minimize damage to the joints and slow the condition’s progress with treatment.
Psoriatic arthritis symptoms like stiffness and swelling can present differently from person to person. For example, some individuals with psoriatic knee arthritis will experience stiffness or pain in one knee, while others experience symptoms in both knees. Psoriatic arthritis in the knee can also cause swelling in the surrounding:
Symptoms can also present in the:
Symptoms usually begin between the ages of 30 and 50. Common symptoms include:
Stiffness after resting or sleeping.
Inflammation in the knee and surrounding area.
Warm or hot skin on the knee from the inflammation.
Pain in and around the joints, tendons, or ligaments.
Joint sticking, difficulty moving, or reduced range of motion.
Other symptoms include:
Pain and redness in the eyes
Swollen fingers or toes
Difficulty walking from pain in the feet or Achilles tendon.
The severity of psoriasis does not determine psoriatic arthritis symptoms. Symptoms can go through a pattern of relapses and remissions. Individuals can have a sudden attack where symptoms get worse over a short time. After the flare-up, symptoms can improve as the condition goes into remission. Symptoms may not present for a long time until another flare-up. For example, an individual may have severe psoriasis but only mild psoriatic arthritis.
Psoriatic arthritis develops when the body’s immune system mistakenly attacks healthy cells and tissues. The faulty immune response causes the body to quickly generate new skin cells that stack on top of each other forming plaques. When the condition affects the joints, it leads to inflammation. While there is no apparent cause for psoriatic arthritis, researchers have found connections to genetics and the environment, as well as, individuals with close relatives that have psoriatic arthritis could be more likely to develop the condition. Other factors that could influence the development include:
The condition can happen at any age, but according to the National Psoriasis Foundation, most individuals first notice symptoms about ten years after their psoriasis begins. However, only 30% of individuals with psoriasis develop psoriatic arthritis.
Doctors use imaging tools to diagnose psoriatic arthritis in the knee. They will use:
To help them check for irregularities or signs of inflammation in the joint and surrounding tissues.
Additional tests are used to rule out other common forms of arthritis like rheumatoid and osteoarthritis.
Blood tests check for inflammation and specific antibodies.
In some cases, a small amount of fluid from the joint is taken to help eliminate the possibility of other underlying conditions like an infection.
There is currently no cure for psoriatic arthritis, but treatments are being developed and show promise for long-term management. Current treatments focus on managing symptoms and improving the quality of life for the individual.
Biologic medications like tumor necrosis factor or TNF inhibitors are recommended as the first-line therapy for most individuals with a new diagnosis of psoriatic arthritis. These meds help block TNF, which plays a crucial role in inflammation. They have shown to be effective at reducing the severity of symptoms and the frequency of flare-ups. Biologics can cause unwanted side effects, especially in individuals that experience frequent infections and need routine monitoring.
Small Molecule Medications
Individuals that cannot use biologic medications may be recommended a new class of medication called oral small molecules or OSMs. Examples include apremilast – Otezla and tofacitinib – Xeljanz.
Disease-modifying Antirheumatic Drugs
Disease-modifying antirheumatic drugs – DMARDs are a long-term option. They are used to slow the progression of psoriatic arthritis, and examples include methotrexate and cyclosporine. DMARDs work best when an individual begins taking them as early as they can take time to work. However, individuals are encouraged to continue taking them, even if symptoms do not improve right away.
A doctor may prescribe nonsteroidal anti-inflammatory drugs – NSAIDs and corticosteroid injections when knee symptoms flare-up. These are short-term treatments that provide immediate relief, as long-term use can lead to side effects. Individuals can find relief with combined self-care that includes:
Taking over-the-counter NSAIDs like ibuprofen/Advil or naproxen/Aleve.
Applying ice and heat packs.
Gentle exercise to promote a full range of motion.
Gentle stretching or yoga can help relax tight muscles.
However, chiropractic is not the primary treatment for arthritis but is intended to be used in combination to relieve pain, loosen and stretch the muscles and balance the body.
Strength, Balance, and Improved Body Composition
Functional fitness is the ability to move comfortably every day. The benefits of physical activity also contribute to improved body composition. Working to reach a certain level of functional fitness can help the aging process that has been shown to reduce metabolic rate. Inactivity is why individuals lose Lean Body Mass as they age, leading to increased body fat. Lean Body Mass contributes to the body’s overall Basal Metabolic Rate or BMR, also known as metabolism. This is the number of calories the body needs to support essential functions. Everyone is encouraged to engage in strength training or resistance exercises, but specifically older adults. This can help regain muscle loss which can lead to an increase in lean body mass. The increase in Lean Body Mass increases BMR, which helps prevent fat gain.
Managing rheumatoid arthritis is an ongoing balancing act. Flare-ups can still present despite following the rheumatologist’s lifestyle instructions, proper medication use, and a well-maintained RA plan. Monitoring daily activities can help minimize the chances of experiencing episodes.
Rheumatoid Arthritis Flare-Ups
A rheumatoid arthritis flare-up is a short-term escalation of arthritis symptoms. A flare-up can go away within a day or can persist for several weeks or months. A flare-up usually involves joint stiffness and pain but can also present as any symptoms worsening. If the flare-up is severe, it can affect the ability to perform regular everyday activities.
Symptoms can vary, and not every person experiences the same. Most individuals describe flare-ups with a sudden increase in:
Limited joint mobility
Symptoms that feel like the flu.
Frequency and severity can also vary.
Back Pain Symptoms
Rheumatoid arthritis can affect many joints. It is the inflammation of a joint’s synovial membrane. These include the facet joints in the spine. The most commonplace in the spine affected by rheumatoid arthritis is the upper neck, around the base of the skull. The joints at the top of the neck get inflamed and can become unstable or form abnormal tissue that sticks out and compress the spinal cord.
Several potential flare-up triggers include:
Not getting enough sleep
Excessive physical activity and/or exercise
Repetitive overuse injury
Airborne toxins can also be a trigger to a flare-up. Substances include chemicals like household cleaners. Switching to organic and environmentally safe cleaners can help. Airborne toxins are a concern in densely populated cities and areas that experience air pollution and smog. To minimize risks, staying indoors during times of poor air quality is recommended.
However, flare-ups can happen without an identifiable trigger. Certain foods can increase inflammation and could contribute to a flare-up, including:
Avoiding these foods and following a diet that has been developed to prevent symptoms will help significantly. The objective is to learn to identify an RA flare-up to moderate activities accordingly.
Managing any chronic medical condition is challenging, especially when trying to predict when a flare-up will happen. There is not a foolproof strategy for prevention, but advice that can help minimize the risks of an RA flare-up.
Understand that the disease can change over time. This means changes in medications and the need for multi-approach treatment. Learning healthy self-care techniques will go a long way in managing symptoms.
Metabolic processes, like energy production, and environmental pollution, can result in free radical production. These are highly reactive molecules that can damage the body’s cells and lead to oxidative stress. This can develop into a disease, including heart disease. The body has natural protective mechanisms to neutralize free radical molecules, including glutathione, which is the body’s top antioxidant. If glutathione becomes depleted because of increased free radicals, the body switches to dietary antioxidants from food as a secondary defense.
Rheumatoid arthritis is said to affect around 1.5 million individuals. Recognized as an autoimmune condition that presents with chronic pain in the body’s joints. It commonly affects regularly used joints like the shoulders, hands, and feet. The condition can begin to present in individuals in their 30s. Concerns that come with a rheumatoid arthritis diagnosis are the condition’s effect on the spinal facet joints. These joints are susceptible to attack from a dysfunctional immune system, leaving them prone to weakness, inflammation, and nerve compression. Chiropractors understand the manifestation of rheumatoid arthritis. They can pinpoint at-risk facet joints and provide corrective relief before more dangerous symptoms begin to present.
Facet joint risks
There are two facet joints that connect each vertebra to the one above and below. Their objective is to stabilize the spine, whether in a neutral position or engaged in flexion/extension movement. When targeted by the body’s immune system, the joints begin to weaken. The body attacks the synovial fluid that lubricates the joints. This creates friction that generates inflammation. Over time the joints break down leading to everything from loss of mobility to bone spurs. When left untreated the facet joints begin to deteriorate, causing nerve compression that can lead to permanent nerve damage. When the joints are not working properly the spine has to work around them.
Sciatica all are possible with facet joint dysfunction.
Currently, rheumatoid arthritis cannot be cured but symptoms can go into remission when treatment begins early.Chiropractic is an effective treatment at disrupting the symptoms of joint deterioration that stops the progression.
It has the ability to increase and maintain an individual’s range of motion, from a condition that causes loss of mobility.
It helps to bring rapid pain relief and helps with postural improvements.
It maintains positive spinal health and homeostasis.
Prevents problems with compression and subluxations.
Stretching and strengthening exercises are incorporated to preserve an individual’s spinal integrity.
Diet and nutrition are also adjusted to mitigate the effects, helping with inflammation prevention.
The spinal focus
As rheumatoid arthritis affects the body’s joints, it is vital to protect the facet joints. These joints can experience degenerative damage that can cause long-term problems. Injury Medical Chiropractic and Functional Medicine Clinic provide individuals with the tools necessary to combat rheumatoid arthritis that medications by themselves might not be able to.
Muscle Mass Fitness for Long-Term Health
Muscle building is not just for bodybuilders and athletes. Everyone benefits from building muscle for long-term health. Monitoring the changes in Lean Body Mass can be accomplished by having body composition measured. Body composition analysis can divide an individual’s weight into various components. These include:
Lean Body Mass
Basal Metabolic Rate will give a clearer picture of overall fitness and health.
Building Lean Body Mass is an investment for maintaining health long-term. The more Lean Body Mass that is built the more is in storage/reserve when the body really needs it. Before adding protein shakes and resistance workouts to the daily regimen, a plan needs to be developed. The first step to building a healthy level of lean body mass is to measure how much there is with a body composition analysis.
The information herein is not intended to replace a one-on-one relationship with a qualified health care professional, licensed physician, and is not medical advice. We encourage you to make your own health care decisions based on your research and partnership with a qualified health care professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from a wide array of disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the musculoskeletal system’s injuries or disorders. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and support, directly or indirectly, our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request. We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900.
Inflammatory spinal arthritis can cause significant joint pain and severely damage sleep quality. Any of the following conditions can cause individuals to experience sleep problems:
Juvenile idiopathic arthritis
Dr. Jimenez from Injury Medical Chiropractic and Functional Medicine Clinic gives insight into how inflammatory spinal arthritis can disrupt healthy sleep, along with some tips to help individuals with joint pain restore healthy sleep.
Inflammatory Spinal Arthritis and Sleep
First, it is not just the joint pain of arthritis that is causing sleep problems. Research is discovering that more factors could be at play. A study in the journal SLEEP examined how individuals with chronic pain, including osteoarthritis slept. What was revealed was a strong connection between chronic pain and insomnia.
Insomnia can lead to added joint pain because poor sleep can trigger inflammatory pathways that worsen arthritis pain. Plus a poor night of sleep can heighten an individual’s perception of pain the next day. Arthritis pain does not just impact the sleep of adults, but young individuals with juvenile idiopathic arthritis can also struggle with getting healthy sleep. Sleep, pain levels, and mood are strongly related.
Achieving quality sleep and a well-rested body can be done. Things to consider to help secure a healthy sleep.
Medication interference/side effects
Corticosteroids could be part of the sleep problem, as corticosteroid treatment has been linked to insomnia. If struggling to fall asleep, talk with a doctor about altering any prescribed medication regimen before sleep like taking aspirin or a nonsteroidal anti-inflammatory NSAID medication in its place.
Adjust sleep position to joint pain
If the neck is sore/aching rest the head on a flat pillow so the cervical spine is in a neutral position. For low back joint pain, individuals might find relief by sleeping on their back or side with the knees and hips flexed at a 90-degree angle. For hip joint stiffness, sleeping on the side with a pillow between the legs is recommended.
A firm mattress and support pillow
A firm mattress will support the body and help reduce pain. The right pillow/s are also important for healthy sleep. A lumbar and cervical pillow can help cushion tender areas.
Joint pain first thing in the morning needs time to adjust. For morning physical chores try to reschedule for later on in the day or if possible the night before. This could be fixing lunches, picking out clothes, preparing breakfast, or packing the work case, tools, etc. The extra time will reduce morning stress and allow the body to gently adjust.
Wake up and stretch
With joint pain in the morning, some gentle stretching can help. Doing some stretches before even getting out of bed will help minimize pain and allow the body to gradually prepare for movement. Follow the stretch session up with a hot shower to loosen stiff joints.
Increase Sleep Quality
Sleep problems can affect anyone even those that don’t have inflammatory spinal arthritis/joint pain. There could be other issues causing sleep problems unrelated to joint pain. If still not getting quality sleep, talk to a rheumatologist about available options.
Osteoarthritis and Exercise
Obesity is a significant risk factor in the development of osteoarthritis. This is not only from the effects of extra weight on the body’s joints but also as a result of the pro-inflammatory effects of adipose tissue. The hips and knees are the weight-bearing joints. Excessive adipose tissue on the midsection and legs have been shown to negatively impact these weight-bearing joints.
Promoting Lean Body Mass and encouraging weight loss can potentially lower the risk of osteoarthritis and improve the quality of life. Gentle exercise is regarded as safe for individuals with osteoarthritis and is a key component to improve body composition, reduce body fat mass, improve lean body mass and maintain a healthy weight. Improving body composition and utilizing exercise in weight management can have a direct and positive effect on joint health.
Dr. Alex Jimenez�s Blog Post Disclaimer
The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.*
Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*
Our diet can significantly affect inflammation in our bodies. Several foods can increase inflammation while other foods can reduce inflammation. According to healthcare professionals, a diet that is high in sugar may be associated with chronic inflammation. A systematic review in 2018 demonstrated that eating excess sugar can ultimately cause inflammation and a variety of other health issues, such as diabetes. Another 2014 research study showed that people who decreased their consumption of sugary or sweetened drinks had reduced inflammation. These research findings support the theory that eating excess sugar can cause chronic inflammation and various other diseases, including diabetes.
How Sugar Can Cause Inflammation
Healthcare professionals have tried to understand how eating excess sugar can cause chronic inflammation. Sugar triggers the production of free fatty acids in the liver. When the human body digests these free fatty acids, the resulting compounds can trigger inflammation. Different types of sugar may also cause more inflammation. By way of instance, one research study found that fructose can cause more inflammation than glucose. However, a systematic review found that fructose didn’t cause more inflammation than glucose. Therefore, further research studies are still required to determine which types of sugar may cause more inflammation. Symptoms associated with chronic inflammation can include:
pain and fatigue
sleeping problems or insomnia
anxiety, depression, and other mood disorders
digestive problems like acid reflux, constipation, and/or diarrhea
weight gain or obesity
People with chronic inflammation may also have an increased risk of developing a variety of other health issues, including diabetes and dementia. Chronic inflammation in older adults may also be associated with an increased risk of death.
Health Issues Caused by Chronic Inflammation
Observational research studies in humans have associated diets with high added sugar and refined carbohydrates to the increased risk of developing a variety of health issues, including diabetes, IBD, liver disease, dementia, and arthritis.
Research studies showed a connection between the increased consumption of added sugar and type 2 diabetes. A large analysis that included over 38,000 participants found that simply consuming one serving of sweetened drinks or beverages on a regular basis was associated with an 18 percent increased risk of developing type 2 diabetes. Another research study found that increasing the consumption of high-fructose corn syrup was also associated with diabetes.
Increased consumption of added sugar and refined carbohydrates has also been associated with the development of other diseases, such as arthritis, inflammatory bowel disease, liver disease, and dementia. Furthermore, excess fructose consumption has been associated with non-alcoholic fatty liver disease. Healthcare professionals believe this may be due to a combination of ongoing low-grade inflammation, increased gut permeability, and bacterial overgrowth in the gut.
Other Foods That Can Cause Inflammation
sugary foods like pastries, desserts, and chocolate
saturated fats from processed meats and dairy products
trans fats found in fast, fried, foods
vegetable and seed oils
MSG in prepared Asian foods and deli meats
For information regarding how excess sugar can cause chronic inflammation and various other health issues like diabetes, please review this article:
Diet can affect inflammation in our bodies. Several foods can increase inflammation while other foods can reduce inflammation. A diet that is high in sugar may be associated with inflammation. Numerous research studies have demonstrated that eating excess sugar can ultimately cause chronic inflammation and various other diseases, including diabetes. Because sugar triggers the production of free fatty acids in the liver, it can also trigger inflammation. Excess sugar can cause chronic inflammation. Different types of sugar may also cause different amounts of inflammation. There are many symptoms associated with chronic inflammation, including pain, fatigue, obesity, anxiety, and depression, among others. Inflammation can lead to a variety of health issues, such as diabetes and arthritis. Although excess sugar is associated with chronic inflammation, other foods like saturated fats and refined carbohydrates can also cause health issues. In the following article, we discuss how sugar can cause inflammation and a variety of other health issues, such as diabetes, in the human body. – Dr. Alex Jimenez D.C., C.C.S.T. Insights
Sea Green Smoothie
Servings: 1 Cook time: 5-10 minutes
� 1/2 cup cantaloupe, cubed
� 1/2 banana
� 1 handful of kale or spinach
� 1 handful of Swiss chard
� 1/4 avocado
� 2 teaspoons spirulina powder
� 1 cup of water
� 3 or more ice cubes
Blend all ingredients in a high-speed blender until completely smooth and enjoy!
Leafy Greens Hold the Key to Gut Health
A unique type of sugar found in leafy greens can help feed our beneficial gut bacteria. Sulfoquinovose (SQ) is the only known sugar molecule to be made up of sulfur, an extremely essential mineral in the human body. The human body uses sulfur to produce enzymes, proteins, and a variety of hormones as well as antibodies for our cells. A fast and easy way to get leafy greens into your diet is to toss a couple of handfuls of them into a delicious smoothie!
The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas*& New Mexico*�
Curated by Dr. Alex Jimenez D.C., C.C.S.T.
Spritzler, Franziska. �6 Foods That Cause Inflammation.� Healthline, Healthline Media, 12 Nov. 2019, www.healthline.com/nutrition/6-foods-that-cause-inflammation#1.
Caporuscio, Jessica. �Does Sugar Cause Inflammation? What the Research Says.� Medical News Today, MediLexicon International, 19 Sept. 2019, www.medicalnewstoday.com/articles/326386.
Brown, Mary Jane. �Does Sugar Cause Inflammation in the Body?� Healthline, Healthline Media, 12 Nov. 2017, www.healthline.com/nutrition/sugar-and-inflammation.
Reducing stress is important for emotional well being and physical health. Rheumatoid arthritis is a complex condition with no cure and can cause intense chronic pain. Stress only exacerbates the symptoms, affects pain perception, and weakens the body. Stress management is highly important for reducing pain. In a weakened state, an individual is more vulnerable to arthritis symptoms, like flare-ups, weakness, and fatigue.�Chiropractic can help.
There are non-surgical treatments for arthritis, like medications, physical, and massage therapy that address the physical nature of the condition. By eliminating stressful triggers and making healthy behavioral/lifestyle changes a better sense of well being can be achieved.
Different emotions can run rampant:
And all of these feelings can generate intense stress on an individual. Chiropractic excels in wellness and is becoming more common for individuals to visit chiropractic clinics for treating a variety of different kinds of pain symptoms and conditions. Chiropractic adjustments provide countless benefits to those with arthritis. We�ll explore how chiropractic can help those with arthritis and give additional information along with suggestions on how to alleviate the pain.
What Chiropractic Does
A doctor of chiropractic is a health professional that focuses on wellness and optimal health instead of ailment/sickness symptoms. Their specialty aims at adjusting the spine to correct misalignments that could be pressing down on nerves and causing major disruption in the body. Regular chiropractic not only restores health throughout the body but helps alleviate back pain and any other symptoms associated with an out of alignment spine.
They also work in setting up exercise programs specific to the condition being treated along with the proper diet to utilize in assisting with the management of inflammation and pain.
Arthritis is inflammation in the body’s joints which results in pain, stiffness and limited range of movement. There are over 200 different varieties of arthritis. Generally associated with age, it can affect young people. It can strike pretty much any area of the body. Arthritis can cause damage to soft tissues and muscles.
Osteoarthritis also known as degenerative joint disease, is the most common type. It comes from repeated trauma to the joints and occurs more often in the elderly.
Other forms include:
Rheumatoid arthritis is the second common type in which the body�s immune system attacks the joint/s.
Psoriatic arthritis, an autoimmune form of arthritis.
Ankylosing spondylitis is a type of arthritis where the body attacks itself.
Septic arthritis is caused by a viral or bacterial infection of the joint/s.
Diagnosing arthritis involves a thorough physical examination. Rheumatologists often need help with these cases, and so a medical work-up can be done and a chiropractor could be recommended. This includes X-rays or MRIs, urine, blood analysis, and physical examinations. Having the condition properly diagnosed will help to more effectively treat the symptoms.
The most common treatment is medication, which takes down the inflammation, the swelling and reduces pain. Chiropractors can be of great help in managing arthritis. Medications work but as we’ve seen they can have long-term health risks like impaired healing, damage to the stomach lining and internal bleeding.
A chiropractor can reduce stress, and reliance on medications, all the while managing the pain and symptoms in a natural way. Chiropractic can:
Improve range of motion
Keeps the spine properly aligned
Increase muscle tone
Develop a dietary and nutritional plan to reduce inflammation
Recommend an exercise regimen conducive to arthritis symptoms
According to the American Chiropractic Association, this is vital in managing arthritis symptoms.
Understand that chiropractic cannot cure arthritis. They can help alleviate symptoms, slow the progression and help to reduce stress levels. They will use adjustments in combination with other treatments. This can include:
Hot and cold treatments
Electronic muscle stimulation
Water aerobics or make walking around the park/neighborhood part of a daily routine, as it promotes a healthy mind by reducing stress and anxiety. Gentle exercises like aerobic exercise are perfect because it improves mobility and helps shed a few pounds taking pressure off the joints. Exercise creates endorphins, which reduces pain and uplifts the mood.
With any type of painful condition, it’s easy to feel alone. Joining a support group can connect you with people who understand what’s going on and the emotions you’re experiencing. The community helps diminish the sense of isolation.
This focuses on calming the body and mind by making a conscious effort to relax. Even for only a few moments, you might find this technique effective at controlling the stress response. Begin by focusing on one part of the body like the hands, feet, etc.
Concentrate until the area you’re focusing on is completely free of stress or tension. Then imagine weightlessness flow through the body. Close your eyes, lie down, turn off the lights, and think of something soothing. There are no strict guidelines for relaxation. Whatever puts you in a relaxed frame of mind is the way to do it.
Warm moist heat from a shower, bath, or steam room can decrease the secretion of stress hormones and raise levels of endorphins, as aforementioned the body’s natural pain killers.
Take time for yourself
When it comes to reducing stress, balance is key. Staying active, and regular rest/sleep is vital to successful treatment. A balance needs to be in everything you do. Therefore, make time for the things you want to do.
Inflammatory diseases like arthritis have shown the best results are achieved from combating it from all angles. Working with a chiropractor and rheumatologist to combine treatments can make all the difference. A healthy diet and active exercise program will get you in the right direction toward a healthy active lifestyle. If you or a loved one are suffering from arthritis, don�t hesitate to call. We�re here to help in any way possible!
The most�common type of arthritis in children and adolescents is Juvenile idiopathic arthritis aka (JIA) a type of inflammatory arthritis that affects kids 16 years and younger. It is a rare condition, that affects around 1 in every 1,000 children. It can cause�joint�pain and stiffness throughout the body, especially the facet joints/spinal joints.
Types of Arthritis that Fall Under JIA
Juvenile Idiopathic arthritis was known as juvenile rheumatoid arthritis, but it is not a child/teenage version of adult rheumatoid arthritis. Juvenile Idiopathic arthritis falls into a group of several types of arthritis. When a doctor diagnoses JIA, they will determine the type.
To better understand how this arthritis affects the spine, it helps to know some of the terminology.
Enthesitis: Inflammation of the entheses is the area where tendons and ligaments connect to bone/s.
Spondyloarthritis: Arthritis that attacks the entheses of the spine. Ankylosing spondylitis is an example of spondyloarthritis.
The neck joints are the most common to be attacked by JIA. Whereas, spondyloarthritis causes pain and stiffness in the low back.
Juvenile idiopathic arthritis happens in children aged 16 years and younger. Symptoms include:
Mild heat or a warmness that has been present for at least 6 weeks.
Other symptoms can include muscles and soft tissues becoming tight, erosion of the bone,�joint misalignment, and abnormal growth patterns.
Diagnosis Can Be A Challenge
Diagnosis is not always straightforward, and there are criteria for diagnosing juvenile idiopathic arthritis. The doctor will perform a physical exam and order tests. They will monitor the child�s symptoms for at least 6 weeks initially, and then for 6 months after the onset of the disease. During this time, figuring the number of joints involved helps determine the diagnosis. As joint involvement can vary by the type of arthritis, and symptoms can and do change regularly.
This arthritis attacks the joints of the spine, specifically in the neck. However, with certain types of spondyloarthropathy, the lower back can become the target.
Diagnosing arthritis involves a complete and thorough examination. If a chiropractor has been brought in to help with the case, a medical work-up by a rheumatologist could be recommended. This includes radiology/X-rays or an MRI, urine, blood analysis and physical examinations.
A doctor may recommend a multi-disciplinary approach to treat JIA. They may prescribe various types of therapies/treatments focused on stopping the disease’s progression. The treatment plan will include teaching healthy habits to prevent future back pain.
Treatment usually starts with nonsteroidal anti-inflammatory’s. A doctor can also prescribe a corticosteroid to control the inflammation. Most respond well to anti-inflammatory medication, however, these medicines do not treat the underlying disease or the root cause.
Inflammatory arthritis and its progression can be controlled with certain medications. There are disease-modifying antirheumatic medications that can slow the disease�s progression. There are also TNF-blocking medications that can help block a specific protein known as tumor necrosis factor that causes inflammation. Etanercept known on the market as Enbrel and adalimumab aka Humira are examples of TNF-blockers that can prevent the disease from progressing.
Understand that chiropractic medicine cannot cure arthritis, but it can help alleviate the symptoms and slow the progression. They will use spinal adjustments in conjunction with other treatments. These can include:
Hot and cold treatments
Electronic muscle stimulation
Physical Therapy Exercise
Healthy lifestyle education
Patients can develop a forward posture that can lead to a hunched back and neck pain. Postural training and back extension exercises are helpful. Stretching and range of motion exercises keep the facet and rib joints functioning and mobile. Deep breathing expands the chest which expands the rib joints and aids lung function. Depending on the type and severity, a doctor might try other approaches like spine surgery.
If you or someone has been diagnosed with juvenile idiopathic arthritis in the spine,�learn as much as possible about the disease and the ways to combat it. Being informed about this or any disease encourages empowerment and engagement throughout the treatment process.
The best results are achieved by attacking it from all angles. Working with a chiropractor and rheumatologist in combination. A chiropractor will train the individual on how to maintain a healthy diet and maintain an active exercise program to help with movement. This is geared toward a healthy outcome.
Rheumatoid arthritis (RA) is a condition that causes considerable discomfort if diagnosed with this autoimmune disease. This is when your immune system starts attacking your joints, instead of foreign invaders, which then causes inflammation.
The worse the RA, the more severe the symptoms become. If things get bad enough you can lose mobility altogether, which is why it is so important to get treatment. Fortunately, chiropractic is excellent for reducing inflammation and improving mobility. Chiropractic treatment can do a lot to ease your pain and get you back to moving the way you are supposed to.
RA and Chiropractic
Chiropractic is an effective RA treatment for a number of reasons. Chiropractic treatment:
The image many people have of a chiropractic adjustment is one of popping backs and hard, jerking motions. While adjustments can certainly include these things, they do not have to. According to the Arthritis Foundation, chiropractors have more than 150 techniques they can use to adjust your body.
They strive to give treatments specific to the needs of each patient, which means adjusting the body as gently as necessary to produce the desired result. If your joints are swollen and painful the chiropractor will carefully work to realign the joint�which reduces inflammation and improves movement�while minimizing any pain or discomfort you feel from the adjustment.
With RA typically the worst symptoms are the result of inflammation. Chiropractic treatment may not be able to change the way your immune system is malfunctioning, but it can do a lot to help the painful areas become less inflamed.
The treatment you get from your chiropractor will ensure that your joints are moving as properly as possible given your condition. By putting the body back in alignment, chiropractic improves the way the nervous system operates and lessens inflammation.
One of the most difficult things for many with RA is the loss of mobility that comes when their joints swell. When the pain becomes more substantial it is normal for RA sufferers to avoid movement because it hurts.
But it is important to remember that movement, even when it hurts, is necessary to maintain joint mobility. The longer you avoid moving a joint the more likely it is that you will lose function.
A useful aspect of chiropractic is that you can get help with moving, so you are not all alone with the daunting prospect of moving your joints so they start working better. Your chiropractor is your partner in movement, helping to guide your body so that it moves as well as possible. Results are different for everyone based on their unique situations, but you can be sure that chiropractic will serve as a powerful tool to keep your body working as well as possible.
Hand Deformed From Rheumatoid Arthritis
Drug-Free and Non-invasive
In chiropractic, the focus is to help the body heal itself, which means avoiding surgery and prescription medications as much as possible. Surgery and medication often have unwanted side-effects�sometimes worse than the problem they were intended to solve. With chiropractic negative side-effects are unlikely. You can get a lot of relief from gentle, effective treatments that will not make you feel worse than when you started.
Please contact our office to schedule an appointment. We look forward to speaking with you!
Opioid Addiction Alternative
Opioids (such as hydrocodone, oxycodone, codeine, and morphine) mask symptoms and do nothing to address the cause of pain.
There is an opioid crisis raging.� A sensible and safe alternative to opioids: Custom-made orthotics help relieve low back pain as well as hip and neck pain by removing imbalances in the musculoskeletal system, which originate in the feet.
Before considering taking an opioid for pain control, give Chiropractic care and foot orthotics a try. The combination of Chiropractic and orthotics is proven in clinical studies.
In 2015, about 2 million Americans had substance abuse disorders related to opioid medications.
In 2012, 80 out of 100 Americans were prescribed opioids. That’s about 259 million prescriptions � more than enough to give every American adult their own bottle of pills.
Less Pain & More Comfort
Custom orthotics help more than your feet! Stabilizing orthotics bring health and healing to the whole body by balancing the musculoskeletal system.
About 1.5 million people in the United States have rheumatoid arthritis. Rheumatoid arthritis, or RA, is a chronic, autoimmune disease characterized by pain and inflammation of the joints. With RA, the immune system, which protects our well-being by attacking foreign substances like bacteria and viruses, mistakenly attacks the joints. Rheumatoid arthritis most commonly affects the joints of the hands, feet, wrists, elbows, knees and ankles. Many healthcare professionals recommend early diagnosis and treatment of RA.
Rheumatoid arthritis is the most commonly diagnosed systemic inflammatory arthritis. Women, smokers, and those with a family history of the disease are most often affected. Criteria for diagnosis include having at least one joint with definite swelling that is not explained by another disease. The likelihood of a rheumatoid arthritis diagnosis increases with the number of small joints involved. In a patient with inflammatory arthritis, the presence of a rheumatoid factor or anti-citrullinated protein antibody, or elevated C-reactive protein level or erythrocyte sedimentation rate suggests a diagnosis of rheumatoid arthritis. Initial laboratory evaluation should also include complete blood count with dif- ferential and assessment of renal and hepatic function. Patients taking biologic agents should be tested for hepatitis B, hepatitis C, and tuberculosis. Earlier diagnosis of rheumatoid arthritis allows for earlier treatment with disease-modifying antirheumatic agents. Combinations of medications are often used to control the disease. Methotrexate is typically the first-line drug for rheumatoid arthritis. Biologic agents, such as tumor necrosis factor inhibitors, are generally considered second-line agents or can be added for dual therapy. The goals of treatment include minimiza- tion of joint pain and swelling, prevention of radiographic damage and visible deformity, and continuation of work and personal activities. Joint replacement is indicated for patients with severe joint damage whose symptoms are poorly controlled by medical management. (Am Fam Physician. 2011;84(11):1245-1252. Copyright � 2011 American Academy of Family Physicians.)
Rheumatoid arthritis (RA) is the most common inflammatory arthritis, with a lifetime prevalence of up to 1 percent worldwide.1 Onset can occur at any age, but peaks between 30 and 50 years.2 Disability is common and significant. In a large U.S. cohort, 35 percent of patients with RA had work disability after 10 years.3
Etiology and Pathophysiology
Like many autoimmune diseases, the etiology of RA is multifactorial. Genetic susceptibility is evident in familial clustering and monozygotic twin studies, with 50 percent of RA risk attributable to genetic factors.4 Genetic associations for RA include human leukocyte antigen-DR45 and -DRB1, and a variety of alleles called the shared epitope.6,7 Genome-wide association studies have identified additional genetic signatures that increase the risk of RA and other autoimmune diseases, including STAT4 gene and CD40 locus.5 Smoking is the major environmental trigger for RA, especially in those with a genetic predisposition.8 Although infections may unmask an autoimmune response, no particular pathogen has been proven to cause RA.9
RA is characterized by inflammatory pathways that lead to proliferation of synovial cells in joints. Subsequent pannus formation may lead to underlying cartilage destruction and bony erosions. Overproduction of pro-inflammatory cytokines, including tumor necrosis factor (TNF) and interleukin-6, drives the destructive process.10
Older age, a family history of the disease, and female sex are associated with increased risk of RA, although the sex differential is less prominent in older patients.1 Both current and prior cigarette smoking increases the risk of RA (relative risk [RR] = 1.4, up to 2.2 for more than 40-pack-year smokers).11
Pregnancy often causes RA remission, likely because of immunologic tolerance.12 Parity may have long-lasting impact; RA is less likely to be diagnosed in parous women than in nulliparous women (RR = 0.61).13,14 Breastfeeding decreases the risk of RA (RR = 0.5 in women who breastfeed for at least 24 months), whereas early menarche�(RR = 1.3 for those with menarche at 10 years of age or younger) and very irregular menstrual periods (RR = 1.5) increase risk.14 Use of oral contraceptive pills or vitamin E does not affect RA risk.15
Patients with RA typically present with pain and stiffness in multiple joints. The wrists, proximal interphalangeal joints, and metacarpophalangeal joints are most commonly involved. Morning stiffness lasting more than one hour suggests an inflammatory etiology. Boggy swelling due to synovitis may be visible (Figure 1), or subtle synovial thickening may be palpable on joint examination. Patients may also present with more indolent arthralgias before the onset of clinically apparent joint swelling. Systemic symptoms of fatigue, weight loss, and low-grade fever may occur with active disease.
In 2010, the American College of Rheumatology and European League Against Rheumatism collaborated to create new classification criteria for RA (Table 1).16 The new criteria are an effort to diagnose RA earlier in patients who may not meet the 1987 American College of Rheumatology classification criteria. The 2010 criteria do not include presence of rheumatoid nodules or radiographic erosive changes, both of which are less likely in early RA. Symmetric arthri- tis is also not required in the 2010 criteria, allowing for early asymmetric presentation.
In addition, Dutch researchers have developed and validated a clinical prediction rule for RA (Table 2).17,18 The purpose of this rule is to help identify patients with undifferentiated arthritis that is most likely to progress to RA, and to guide follow-up and referral.
Autoimmune diseases such as RA are often characterized by the presence of autoanti- bodies. Rheumatoid factor is not specific for RA and may be present in patients with other diseases, such as hepatitis C, and in healthy older persons. Anti-citrullinated protein antibody is more specific for RA and may play a role in disease pathogenesis.6 Approxi- mately 50 to 80 percent of persons with RA have rheumatoid factor, anti-citrullinated protein antibody, or both.10 Patients with RA may have a positive antinuclear antibody test result, and the test is of prognostic impor- tance in juvenile forms of this disease.19 C-reactive protein levels and erythrocyte sedimentation rate are often increased with active RA, and these acute phase reactants are part of the new RA classification criteria.16 C-reactive protein levels and erythrocyte sedimentation rate may also be used to follow disease activity and response to medication.
Baseline complete blood count with differential and assessment of renal and hepatic function are helpful because the results may influence treatment options (e.g., a patient with renal insufficiency or significant thrombocytopenia likely would not be prescribed a nonsteroidal anti-inflammatory drug [NSAID]). Mild anemia of chronic disease occurs in 33 to 60 percent of all patients with RA,20 although gastrointestinal blood loss should also be considered in patients taking corticosteroids or NSAIDs. Methotrexate is contraindicated in patients with hepatic disease, such as hepatitis C, and in patients with significant renal impairment.21 Biologic therapy, such as a TNF inhibitor, requires a negative tuberculin test or treatment for latent tuberculosis. Hepatitis B reactivation can also occur with TNF inhibitor use.22 Radiography of hands and feet should be performed to evaluate for characteristic periarticular erosive changes,�which may be indicative of a more aggressive RA subtype.10
Skin findings suggest systemic lupus erythematosus, systemic sclerosis, or psoriatic arthritis. Polymyalgia rheumatica should be considered in an older patient with symptoms primarily in the shoulder and hip, and the patient should be asked questions related to associated temporal arteritis.
Chest radiography is helpful to evaluate for sarcoidosis as an etiology of arthritis.�Patients with inflammatory back symptoms, a history of inflammatory bowel disease, or inflammatory eye disease may have spondyloarthropathy. Persons with less than six weeks of symptoms may have a viral process, such as parvovirus. Recurrent self-limited episodes of acute joint swelling suggest crystal arthropathy, and arthrocentesis should be performed to evaluate for monosodium urate monohydrate or calcium pyrophosphate dihydrate crystals. The presence of numerous myofascial trigger points and somatic symptoms may suggest fibromyalgia, which can coexist with RA. To help guide diagnosis and determine treatment strategy, patients with inflammatory arthritis should be promptly referred to a rheumatology subspecialist.16,17
Rheumatoid arthritis, or RA, is the most common type of arthritis. RA is an autoimmune disease, caused when the immune system, the human body’s defense system, attacks its own cells and tissues, particularly the joints. Rheumatoid arthritis is frequently identified by symptoms of pain and inflammation, often affecting the small joints of the hands, wrists and feet. According to many healthcare professionals, early diagnosis and treatment of RA is essential to prevent further joint damage and decrease painful symptoms. Dr. Alex Jimenez D.C., C.C.S.T. Insight
After RA has been diagnosed and an initial evaluation performed, treatment should begin. Recent guidelines have addressed the management of RA,21,22 but patient preference also plays an important role. There are special considerations for women of childbearing age because many medications have deleterious effects on pregnancy. Goals of therapy include minimizing joint pain and swelling, preventing deformity (such as ulnar deviation) and radiographic damage (such as erosions), maintaining quality of life (personal and work), and controlling extra-articular manifestations. Disease-modifying antirheumatic drugs (DMARDs) are the mainstay of RA therapy.
DMARDs can be biologic or nonbiologic (Table 3).23 Biologic agents include monoclonal antibodies and recombinant receptors to block cytokines that promote the inflammatory cascade responsible for RA symptoms. Methotrexate is recommended as the first- line treatment in patients with active RA, unless contraindicated or not tolerated.21 Leflunomide (Arava) may be used as an alternative to methotrexate, although gastrointestinal adverse effects are more common. Sulfasalazine (Azulfidine) or hydroxychloroquine (Plaquenil) pro-inflammatory as monotherapy in patients with low disease�activity or without poor prognostic features (e.g., seronegative, non-erosive RA).21,22
Combination therapy with two or more DMARDs is more effective than monotherapy; however, adverse effects may also be greater.24 If RA is not well controlled with a nonbiologic DMARD, a biologic DMARD should be initiated.21,22 TNF inhibitors are the first-line biologic therapy and are the most studied of these agents. If TNF inhibitors are ineffective, additional biologic therapies can be considered. Simultaneous use of more than one biologic therapy (e.g., adalimumab [Humira] with abatacept [Orencia]) is not�recommended because of an unacceptable rate of adverse effects.21
NSAIDs and Corticosteroids
Drug therapy for RA may involve NSAIDs and oral, intramuscular, or intra-articular corticosteroids for controlling pain and inflammation. Ideally, NSAIDs and corticosteroids are used only for short-term management. DMARDs are the preferred therapy.21,22
Dietary interventions, including vegetarian and Mediterranean diets, have been�studied in the treatment of RA without convincing evidence of benefit.25,26 Despite some favorable outcomes, there is a lack of evidence for the effectiveness of acupuncture in placebo-controlled trials of patients with RA.27,28 In addition, thermotherapy and therapeutic ultrasound for RA have not been studied adequately.29,30 A Cochrane review of herbal treatments for RA concluded that gamma-linolenic acid (from evening primrose or black currant seed oil) and Tripterygium wilfordii (thunder god vine) have potential benefits.31 It is important to inform patients that serious adverse effects have been reported with use of herbal therapy.31
Exercise and Physical Therapy
Results of randomized controlled trials sup- port physical exercise to improve quality of life and muscle strength in patients with RA.32,33 Exercise training programs have not been shown to have deleterious effects on RA disease activity, pain scores, or radiographic joint damage.34 Tai chi has been shown to improve ankle range of motion in persons with RA, although randomized trials are limited.35 Randomized controlled trials of Iyengar yoga in young adults with RA are underway.36
Duration of Treatment
Remission is obtainable in 10 to 50 percent of patients with RA, depending on how remission is defined and the intensity of therapy.10 Remission is more likely in males, nonsmokers, persons younger than 40 years, and in those with late-onset disease (patients older than 65 years), with shorter duration of disease, with milder disease activity, without elevated acute phase reactants, and without positive rheumatoid factor or anti-citrullinated protein antibody findings.37
After the disease is controlled, medication dosages may be cautiously decreased to the minimum amount necessary. Patients will require frequent monitoring to ensure stable symptoms, and prompt increase in medication is recommended with disease flare-ups.22
Joint replacement is indicated when there is severe joint damage and unsatisfactory control of symptoms with medical management. Long-term outcomes are support, with only 4 to 13 percent of large joint replacements requiring revision within 10 years.38 The hip and knee are the most commonly replaced joints.
Although RA is considered a disease of the joints, it is also a systemic disease capable of involving multiple organ systems. Extra-articular manifestations of RA are included in Table 4.1,2,10
Patients with RA have a twofold increased risk of lymphoma, which is thought to be caused by the underlying inflammatory�process, and not a consequence of medical treatment.39 Patients with RA are also at an increased risk of coronary artery disease, and physicians should work with patients to modify risk factors, such as smoking, high blood pressure, and high cholesterol.40,41 Class III or IV congestive heart failure (CHF) is a contraindication for using TNF inhibitors, which can worsen CHF outcomes.21 In patients with RA and malignancy, caution is needed with continued use of DMARDs, especially TNF inhibitors. Biologic DMARDs, methotrexate, and leflunomide should not be initiated in patients with active herpes zoster, significant fungal infection, or bacterial infection requiring antibiotics.21 Complications of RA and its treatments are listed in Table 5.1,2,10
Patients with RA live three to 12 years less than the general population.40 Increased mortality in these patients is mainly due to accelerated cardiovascular disease, especially in those with high disease activity and chronic inflammation. The relatively new biologic therapies may reverse progression of atherosclerosis and extend life in those with RA.41
Data Sources: A PubMed search was completed in Clinical Queries using the key terms rheumatoid arthritis, extra-articular manifestations, and disease-modifying antirheumatic agents. The search included meta-analyses, randomized controlled trials, clinical trials, and reviews. Also searched were the Agency for Healthcare Research and Quality evidence reports, Clinical Evidence, the Cochrane database, Essential Evidence, and UpToDate. Search date: September 20, 2010.
Author disclosure: No relevant financial affiliations to disclose.
In conclusion, rheumatoid arthritis is a chronic, autoimmune disease which causes painful symptoms, such as pain and discomfort, inflammation and swelling of the joints, among others. The joint damage characterized as RA is symmetrical, meaning it generally affects both sides of the body. Early�diagnosis is essential for treatment of RA. The scope of our information is limited to chiropractic and spinal health issues. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at�915-850-0900�.
Curated by Dr. Alex Jimenez
Additional Topic Discussion: Relieving Knee Pain without Surgery
Knee pain is a well-known symptom which can occur due to a variety of knee injuries and/or conditions, including�sports injuries. The knee is one of the most complex joints in the human body as it is made-up of the intersection of four bones, four ligaments, various tendons, two menisci, and cartilage. According to the American Academy of Family Physicians, the most common causes of knee pain include patellar subluxation, patellar tendinitis or jumper’s knee, and Osgood-Schlatter disease. Although knee pain is most likely to occur in people over 60 years old, knee pain can also occur in children and adolescents. Knee pain can be treated at home following the RICE methods, however, severe knee injuries may require immediate medical attention, including chiropractic care.
1. Etiology and pathogenesis of rheumatoid arthritis. In: Firestein GS, Kelley WN, eds. Kelley�s Textbook of Rheu- matology. 8th ed. Philadelphia, Pa.: Saunders/Elsevier; 2009:1035-1086. 2. Bathon J, Tehlirian C. Rheumatoid arthritis clinical and laboratory manifestations. In: Klippel JH, Stone JH, Crofford LJ, et al., eds. Primer on the Rheumatic Dis- eases. 13th ed. New York, NY: Springer; 2008:114-121. 3. Allaire S, Wolfe F, Niu J, et al. Current risk factors for work disability associated with rheumatoid arthritis. Arthritis Rheum. 2009;61(3):321-328. 4. MacGregor AJ, Snieder H, Rigby AS, et al. Characteriz- ing the quantitative genetic contribution to rheumatoid arthritis using data from twins. Arthritis Rheum. 2000; 43(1):30-37. 5. Orozco G, Barton A. Update on the genetic risk fac- tors for rheumatoid arthritis. Expert Rev Clin Immunol. 2010;6(1):61-75. 6. Balsa A, Cabezo?n A, Orozco G, et al. Influence of HLA DRB1 alleles in the susceptibility of rheumatoid arthritis and the regulation of antibodies against citrullinated proteins and rheumatoid factor. Arthritis Res Ther. 2010;12(2):R62. 7. McClure A, Lunt M, Eyre S, et al. Investigating the via- bility of genetic screening/testing for RA susceptibility using combinations of five confirmed risk loci. Rheuma- tology (Oxford). 2009;48(11):1369-1374. 8. Bang SY, Lee KH, Cho SK, et al. Smoking increases rheu- matoid arthritis susceptibility in individuals carrying the HLA-DRB1 shared epitope, regardless of rheumatoid factor or anti-cyclic citrullinated peptide antibody sta- tus. Arthritis Rheum. 2010;62(2):369-377. 9. Wilder RL, Crofford LJ. Do infectious agents cause rheu- matoid arthritis? Clin Orthop Relat Res. 1991;(265): 36-41. 10. Scott DL, Wolfe F, Huizinga TW. Rheumatoid arthritis. Lancet. 2010;376(9746):1094-1108. 11. Costenbader KH, Feskanich D, Mandl LA, et al. Smoking intensity, duration, and cessation, and the risk of rheu- matoid arthritis in women. Am J Med. 2006;119(6): 503.e1-e9. 12. Kaaja RJ, Greer IA. Manifestations of chronic disease during pregnancy. JAMA. 2005;294(21):2751-2757. 13. Guthrie KA, Dugowson CE, Voigt LF, et al. Does preg- nancy provide vaccine-like protection against rheuma- toid arthritis? Arthritis Rheum. 2010;62(7):1842-1848. 14. Karlson EW, Mandl LA, Hankinson SE, et al. Do breast- feeding and other reproductive factors influence future risk of rheumatoid arthritis? Results from the Nurses� Health Study. Arthritis Rheum. 2004;50(11):3458-3467. 15. Karlson EW, Shadick NA, Cook NR, et al. Vitamin E in the primary prevention of rheumatoid arthritis: the Women�s Health Study. Arthritis Rheum. 2008;59(11): 1589-1595. 16. Aletaha D, Neogi T, Silman AJ, et al. 2010 rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative [published correction appears in Ann Rheum Dis. 2010;69(10):1892]. Ann Rheum Dis. 2010;69(9):1580-1588. 17. van der Helm-van Mil AH, le Cessie S, van Dongen H, et al. A prediction rule for disease outcome in patients with recent-onset undifferentiated arthritis. Arthritis Rheum. 2007;56(2):433-440. 18. Mochan E, Ebell MH. Predicting rheumatoid arthritis risk in adults with undifferentiated arthritis. Am Fam Physi- cian. 2008;77(10):1451-1453. 19. Ravelli A, Felici E, Magni-Manzoni S, et al. Patients with antinuclear antibody-positive juvenile idiopathic arthri- tis constitute a homogeneous subgroup irrespective of the course of joint disease. Arthritis Rheum. 2005; 52(3):826-832. 20. Wilson A, Yu HT, Goodnough LT, et al. Prevalence and outcomes of anemia in rheumatoid arthritis. Am J Med. 2004;116(suppl 7A):50S-57S. 21. Saag KG, Teng GG, Patkar NM, et al. American College of Rheumatology 2008 recommendations for the use of nonbiologic and biologic disease-modifying antirheu- matic drugs in rheumatoid arthritis. Arthritis Rheum. 2008;59(6):762-784. 22. Deighton C, O�Mahony R, Tosh J, et al.; Guideline Devel- opment Group. Management of rheumatoid arthritis: summary of NICE guidance. BMJ. 2009;338:b702. 23. AHRQ. Choosing medications for rheumatoid arthritis. April 9, 2008. www.effectivehealthcare.ahrq.gov/ ehc/products/14/85/RheumArthritisClinicianGuide.pdf. Accessed June 23, 2011. 24. Choy EH, Smith C, Dore? CJ, et al. A meta-analysis of the efficacy and toxicity of combining disease-modify- ing anti-rheumatic drugs in rheumatoid arthritis based on patient withdrawal. Rheumatology (Oxford). 2005; 4 4 (11) :1414 -1421. 25. Smedslund G, Byfuglien MG, Olsen SU, et al. Effective- ness and safety of dietary interventions for rheumatoid arthritis. J Am Diet Assoc. 2010;110(5):727-735. 26. Hagen KB, Byfuglien MG, Falzon L, et al. Dietary inter- ventions for rheumatoid arthritis. Cochrane Database Syst Rev. 2009;21(1):CD006400. 27. Wang C, de Pablo P, Chen X, et al. Acupuncture for pain relief in patients with rheumatoid arthritis: a systematic review. Arthritis Rheum. 2008;59(9):1249-1256. 28. Kelly RB. Acupuncture for pain. Am Fam Physician. 2009;80(5):481-484. 29. Robinson V, Brosseau L, Casimiro L, et al. Thermother- apy for treating rheumatoid arthritis. Cochrane Data- base Syst Rev. 2002;2(2):CD002826. 30. Casimiro L, Brosseau L, Robinson V, et al. Therapeutic ultrasound for the treatment of rheumatoid arthritis. Cochrane Database Syst Rev. 2002;3(3):CD003787. 31. Cameron M, Gagnier JJ, Chrubasik S. Herbal therapy for treating rheumatoid arthritis. Cochrane Database Syst Rev. 2011;(2):CD002948. 32. Brodin N, Eurenius E, Jensen I, et al. Coaching patients with early rheumatoid arthritis to healthy physical activ- ity. Arthritis Rheum. 2008;59(3):325-331. 33. Baillet A, Payraud E, Niderprim VA, et al. A dynamic exercise programme to improve patients� disability in rheumatoid arthritis: a prospective randomized con- trolled trial. Rheumatology (Oxford). 2009;48(4): 410-415. 34. Hurkmans E, van der Giesen FJ, Vliet Vlieland TP, et al. Dynamic Exercise programs (aerobic capacity and/or mus- cle strength training) in patients with rheumatoid arthri- tis. Cochrane Database Syst Rev. 2009;(4):CD006853. 35. Han A, Robinson V, Judd M, et al. Tai chi for treat- ing rheumatoid arthritis. Cochrane Database Syst Rev. 2004;(3):CD004849. 36. Evans S, Cousins L, Tsao JC, et al. A randomized con- trolled trial examining Iyengar yoga for young adults with rheumatoid arthritis. Trials. 2011;12:19. 37. Katchamart W, Johnson S, Lin HJ, et al. Predictors for remis- sion in rheumatoid arthritis patients: a systematic review. Arthritis Care Res (Hoboken). 2010;62(8):1128-1143. 38. Wolfe F, Zwillich SH. The long-term outcomes of rheu- matoid arthritis: a 23-year prospective, longitudinal study of total joint replacement and its predictors in 1,600 patients with rheumatoid arthritis. Arthritis Rheum. 1998;41(6):1072-1082. 39. Baecklund E, Iliadou A, Askling J, et al. Association of chronic inflammation, not its treatment, with increased lymphoma risk in rheumatoid arthritis. Arthritis Rheum. 2006;54(3):692-701. 40. Friedewald VE, Ganz P, Kremer JM, et al. AJC editor�s consensus: rheumatoid arthritis and atherosclerotic cardiovascular disease. Am J Cardiol. 2010;106(3): 442-447. 41. Atzeni F, Turiel M, Caporali R, et al. The effect of phar- macological therapy on the cardiovascular system of patients with systemic rheumatic diseases. Autoimmun Rev. 2010;9(12):835-839.
M/C dislocation of the foot at tarsal-metatarsal articulation (Lisfranc joint). Direct impact or landing and plantar or dorsal flexing the foot. Lisfranc ligament holding 2nd MT base and 1st Cu is torn. Manifests with or w/o fracture-avulsion.
Imaging: 1st step: foot radiography in most cases sufficient to Dx. MSK US may help: show disrupted Cu1-Cu2. Ligament and widened space > 2.5mm. MRI may help but not essential. Weight-bearing view aids Dx.
2-types: homolateral (1st MTP joint in contact) and divergent (2-5 MT displaced laterally and 1st MT medially)
Management: operative fixation is crucial
N.B. Atraumatic Lisfranc dislocation is a frequent complication of a diabetic Charcot foot
Osteochondral Injury of the Talus (OCD)
Common. Non-traumatic found in superior-medial talar dome. Traumatic may affect supero-lateral dome.
Clinically: pain/effusion/locking. Imaging is crucial.
1st step: radiography may reveal focal radiolucent concavity/halo, fragment.
MRI helpful esp. if OCD is cartilaginous and to demonstrate bone edema.
Jones Fx: extra-articular Fx of proximal metaphysis of the 5th MT. Prone to non-union. Often fixed operatively.
Pseudo-Jones: intra-articular avulsion of 5th MT styloid/base by eccentric contraction of Peroneus Brevis M. Managed conservatively: boot-cast immobilization. Both Jones & Pseudo-Jones Dx by foot series radiography.
Stress Fx. Calcaneus, 2nd, 3rd, 5th MTs. Repeated loading (running) or “March foot” 2nd/3rd MT. Clinically: pain on activity, reduced by rest. Dx: x-rays often unrewarding earlier. MRI or MSK US may help. Managed: Conservatively. Complications; progress into complete Fx
Turf toe: common athletic hyperextension of 1st MTP-sesamoid/plantar plate complex is tearing. 1st MTP unstable/loose. Managed operatively.
Arthritis of the Foot & Ankle
DJD of the ankle: uncommon a primary OA. Typically develops as 2nd to trauma/AVN, RA, CPPD, Hemophilic arthropathy, Juvenile Idiopathic Arthritis, etc. manifests as DJD: osteophytes, JSL, subchondral cysts all seen on x-rays
Inflammatory Arthritis: RA may develop in the ankle or any synovial joint. Will typically presents with symmetrical Hands/feet RA initially (2nd, 3rd MCP, wrists, MTPs in feet) usually with erosion, uniform JSL, juxta-articular osteopenia, and delayed subluxations.
HLA-B27 spondyloarthropathies: commonly affect lower extremity: heel, ankle esp in Reactive (Reiter). Erosive-productive bone proliferation is a crucial Dx.
Gouty Arthritis: common in the lower extremity. Ankle, mid-foot foot esp 1st MTPs. Initial onset: acute gouty arthritis with ST effusion and no erosions/tophi. Chronic tophaceous gout: peri-articular, intra-osseous punched-out erosions with over-hanging edges, no initial JSL/osteopenia, ST. Tophi may be seen.
Miscellaneous arthropathy: PVNS. Not common. Affects 3-4th decades of life. The result of synovial proliferation with Macrophages and multi-nucleated Giant Cells filled with hemosiderin and fatty accumulation may lead to inflammation, cartilage damage, extrinsic bone erosions. Dx: x-rays are insensity, MRI modality of choice. Synovial biopsy. Management: operative, can be difficult.
(Charcot’s joint) Common and on the rise d/t epidemic in type 2 DM. May present with pain initially (50% of cases) and painless destructive arthropathy as a late manifestation. Early Dx: delayed. Imaging is crucial: x-rays: initially unrewarding, some SF effusion is seen. MRI helps with early Dx and extremity off-loading. Late Dx: irreversible dislocations, collapse, disability. Note: Lisfrance dislocation in Charcot joint
M/C mid-foot (TM joint) in 40% of cases, ankle 15%. Progression: Rocker-bottom foot, ulcerations, infections, increased morbidity, and mortality.
Early Dx: by MRI is crucial. Suspect it in patients with type 2 DM especially if early non-traumatic foot/ankle pain reported.
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