Categories
Ailmemts & Remedies

Joint Pain

Alternative Names:
Stiffness in a joint; Pain – joints; Arthralgia

Definition:
Joint pain can affect one or more joints. See also arthritis (inflammation of joints), muscle pain, and bursitis.

Joint pain can affect one or more joints depending on the causes & symptoms.

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Causes:
Joint pain can be caused by many types of injuries or conditions. No matter what causes it, joint pain can be very bothersome.

Rheumatoid arthritis is an autoimmune disorder that causes stiffness and pain in the joints. Osteoarthritis involves growth of bone spurs and degeneration of cartilage at a joint. It is very common in adults older than 45 and can cause joint pain.

Joint pain may also be caused by bursitis (inflammation of the bursae). The bursae are fluid-filled sacs that cushion and pad bony prominences, allowing muscles and tendons to move freely over the bone.

Most Common Causes:
*Unusual exertion or overuse, including strains or sprains
*Injury, including fracture
*Gout (especially found in the big toe)
*Osteoarthritis
*Septic arthritis
*Tendonitis
*Bursitis

Infectious diseases, including :
*Influenza
*Measles (rubeola)
*Rheumatic fever
*Epstein-Barr viral syndrome
*Hepatitis
*Mumps
*Rubella (German measles)
*Varicella (chickenpox)
*Paravirus
*Lyme disease
*Chondromalacia patellae
*Osteomyelitis
*Autoimmune diseases such as rheumatoid arthritis and lupus

Symptoms:

Pain, swelling, stiffness, and/or warmth in your joints. In the absence of an injury, pain in one or more of your joints often is caused by inflammation or infection.

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Treatment:

Home Care :
Follow prescribed therapy in treating the underlying cause.

For nonarthritis joint pain, both rest and exercise are important. Warm baths, massage, and stretching exercises should be used as frequently as possible.

Anti-inflammatory medications may help relieve pain and swelling. Consult your health care provider before giving aspirin or NSAIDs such as ibuprofen to children.

When to Contact a Medical Professional:
*You have fever that is not associated with flu symptoms
*You have lose 10 pounds or more without trying (unintended weight loss)
*Your joint pain lasts for more than 3 days
*You have severe, unexplained joint pain, particularly if you have other unexplained symptoms

What to Expect at Your Doctor Visit:
Your health care provider will perform a physical exam and ask you about your medical history. The following questions may help identify the cause of your joint pain:

*Which joint hurts? Is the pain on one side or both sides?
*How long have you been having this pain? Have you had it before?
*Did this pain begin suddenly and severely, or slowly and mildly?
*Is the pain constant or does it come and go? Has the pain become more severe?
*What started your pain?
*Have you injured your joint?
*Have you had an illness or fever?
*Does resting the joint reduce the pain or make it worse?
*Does moving the joint reduce the pain or make it worse?
*Are certain positions comfortable? Does keeping the joint elevated help?
*Do medications, massage, or applying heat reduce the pain?

What other symptoms do you have?
*Is there any numbness?
*Can you bend and straighten the joint? Does the joint feel stiff?
*Are your joints stiff in the morning? If so, how long does the stiffness last?

What makes the stiffness better?
*Tests that may be done include:
*CBC or blood differential
*Joint x-ray

Physical therapy for muscle and joint rehabilitation may be recommended. A procedure called arthrocentesis may be needed to remove fluid from the sore joint.

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Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://www.nlm.nih.gov/medlineplus/ency/article/003261.htm
http://www.health.harvard.edu/fhg/symptoms/jointPain/jointPain1.shtml
http://health.nytimes.com/health/guides/symptoms/joint-pain/overview.html?inline=nyt-classifier

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Categories
Ailmemts & Remedies

Chikungunya

Stegomyia aegypti (formerly Aedes aegypti) mos...
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Definition:
Chikungunya is viral fever caused by an alphavirus. Chikungunya is spread by the bite of Aedes and Culex mosquitoes.
This virus belongs to the genus Alphavirus in the Togaviridae family of viruses. Other Alphaviruses include the Sindbis, eastern and western encephalitis, Semliki Forest and Ross River viruses. The Togaviridae family also includes the genus Rubivirus   to which Rubella belongs.

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It is an insect-borne virus, of the genus, Alphavirus, that is transmitted to humans by virus-carrying Aedes mosquitoes. There have been recent outbreaks of CHIKV associated with severe morbidity. CHIKV causes an illness with symptoms similar to dengue fever. CHIKV manifests itself with an acute febrile phase of the illness lasts only two to five days. Followed by a prolonged arthralgic disease that affects the joints of the extremities. The pain associated with CHIKV infection of the joints persists for weeks or months.

It is a rare viral infection transmitted by the bite of an infected mosquito. It is characterized by a rash, fever, and severe joint pain (arthralgias) that usually lasts for three to seven days. Because of its effect on the joints, Chikungunya has been classified among the Arthritic Viruses. It primarily occurs in tropical areas of the world.

Chikungunya was first described in 1955, following an outbreak on the Makonde Plateau, along the border between Tanganyika and Mozambique in 1952.

Chikungunya is found in Africa, southern India, Pakistan, South-East Asia and the Philippines and occurs predominantly during the rainy season. The range of hosts includes humans, primates, other mammals, and birds. In October 2006, the World Health Organization (WHO) reported chikungunya fever outbreaks in eight states in India.

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ChickV Map

Chikungunya virus..

Between March 2005 and February 2006, 1,722 cases of chikungunya were reported in La Reunion, an island in the Indian Ocean east of Madagascar (territory of France). Two-hundred deaths were attributed to chikungunya.

Signs and symptoms:
Symptoms include:

*high fever
*joint pain with or without swelling (arthritis or arthralgia), typically in the knee, ankle and small joints of the extremities
*chills
*headache
*low back pain
*rash
*vomiting
*mild hemorrhaging may be present especially in children

Asymptomatic (“silent”) infections are common, and immunity is long lasting.

The incubation period of Chikungunya disease is from two to four days. Symptoms of the disease include a fever up to 39 C (102.2 F), a petechial or maculopapular rash of the trunk and occasionally the limbs, and arthralgia or arthritis affecting multiple joints. Other nonspecific symptoms can include headache, conjunctival injection, and slight photophobia. Typically, the fever lasts for two days and then ends abruptly. However, other symptoms, namely joint pain, intense headache, insomnia and an extreme degree of prostration last for a variable period; usually for about 5 to 7 days. Patients have complained of joint pains for much longer time periods depending on their age.

Diagnosis:
Common laboratory tests for chikungunya include RT-PCR, virus isolation, and serological tests.

*Virus isolation provides the most definitive diganosis but takes 1-2 weeks for completion and must be carried out in Biosafety level 3 laboratories. The technique involves exposing specific cell lines to samples from whole blood and identifying chikungunya virus-specific responses.

*RT-PCR using nested primer pairs to amplify several Chikungunya-specific genes from whole blood. Results can be determined in 1-2 days.

*Serological diagnosis requires a larger amount of blood than the other methods and uses an ELISA assay to measure Chikungunya-specific IgM levels. Results require 2-3 days and false positives can occur with infection via other related viruses such as O’nyong’nyong virus and Semliki Forest Virus.

Causes:
Chikungunya virus is indigenous to tropical Africa and Asia, where it is transmitted to humans by the bite of infected mosquitoes, usually of the genus Aedes. CHIK fever epidemics are sustained by human-mosquito-human transmission. The word “chikungunya” is thought to derive from description in local dialect of the contorted posture of patients afflicted with the severe joint pain associated with this disease. The main virus reservoirs are monkeys, but other species can also be affected, including humans.

Treatment:
There are no specific treatments for Chikungunya. There is no vaccine currently available. A Phase II vaccine trial, sponsored by the US Government and published in the American Journal of Tropical Medicine and Hygiene in 2000, used a live, attenuated virus, developing viral resistance in 98% of those tested after 28 days and 85% still showed resistance after one year.

Chikungunya fever is not a life threatening infection. Symptomatic treatment for mitigating pain and fever using anti-inflammatory drugs along with rest usually suffices. While recovery from chikungunya is the expected outcome, convalescence can be prolonged (up to a year or more), and persistent joint pain may require analgesic (pain medication) and long-term anti-inflammatory therapy.

A serological test for Chikungunya is available from the University of Malaya in Kuala Lumpur, Malaysia.

Chloroquine is gaining ground as a possible treatment for the symptoms associated with chikungunya, and as an anti-inflammatory agent to combat the arthritis associated with Chikungunya virus. A University of Malaya study found that for arthritis-like symptoms that are not relieved by aspirin and non-steroidal anti-inflammatory drugs (NSAID), chloroquine phosphate (250 mg/day) has given promising results. Research by an Italian scientist, Andrea Savarino, and his colleagues together with a French government press release in March 2006 have added more credence to the claim that chloroquine might be effective in treating chikungunya. Unpublished studies in cell culture and monkeys show no effect of chloroquine treatment on reduction of chikungunya disease. The fact sheet on Chikungunya advises against using aspirin, ibuprofen, naproxen and other NSAIDs that are recommended for arthritic pain and fever.

DNA vaccine: ….>click  &  see
DNA vaccination is a technique for protecting an organism against disease by injecting it with genetically engineered DNA to produce an immunological response. Nucleic acid vaccines are still experimental, and have been applied to a number of viral, bacterial and parasitic models of disease, as well as to several tumour models. DNA vaccines have a number of advantages over conventional vaccines, including the ability to induce a wider range of immune response types.A recent study report that a novel consensus-based approach to vaccine design for Chikungunya virus, employing a DNA vaccine strategy. The vaccine cassette was designed based on CHIKV Capsid and Envelope specific consensus sequences with several modifications, including codon optimization, RNA optimization, the addition of a Kozak sequence, and a substituted immunoglobulin E leader sequence. Analysis of cellular immune responses, including epitope mapping, demonstrates that these constructs induces both potent and broad cellular immunity in mice. In addition, antibody ELISAs demonstrate that these synthetic immunogens are capable of inducing high titer antibodies capable of recognizing native antigen. Taken together, these results support further study of the use of consensus CHIKV antigens in a potential vaccine cocktail.

Prognosis:
Recovery from the disease varies by age. Younger patients recover within 5 to 15 days; middle-aged patients recover in 1 to 2.5 months. Recovery is longer for the elderly. The severity of the disease as well as its duration is less in younger patients and pregnant women. In pregnant women, no untoward effects are noticed after the infection.

Ocular inflammation from Chikungunya may present as iridocyclitis, and have retinal lesions as well.

Pedal oedema (swelling of legs) is observed in many patients, the cause of which remains obscure as it is not related to any cardiovascular, renal or hepatic abnormalities.

Prevention:
The most effective means of prevention are those that protect against any contact with the disease-carrying mosquitoes. These include using insect repellents with substances like DEET (N,N-Diethyl-meta-toluamide; also known as N,N’-Diethyl-3-methylbenzamide or NNDB), icaridin (also known as picaridin and KBR3023), PMD (p-menthane-3,8-diol, a substance derived from the lemon eucalyptus tree), or IR3535. Wearing bite-proof long sleeves and trousers (pants) also offers protection. In addition, garments can be treated with pyrethroids, a class of insecticides that often has repellent properties. Vaporized pyrethroids (for example in mosquito coils) are also insect repellents. Securing screens on windows and doors will help to keep mosquitoes out of the house. In the case of the day active Aedes aegypti and Aedes albopictus, however, this will only have a limited effect, since many contacts between the vector and the host occur outside. Thus, mosquito control is especially important.

Preventive measures include the same as those for other mosquito-associated diseases (e.g. malaria, malaria, yellow fever, west nile virus).

No vaccine is available against this virus infection. Prevention is entirely dependent upon taking steps to avoid mosquito bites and elimination of mosquito breeding sites.

To avoid mosquito bites:
* Wear full sleeve clothes and long dresses to cover the limbs;
* Use mosquito coils, repellents and electric vapour mats during the daytime;
* Use mosquito nets – to protect babies, old people and others, who may rest during the day. The effectiveness of such nets can be improved by treating them with permethrin (pyrethroid insecticide). Curtains (cloth or bamboo) can also be treated with insecticide and hung at windows or doorways, to repel or kill mosquitoes.

Mosquitoes become infected when they bite people who are sick with chikungunya. Mosquito nets and mosquito nets and mosquito coils will effectively prevent mosquitoes from biting sick people.

To prevent mosquito breeding
The Aedes mosquitoes that transmit chikungunya breed in a wide variety of manmade containers which are common around human dwellings. These containers collect rainwater, and include discarded tires, flowerpots, old oil drums, animal water troughs, water storage vessels, and plastic food containers. These breeding sites can be eliminated by

*Draining water from coolers, tanks, barrels, drums and buckets, etc.;*Emptying coolers when not in use;
* Removing from the house all objects, e.g. plant saucers, etc. which have water collected in them
* Cooperating with the public health authorities in anti-mosquito measures.
Role of public health authorities
* National programme for prevention and control of vector borne diseases should be strengthened and efficiently implemented with multisectoral coordination

* Legislations for elimination of domestic/peridomestic mosquitogenic sites should be effectively enforced

*Communities must be made aware of the disease and their active cooperation in prevention and control measures elicited .
Read about other arboviral infections:

*Rift Valley Fever

*Dengue Fever

*Yellow Fever: The Disease and Symptoms

*Yellow Fever Infection: Historical Perspective

*Yellow Fever Vaccine: Disease Prevention

Epidemiology
Chikungunya virus is an alphavirus closely related to the O’nyong’nyong virus,[15] the Ross River virus in Australia, and the viruses that cause eastern equine encephalitis and western equine encephalitis

Chikungunya is generally spread through bites from Aedes aegypti mosquitoes, but recent research by the Pasteur Institute in Paris has suggested that chikungunya virus strains in the 2005-2006 Reunion Island outbreak incurred a mutation that facilitated transmission by Aedes albopictus (Tiger mosquito). Concurrent studies by arbovirologists at the University of Texas Medical Branch in Galveston Texas confirmed definitively that enhanced chikungunya virus infection of Aedes albopictus was caused by a point mutation in one of the viral envelope genes (E1). Enhanced transmission of chikungunya virus by Aedes albopictus could mean an increased risk for chikungunya outbreaks in other areas where the Asian tiger mosquito is present. A recent epidemic in Italy was likely perpetuated by Aedes albopictus.

In Africa, chikungunya is spread via a sylvatic cycle in which the virus largely resides in other primates in between human outbreaks.

History
The name is derived from the Makonde word meaning “that which bends up” in reference to the stooped posture developed as a result of the arthritic symptoms of the disease. The disease was first described by Marion Robinson and W.H.R. Lumsden[22] in 1955, following an outbreak in 1952 on the Makonde Plateau, along the border between Mozambique and Tanganyika (the mainland part of modern day Tanzania).

According to the initial 1955 report about the epidemiology of the disease, the term chikungunya is derived from the Makonde root verb kungunyala, meaning to dry up or become contorted. In concurrent research, Robinson glossed the Makonde term more specifically as “that which bends up.” Subsequent authors apparently overlooked the references to the Makonde language and assumed that the term derived from Swahili, the lingua franca of the region. The erroneous attribution of the term as a Swahili word has been repeated in numerous print sources. Many other erroneous spellings and forms of the term are in common use including “Chicken guinea”, “Chicken gunaya,” and “Chickengunya”.

Since its discovery in Tanganyika, Africa in 1952, chikungunya virus outbreaks have occurred occasionally in Africa, South Asia, and Southeast Asia, but recent outbreaks have spread the disease over a wider range.

You may click to learn more about Chikungunya.:->.………………(1)………(2)……..(3)

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://en.wikipedia.org/wiki/Chikungunya
http://microbiology.suite101.com/article.cfm/chikungunya

http://www.webmd.com/a-to-z-guides/chikungunya

http://www.searo.who.int/en/Section10/Section2246.htm

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Suppliments our body needs

Glucosamine

Definition:
Glucosamine (C6H13NO5) is an amino sugar and a prominent precursor in the biochemical synthesis of glycosylated proteins and lipids. A type of glucosamine forms chitin, which composes the exoskeletons of crustaceans and other arthropods, cell walls in fungi and many higher organisms. Glucosamine is one of the most abundant monosaccharides. It is produced commercially by the hydrolysis of crustacean exoskeletons or, less commonly and more expensive to the consumer, by fermentation of a grain such as corn or wheat. Glucosamine is commonly used as a treatment for osteoarthritis, although its acceptance as a medical therapy varies.

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Glucosamine is a compound found naturally in the body, made from glucose and the amino acid glutamine. Glucosamine is needed to produce glycosaminoglycan, a molecule used in the formation and repair of cartilage and other body tissues. Production of glucosamine slows with age.

Glucosamine is available as a nutritional supplement in health food stores and many drug stores. Glucosamine supplements are manufactured in a laboratory from chitin, a substance found in the shells of shrimp, crab, lobster, and other sea creatures. In additional to nutritional supplements, glucosamine is also used in sports drinks and in cosmetics.

Glucosamine is often combined with chondroitin sulfate, a molecule naturally present in cartilage. Chondroitin gives cartilage elasticity and is believed to prevent the destruction of cartilage by enzymes. Glucosamine is sometimes combined with methylsulfonylmethane, or MSM, in nutritional supplements.

Biochemistry:
Glucosamine was first identified in 1876 by Dr. Georg Ledderhose, but the stereochemistry was not fully defined until 1939 by the work of Walter Haworth.[1] D-Glucosamine is made naturally in the form of glucosamine-6-phosphate, and is the biochemical precursor of all nitrogen-containing sugars.   Specifically, glucosamine-6-phosphate is synthesized from fructose-6-phosphate and glutamine[3] as the first step of the hexosamine biosynthesis pathway.[4] The end-product of this pathway is UDP-N-acetylglucosamine (UDP-GlcNAc), which is then used for making glycosaminoglycans, proteoglycans, and glycolipids.

As the formation of glucosamine-6-phosphate is the first step for the synthesis of these products, glucosamine may be important in regulating their production. However, the way that the hexosamine biosynthesis pathway is actually regulated, and whether this could be involved in contributing to human disease, remains unclear.

Health effects:
Oral glucosamine is commonly used for the treatment of osteoarthritis. Since glucosamine is a precursor for glycosaminoglycans, and glycosaminoglycans are a major component of joint cartilage, supplemental glucosamine may help to rebuild cartilage and treat arthritis. Its use as a therapy for osteoarthritis appears safe, but there is conflicting evidence as to its effectiveness. A randomized, double-blind, placebo-controlled trial found glucosamine sulfate is no better than placebo in reducing the symptoms or progression of hip osteoarthritis.

There is promising evidence that glucosamine may reduce pain symptoms of knee osteoarthritis and possibly slow the progression of osteoarthritis. For example, a study published in the journal Archives of Internal Medicine examined people with osteoarthritis over three years. Researchers assessed pain and structural improvements seen on x-ray. They gave 202 people with mild to moderate osteoarthritis 1,500 mg of glucosamine sulfate a day or a placebo.

At the end of the study, researchers found that glucosamine slowed the progression of knee osteoarthritis compared to the placebo. People in the glucosamine group had a significant reduction in pain and stiffness. On x-ray, there was no average change or narrowing of joint spaces in the knees (a sign of deterioration) of the glucosamine group. In contrast, joint spaces of participants taking the placebo narrowed over the three years.

One of the largest studies on glucosamine for osteoarthritis was a 6-month study sponsored by the National Institutes of Health. Called GAIT, the study compared the effectiveness of glucosamine hydrochloride (HCL), chondroitin sulfate, a combination of glucosamine and chondroitin sulfate, the drug celecoxib (Celebrex), or a placebo in people with knee osteoarthritis.

Glucosamine or chondroitin alone or in combination didn’t reduce pain in the overall group, although people in the study with moderate-to-severe knee pain were more likely to respond to glucosamine.

One major drawback of the GAIT Trial was that glucosamine hydrochloride was used rather than the more widely used and researched glucosamine sulfate. A recent analysis of previous studies, including the GAIT Trial, concluded that glucosamine hydrochloride was not effective. The analysis also found that studies on glucosamine sulfate were too different from one another and were not as well-designed as they should be, so they could not properly draw a conclusion. More research is needed.

Still, health care providers often suggest a three month trial of glucosamine and discontinuing it if there is no improvement after three months. A typical dose for osteoarthritis is 1,500 mg of glucosamine sulfate each day.

Other Conditions
Other conditions for which glucosamine is used include rheumatoid arthritis, inflammatory bowel disease (Crohn’s disease and ulcerative colitis), chronic venous insufficiency, and skin conditions, although further evidence is needed.

Use:
A typical dosage of glucosamine salt is 1,500 mg per day. Glucosamine contains an amino group that is positively charged at physiological pH. The anion included in the salt may vary. Commonly sold forms of glucosamine are glucosamine sulphate and glucosamine hydrochloride. The amount of glucosamine present in 1500 mg of glucosamine salt will depend on which anion is present and whether additional salts are included in the manufacturer’s calculation. Glucosamine is often sold in combination with other supplements such as chondroitin sulfate and methylsulfonylmethane.

Glucosamine is a popular alternative medicine used by consumers for the treatment of osteoarthritis. Glucosamine is also extensively used in veterinary medicine as an unregulated but widely accepted supplement.

Bioavailability and pharmacokinetics:
Two recent studies confirm that glucosamine is bioavailable both systemically and at the site of action (the joint) after oral administration of crystalline glucosamine sulfate in osteoarthritis patients. Steady state glucosamine concentrations in plasma and synovial fluid were correlated and in line with those effective in selected in vitro studies

Clinical studies:
There have been multiple clinical trials of glucosamine as a medical therapy for osteoarthritis, but results have been conflicting. The evidence both for and against glucosamine’s efficacy has led to debate among physicians about whether to recommend glucosamine treatment to their patients.

Multiple clinical trials in the 1980s and 1990s, all sponsored by the European patent-holder, Rottapharm, demonstrated a benefit for glucosamine. However, these studies were of poor quality due to shortcomings in their methods, including small size, short duration, poor analysis of drop-outs, and unclear procedures for blinding. Rottapharm then sponsored two large (at least 100 patients per group), three-year-long, placebo-controlled clinical trials of the Rottapharm brand of glucosamine sulfate. These studies both demonstrated a clear benefit for glucosamine treatment. There was not only an improvement in symptoms but also an improvement in joint space narrowing on radiographs. This suggested that glucosamine, unlike pain relievers such as NSAIDs, can actually help prevent the destruction of cartilage that is the hallmark of osteoarthritis. On the other hand, several subsequent studies, independent of Rottapharm, but smaller and shorter, did not detect any benefit of glucosamine.

Due to these controversial results, some reviews and meta-analyses have evaluated the efficacy of glucosamine. Richy et al. performed a meta-analysis of randomized clinical trials in 2003 and found efficacy for glucosamine on VAS and WOMAC pain, Lequesne index and VAS mobility and good tolerability.

Recently, a review by Bruyere et al. about glucosamine and chondroitin sulfate for the treatment of knee and hip osteoarthritis concludes that both products act as valuable symptomatic therapies for osteoarthritis disease with some potential structure-modifying effects.

This situation led the National Institutes of Health to fund a large, multicenter clinical trial (the GAIT trial) studying reported pain in osteoarthritis of the knee, comparing groups treated with chondroitin sulfate, glucosamine, and the combination, as well as both placebo and celecoxib. The results of this 6-month trial found that patients taking glucosamine HCl, chondroitin sulfate, or a combination of the two had no statistically significant improvement in their symptoms compared to patients taking a placebo. The group of patients who took celecoxib did have a statistically significant improvement in their symptoms. These results suggest that glucosamine and chondroitin did not effectively relieve pain in the overall group of osteoarthritis patients, but it should be interpreted with caution because most patients presented only mild pain (thus a narrow margin to appraise pain improvement) and because of an unusual response to placebo in the trial (60%). However, exploratory analysis of a subgroup of patients suggested that the supplements taken together (glucosamine and chondroitin sulfate) may be significantly more effective than placebo (79.2% versus 54%; p = 0.002) and a 10% higher than the positive control, in patients with pain classified as moderate to severe (see testing hypotheses suggested by the data).

In an accompanying editorial, Dr. Marc Hochberg also noted that “It is disappointing that the GAIT investigators did not use glucosamine sulfate … since the results would then have provided important information that might have explained in part the heterogeneity in the studies reviewed by Towheed and colleagues” But this concern is not shared by pharmacologists at the PDR who state, “The counter anion of the glucosamine salt (i.e. chloride or sulfate) is unlikely to play any role in the action or pharmacokinetics of glucosamine”. Thus the question of glucosamine’s efficacy will not be resolved without further updates or trials.

In this respect, a 6-month double-blind, multicenter trial has been recently performed to assess the efficacy of glucosamine sulfate 1500 mg once daily compared to placebo and acetaminophen in patients with osteoarthritis of the knee (GUIDE study). The results showed that glucosamine sulfate improved the Lequesne algofunctional index significantly compared to placebo and the positive control. Secondary analyses, including the OARSI responder indices, were also significantly favorable for glucosamine sulfate.

A subsequent meta-analysis of randomized controlled trials, including the NIH trial by Clegg, concluded that hydrochloride is not effective and that there was too much heterogeneity among trials of glucosamine sulfate to draw a conclusion.[46] In response to these conclusions, Dr. J-Y Reginster in an accompanying editorial suggests that the authors failed to apply the principles of a sound systematic review to the meta-analysis, but instead put together different efficacy outcomes and trial designs by mixing 4-week studies with 3-year trials, intramuscular/intraarticular administrations with oral ones, and low-quality small studies reported in the early 1980s with high-quality studies reported in 2007.

However, currently OARSI (OsteoArthritis Research Society International) is recommending glucosamine as the second most effective treatment for moderate cases of osteoarthritis. Likewise, recent European League Against Rheumatism practice guidelines for knee osteoarthritis grants to glucosamine sulfate the highest level of evidence, 1A, and strength of the recommendation, A.

Safety:
Clinical studies have consistently reported that glucosamine appears safe. Since glucosamine is usually derived from shellfish, those allergic to shellfish may wish to avoid it. However, since glucosamine is derived from the shells of these animals while the allergen is within the flesh of the animals, it is probably safe even for those with shellfish allergy. Alternative sources using fungal fermentation of corn are available. Another concern has been that the extra glucosamine could contribute to diabetes by interfering with the normal regulation of the hexosamine biosynthesis pathway, but several investigations have found no evidence that this occurs. A review conducted by Anderson et al in 2005 summarizes the effects of glucosamine on glucose metabolism in in vitro studies, the effects of oral administration of large doses of glucosamine in animals and the effects of glucosamine supplementation with normal recommended dosages in humans, concluding that glucosamine does not cause glucose intolerance and has no documented effects on glucose metabolism. Other studies conducted in lean or obese subjects concluded that oral glucosamine at standard doses does not cause or significantly worsen insulin resistance or endothelial dysfunction.

The U.S. National Institutes of Health is currently conducting a study of supplemental glucosamine in obese patients, since this population may be particularly sensitive to any effects of glucosamine on insulin resistance.

In the United States, glucosamine is not approved by the Food and Drug Administration for medical use in humans. Since glucosamine is classified as a dietary supplement in the US, safety and formulation are solely the responsibility of the manufacturer; evidence of safety and efficacy is not required as long as it is not advertised as a treatment for a medical condition.

In Europe, glucosamine is approved as a medical drug and is sold in the form of glucosamine sulfate. In this case, evidence of safety and efficacy is required for the medical use of glucosamine and several guidelines have recommended its use as an effective and safe therapy for osteoarthritis. Actually, the Task Force of the European League Against Rheumatism (EULAR) committee recently granted glucosamine sulfate a level of toxicity of 5 in a 0-100 scale, and recent OARSI (OsteoArthritis Research Society International) guidelines for hip and knee osteoarthritis also confirm its excellent safety profile.

Most studies involving humans have found that short-term use of glucosamine is well-tolerated. Side effects may include drowsiness, headache, insomnia, and mild and temporary digestive complaints such as abdominal pain, poor appetite, nausea, heartburn, constipation, diarrhea, and vomiting. In rare human cases, the combination of glucosamine and chondroitin has been linked with temporarily elevated blood pressure and heart rate and palpitations.

Since glucosamine supplements may be made from shellfish, people with allergies to shellfish should avoid glucosamine unless it has been confirmed that it is from a non-shellfish source. The source of glucosamine is not required to be printed on the label, so it may require a phone call to the manufacturer.

There is some evidence suggesting that glucosamine, in doses used to treat osteoarthritis, may worsen blood sugar, insulin, and/or hemoglobin A1c (a test that measures how well blood sugar has been controlled during the previous three months) levels in people with diabetes or insulin resistance.

Theoretically, glucosamine may increase the risk of bleeding. People with bleeding disorders, those taking anti-clotting or anti-platelet medication, such as warfarin, clopidogrel, and Ticlid, or people taking supplements that may increase the risk of bleeding, such as garlic, ginkgo, vitamin E, or red clover, should not take glucosamine unless under the supervision of a healthcare provider.

The safety of glucosamine in pregnant or nursing women isn’t known.

Resources:
http://altmedicine.about.com/cs/herbsvitaminsek/a/Glucosamine.htm
http://en.wikipedia.org/wiki/Glucosamine

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Categories
Ailmemts & Remedies

Brusists

Definition:Whether you’re at work or at play, if you overuse or repetitively stress your body’s joints, you may eventually develop a painful inflammation called bursitis.

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You have more than 150 bursae in your body. These small, fluid-filled sacs lubricate and cushion pressure points between your bones and the tendons and muscles near your joints. They help your joints move with ease. Bursitis occurs when a bursa becomes inflamed. When inflammation occurs, movement or pressure is painful.

Bursitis often affects the joints in your shoulders, elbows or hips. But you can also have bursitis by your knee, heel and the base of your big toe. Bursitis pain usually goes away within a few weeks or so with proper treatment, but recurrent flare-ups of bursitis are common.

Symptoms:
If you have bursitis, you may notice:

A dull ache or stiffness in the area around your elbow, hip, knee, shoulder, big toe or other joints:-

*A worsening of pain with movement or pressure

*An area that feels swollen or warm to the touch

*Occasional skin redness in the area of the inflamed bursa

Bursitis of the hip doesn’t cause any visible swelling or skin redness because the bursae are located beneath some of your body’s bulkiest muscles. In this type of bursitis, pain is primarily over the greater trochanter, a portion of your thighbone (femur) that juts out just below where the bone joins the hip.

Causes:
Common causes of bursitis are overuse, stress and direct trauma to a joint, such as with repeated bumping or prolonged pressure from kneeling. Bursitis may also result from an infection, arthritis or gout. Many times, the cause is unknown.

Bursitis in certain locations of your body is caused by repetitive motion related to certain activities:

Shoulder. Bursitis of the shoulder often results from injury to the rotator cuff, the muscles and tendons that connect your upper arm bone to your shoulder blade. Causes of the injury may include falling, lifting and repetitive overhead arm activities. Sometimes it’s hard to distinguish between the pain caused by bursitis and that caused by a rotator cuff injury.

Elbow. This type of bursitis is associated with actions requiring you to repeatedly bend and extend your Elbow. You may get such an inflammation by pushing a vacuum cleaner back and forth. Throwing a baseball and swinging a tennis racket or a golf club are other examples of repeated physical activities that may lead to bursitis or tendinitis of the elbow or shoulder. Simple repeated leaning on your elbows could lead to bursitis over the tip of your elbow

Buttocks. This type of bursitis describes an inflamed bursa over the bone in your buttocks. It may result from sitting on a hard surface for long periods, such as on a bike.

Hip. Bursitis of the hip is frequently associated with arthritis or a hip injury. The pressure from standing or sitting for a prolonged time also may lead to bursitis of the hip.

Knee. In this form of bursitis, a soft, egg-shaped bump occurs on the front of your knee, the result of repetitive kneeling while installing tiles, scrubbing a floor, gardening or doing other activities that place pressure on your knees. A sharp blow to the knee can cause inflammation of the bursae around the kneecap. People with arthritis who are overweight often develop bursitis of the knee.

Ankle.
Inflammation of the bursa in the ankle commonly occurs as a result of improper footwear or prolonged walking or in sports, such as ice-skating.

You may not be able to pinpoint a specific incident or activity that led to your bursitis. In some cases, the inflammation may stem from a staphylococcal infection.

Diagnosis:
Your doctor may have you undergo a physical examination and ask you about your recent activities. By feeling the painful joint and surrounding area, your doctor may be able to identify a specific area of tenderness.

If it appears that something else may be causing the discomfort, your physician may request an X-ray of the affected area. If bursitis is the cause, X-ray images can’t positively establish the diagnosis, but they can help to exclude other causes of your discomfort.

Although you usually can trace bursitis to events of overuse or pressure, there may be no obvious cause. In the latter case, your doctor may want to perform additional screening to rule out other causes of joint inflammation and pain. This may include blood tests or an analysis of fluid from the inflamed bursa.

Treatments :
Bursitis treatment is usually simple and includes:

*Resting and immobilizing the affected area

*Applying ice to reduce swelling

*Taking nonsteroidal anti-inflammatory drugs (NSAIDs) to relieve pain and reduce inflammation

*With simple self-care and home treatment, bursitis usually disappears within a couple of weeks.

Sometimes, your doctor may recommend physical therapy or exercises to strengthen the muscles in the area. Additionally, your doctor may inject a corticosteroid drug into the bursa to relieve inflammation. This treatment generally brings immediate relief and, in many cases, one injection is all you’ll need.

If your bursitis is caused by an infection, you’ll need to take antibiotics. Sometimes the bursa must be surgically drained, but only rarely is surgical removal of the affected bursa necessary.

Lifestyle and home remedies:
To take care of your bursitis at home:

*Take nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs such as aspirin, ibuprofen (Advil, Motrin, others) or naproxen sodium (Aleve) can provide relief. Use as directed.

* Consult your doctor if you need NSAIDs for an extended period of time.

*Apply ice packs. Use them for 20 minutes several times a day during the first few days, or for as long as the joint area is warm to the touch.

*Apply heat. Use heat after the affected joint is no longer warm or red to help relieve muscle and joint pain and stiffness. But don’t overdo it. Don’t apply heat for more than 20 minutes at a time. Sometimes moist heat seems to penetrate deeper and give you more relief than does dry heat.

*Perform stretching exercises. Stretching can help restore full range of motion.

*Elevate the affected joint. Raising your knee or elbow can help reduce swelling.

Keep pressure off your joint. If possible, use an elastic bandage, sling or soft foam pad to protect a joint until the swelling goes down.

Herbal Remedy:

YOU can promote the healing of inflamed fluid sacs between tendons and bones, and fight the pain and tenderness of “tennis elbow” and “frozen shoulder” with these herbs from Mother Nature’s medicine chest:

Coral calcium with trace minerals, glucosamine sulfate, shavegrass.

Prevention:
To help prevent bursitis or reduce the severity of flare-ups:

*Stretch your muscles. Warm up or stretch before physical activity.

*Strengthen your muscles. Strengthening can help protect your joints. Wait until the pain and inflammation are gone before starting to exercise a joint that has bursitis.

*Take frequent breaks from repetitive tasks. Alternate repetitive tasks with rest or other activities.

*Cushion your joint. Use cushioned chairs, foam for kneeling or elbow pads. Avoid resting your elbows on hard surfaces. Avoid shoes that don’t fit properly or that have worn-down heels.

*Don’t sit still for long periods. Get up and move about frequently.

*Practice good posture. For example, avoid leaning on your elbows.

If your bursitis is caused by a chronic underlying condition, such as arthritis, it may recur despite these preventive measures.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://www.mayoclinic.com/health/bursitis
http://www.herbnews.org/bursitisdone.htm

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Ailmemts & Remedies

Osteoarthritis (OA)

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Alternative Names : Hypertrophic osteoarthritis; Osteoarthrosis; Degenerative joint disease; DJD; OA; Arthritis – osteoarthritis.

Definition : Osteoarthritis (OA) is the most common joint disorder.
Osteoarthritis (previously called degenerative arthritis, degenerative joint disease) is a chronic disorder of joint cartilage and surrounding tissues that is characterized by pain, stiffness, and loss of function.

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Osteoarthritis also occurs in almost all animals with a backbone—including fish, amphibians, and birds. Because the disorder is so widespread in the animal kingdom, some authorities believe that osteoarthritis may have evolved from an ancient method of cartilage repair.

Many myths about osteoarthritis persist—for example, that it is an inevitable part of aging, like gray hair and skin changes; that it results in little disability; and that treatment is not effective. Although osteoarthritis is more common in older people, it is not caused simply by the wear and tear that occurs with years of use. Instead, microscopic changes in the structure and composition of cartilage appear to be responsible. Most people who have the disorder, especially younger people, have few if any symptoms; however, some older people develop significant disabilities.
Causes:
Most of the time, the cause of OA is unknown. It is mainly related to aging, but metabolic, genetic, chemical, and mechanical factors can also lead to OA.

Normally, joints have such a low friction level that they are protected from wearing out, even after years of use. Osteoarthritis probably begins most often with an abnormality of the cells that synthesize the components of cartilage, such as collagen (a tough, fibrous protein in connective tissue) and proteoglycans (substances that provide resilience). Next, the cartilage may swell because of water retention, become soft, and then develop cracks on the surface. Tiny cavities form in the bone beneath the cartilage, weakening the bone. Bone can overgrow at the edges of the joint, producing bumps (osteophytes) that can be seen and felt. Ultimately, the smooth, slippery surface of the cartilage becomes rough and pitted, so that the joint can no longer move smoothly and absorb impact. All the components of the joint—bone, joint capsule (tissues that enclose most joints), synovial tissue (tissue lining the joint), tendons, ligaments, and cartilage—fail in various ways, thus altering the joint.

The symptoms of osteoarthritis usually appear in middle age and almost everyone has them by age 70. Before age 55, the condition occurs equally in both sexes. However, after 55 it is more common in women.

The disease causes the cushioning (cartilage) between the bone joints to wear away, leading to pain and stiffness. As the disease gets worse, the cartilage disappears and the bone rubs on bone. Bony spurs usually form around the joint.

OA can be primary or secondary.

Primary OA occurs without any type of injury or obvious cause.

Secondary OA is osteoarthritis due to another disease or condition. The most common causes of secondary OA are metabolic conditions, such as acromegaly, problems with anatomy (for example, being bow-legged), injury, or inflammatory disorders such as septic arthritis.

Some people who repetitively stress one joint or a group of joints, such as foundry workers, coal miners, and bus drivers, are particularly at risk. Much of the risk for osteoarthritis of the knee comes from occupations that involve bending of the joint. Curiously, long-distance running champions appear not to be at higher risk of developing the disorder. However, once osteoarthritis develops, this type of exercise often makes the disorder worse. Obesity may be a major factor in the development of osteoarthritis, particularly of the knee and especially in women.
Symptoms :

The symptoms of osteoarthritis include:

*Deep aching joint pain that gets worse after exercise or putting weight on it and is relieved by rest.

*Grating of the joint with motion

*Joint pain in rainy weather

*Joint swelling

*Limited movement

*Morning stiffness

Some people might not have symptoms.

Usually, symptoms develop gradually and affect only one or a few joints at first. Joints of the fingers, base of the thumbs, neck, lower back, big toes, hips, and knees are commonly affected. Pain, usually made worse by activities that involve weight bearing (such as standing), is the first symptom. In some people, the joint may be stiff after sleep or some other inactivity, but the stiffness usually subsides within 30 minutes of moving the joint.

As the condition causes more symptoms, the joint may become less movable and eventually may not be able to fully straighten or bend. The attempt of the tissues to repair may lead to new growth of cartilage, bone, and other tissue, which can enlarge the joints. The irregular cartilage surfaces cause joints to grind, grate, or crackle when they are moved. Bony growths commonly develop in the joints at the ends or middle of the fingers (called Heberden’s or Bouchard’s nodes).

Osteoarthritis
In some joints (such as the knee), the ligaments, which surround and support the joint, stretch so that the joint becomes unstable. Alternatively, the hip or knee may become stiff, losing its range of motion. Touching or moving the joint (particularly when standing, climbing stairs, or walking) can be very painful.

Osteoarthritis often affects the spine. Back pain is the most common symptom. Usually, damaged disks or joints in the spine cause only mild pain and stiffness. However, osteoarthritis in the neck or lower back can cause numbness, pain, and weakness in an arm or leg if the overgrowth of bone presses on nerves. The overgrowth of bone may be within the spinal canal, pressing on nerves before they exit the canal to go to the legs. This may cause leg pain after walking, suggesting incorrectly that the person has a reduced blood supply to the legs (intermittent claudication (see Peripheral Arterial Disease: Arteries of the Legs and Arms). Rarely, bony growths compress the esophagus, making swallowing difficult.

Osteoarthritis may be stable for many years or may progress very rapidly, but most often it progresses slowly after symptoms develop. Many people develop some degree of disability.

Diagnosis:

Exams and Tests

A physical exam can show limited range of motion, grating of a joint with motion, joint swelling, and tenderness.

An x-ray of affected joints will show loss of the joint space, and in advanced cases, wearing down of the ends of the bone and bone spurs.
The doctor makes the diagnosis based on the characteristic symptoms, physical examination, and the x-ray appearance of joints (such as bone enlargement and narrowing of the joint space). By age 40, many people have some evidence of osteoarthritis on x-rays, especially in weight-bearing joints such as the hip and knee, but only half of these people have symptoms. However, x-rays are not very useful for detecting osteoarthritis early because they do not show changes in cartilage, which is where the earliest abnormalities occur. Also, changes on the x-ray correlate poorly with symptoms. For example, an x-ray may show only a minor change while the person is having severe symptoms, or an x-ray may show numerous changes while the person is having very few, if any, symptoms.

Magnetic resonance imaging (MRI) can reveal early changes in cartilage, but it is rarely needed for the diagnosis. Also, MRI is too expensive to justify routine use. There are no blood tests for the diagnosis of osteoarthritis, although blood tests may help rule out other disorders

Treatment :
The goals of treatment are to relieve pain, maintain or improve joint movement, increase the strength of the joints, and reduce the disabling affects of the disease. The treatment depends on which joints are involved.

MEDICATIONS:

The most common medications used to treat osteoarthritis are nonsteroidal anti-inflammatory drugs (NSAIDs). They are pain relievers that reduce pain and swelling. Types include aspirin, ibuprofen, and naproxen.

Although NSAIDs work well, long-term use of these drugs can cause stomach problems, such as ulcers and bleeding. Manufacturers of NSAIDs include a warning label on their products that alerts users to an increased risk for cardiovascular events (heart attacks and strokes) and gastrointestinal bleeding.

Other medications used to treat OA include:

  • COX-2 inhibitors (coxibs). Coxibs block a substance called COX-2 that causes swelling. This class of drugs was first thought to work as well as other NSAIDs, but with fewer stomach problems. However, reports of heart attacks and stroke have led the FDA to re-evaluate the risks and benefits of the COX-2s. Celecoxib (Celebrex) is still available at the time of this report, but labeled with strong warnings and a recommendation that it be prescribed at the lowest possible dose for the shortest possible period of time. Ask your doctor whether the drug is right and safe for you.
  • Steroids. These medications are injected right into the joint. They can also be used to reduce inflammation and pain.
  • Supplements. Many people are helped by over-the-counter remedies such as glucosamine and chondroitin sulfate. There is some evidence that these supplements can help control pain, although they do not seem to grow new cartilage.
  • Artificial joint fluid (Synvisc, Hyalgan). These medications can be injected into the knee. They may relieve pain for up to 6 months.

LIFESTYLE CHANGES
Exercise helps maintain joint and overall movement. Ask your health care provider to recommend an appropriate home exercise routine. Water exercises, such as swimming, are especially helpful.

Applying heat and cold, protecting the joints, using self-help devices, and rest are all recommended.

Good nutrition and careful weight control are also important. If you’re overweight, losing weight will reduce the strain on the knee and ankle joints.

PHYSICAL THERAPY

Physical therapy can help improve muscle strength and the motion at stiff joints. Therapists have many techniques for treating osteoarthritis. If therapy does not make you feel better after 3-6 weeks, then it likely will not work at all.

BRACES
Splints and braces can sometimes support weakened joints. Some prevent the joint from moving; others allow some movement. You should use a brace only when your doctor or therapist recommends one. Using a brace the wrong way can cause joint damage, stiffness, and pain.

SURGERY
Severe cases of osteoarthritis might need surgery to replace or repair damaged joints. Surgical options include:

  • Total or partial replacement of the damaged joint with an artificial joint (knee arthroplasty,hip arthroplasty)
  • Arthroscopic surgery to trim torn and damaged cartilage and wash out the joint
  • Cartilage restoration to replace the damaged or missing cartilage in some younger patents with arthritis
  • Change in the alignment of a bone to relieve stress on the bone or joint (osteotomy)
  • Surgical fusion of bones, usually in the spine (arthrodesis)

Prognosis:
Your movement may become very limited. Treatment generally improves function.

Possible Complications :
Decreased ability to walk
Decreased ability to perform everyday activities, such as personal hygiene, household chores, or cooking
Adverse reactions to drugs used for treatment
Surgical complications
When to Contact a Medical Professional

Complementary or alternative therapies for osteoarthritis

.Alternative Therapies

Use of Alternative Therapy, Quality of Life, And Healthcare Spending in Chinese Patients with Osteoarthritis.
Acupuncture Therapy , methods

Call your health care provider if you have symptoms of osteoarthritis.

Prevention :
Weight loss can reduce the risk of knee osteoarthritis in overweight women.
How to Live With Osteoarthritis :

*Exercise affected joints gently (in a pool, if possible)

*Massage at and around affected joints (this measure should preferably be performed by a trained therapist)

*Apply a heating pad or a damp and warm towel to affected joints

*Maintain an appropriate weight (so as not to place extra stress on joints)

*Use special equipment as necessary (for example, cane, crutches, walker, neck collar, or elastic knee support to protect joints from overuse; a fixed seat placed in a bathtub to enable less stretching while washing)

*Wear well-supported shoes or athletic shoes


Disclaimer:
This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose

Resources:
http://www.nlm.nih.gov/medlineplus/ency/article/000423.htm
http://www.merck.com/mmhe/sec05/ch066/ch066a.html

 

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