Rheumatoid Arthritis (RA) : Complications

Rheumatoid arthritis is not solely a disease of joint destruction. It can involve almost all organs. A life-threatening joint complication can occur when the cervical spine (neck bones) becomes unstable as a result of RA. Rheumatoid vasculitis (in...

About 15% of all RA patients will have symptoms for a short period of time and will ultimately get better, leaving them with no long-term problems. A number of factors are considered to suggest the likelihood of a worse prognosis. These include: r...

In rare cases, RA resolves spontaneously. However, at least one out of 10 people with RA eventually becomes severely disabled.

About 15% of all RA patients will have symptoms for a short period of time and will ultimately get better, leaving them with no long-term problems. A number of factors are considered to suggest the likelihood of a worse prognosis. These include: r...

Joint pain can affect one or more joints. See also: Arthritis (inflammation of joints; Bursitis; Muscle pain.

An activities of daily living (ADL) evaluation is an assessment of an individual's physical and sometimes mental skills. In the area of physical or occupational therapy , it reflects how well a disabled patient or someone recovering from disease or accident can function in daily life. It is also used to determine how well patients relate to and participate in their environment.

Pericarditis is a condition in which the sac-like covering around the heart (pericardium) becomes inflamed. See also: Bacterial pericarditis

Pericarditis is an inflammation of the two layers of the thin, sac-like membrane that surrounds the heart. This membrane is called the pericardium, so the term pericarditis means inflammation of the pericardium.

Myocarditis is inflammation of the heart muscle. See also: Pediatric myocarditis

Myocarditis is an inflammatory disease of the heart muscle (myocardium) that can result from a variety of causes. While most cases are produced by a viral infection, an inflammation of the heart muscle may also be instigated by toxins, drugs, and hypersensitive immune reactions. Myocarditis is a rare but serious condition that affects both males and females of any age.

Depression may be described as feeling sad, blue, unhappy, miserable, or down in the dumps. Most of us feel this way at one time or another for short periods. True clinical depression is a mood disorder in which feelings of sadness, loss, anger, or frustration interfere with everyday life for an extended period of time. See also: Adolescent depression; Depression in the elderly.

Depression, also known as depressive disorders or unipolar depression, is a mental illness characterized by a profound and persistent feeling of sadness or despair and/or a loss of interest in things that once were pleasurable. Disturbance in sleep, appetite, and mental processes are a common accompaniment.

Depression is sometimes referred to as the common cold of mental illness. It is a debilitating disease with significant societal costs. It is, however, one of the most clearly defined and treatable of mental illnesses. Technically, the term "depression" is used to cover a variety of symptomatic conditions, all characterized by negative mood and a loss of pleasure. Together these conditions comprise a spectrum ranging from major depression to dysthymia to adjustment reactions to normal grief and sadness. At one extreme of this continuum lies major depressive disorder, a syndrome characterized by severe episodes of depressed mood accompanied by loss of sleep, appetite, concentration, energy, and hope. The depressed mood must persist for greater than two weeks in order to warrant this diagnosis. At the other end of the continuum lies the diagnosis of dysthymia, which is characterized by a lower level of mood disturbance that persists chronically; that is, involving more days than not for a period of two years or greater. Many patients complain of depressed mood but do not fit neatly into either of these two categories. These patients' symptoms are frequently best accounted for as a reaction to an acute life stressor. These reactions are typically nonpathological and resolve with time, but they may constitute an adjustment reaction if normal functioning is sufficiently disturbed. Depression is both common and costly. It has a lifetime prevalence of 5 to 10 percent of women and 2 to 5 percent of men. It is an expensive disorder in both direct and indirect terms, as depression causes a higher degree of functional disability than many medical illnesses including diabetes, chronic lung disease, and arthritis. Additional costs to society result from the effect of untreated depression on the treatment of medical illnesses, where it contributes to longer hospital stays and morbidity. This has been particularly well demonstrated in the treatment of myocardial infarction (heart attack), where the presence of major depression has consistently been found to increase mortality. Depressive illness is thought to result from a combination of biological and psychological factors. The biological component is strongly suggested by the high genetic concordance of depressive disorders. In the twenty-first century, there are various competing theories about the nature of this genetic/biological contribution, but the available data do not yet indicate the specific nature of the illness. The psychological component is similarly suggested by the correlation of onset of major depression with negative life events and with the increased risk of depression in individuals who experienced abuse in childhood. A variety of psychological theories exist and are linked to models of psychotherapeutic treatment. Interpersonal psychotherapists, for example, emphasize the role of grieving due to the loss of an important relationship or a transition in social roles (e.g., transition from working to retirement, marriage to divorce). Cognitive therapists emphasize a mind-set of construing life events in a way that leads to depression. Alternately, psychodynamic therapists search for the ways that unconscious coping processes and repetitive relational patterns result in negative effects. A commonly postulated mechanism would include the turning of anger in on the self. For example, a depressed woman may feel critical of herself rather than direct her anger toward an abusive spouse. Treatment of depression parallels theories of etiology in that both biological and psychological treatments exist and have been efficacious. A number of different antidepressant medications have been developed, including monoamine oxidase (MAO) inhibitors, tricyclic antidepressants, and selective serotonin reuptake inhibitors (SSRI). These medicines have demonstrated efficacy in both the treatment of acute depressive episodes and in the prevention of relapses. A variety of psychological therapie

Osteoporosis is the thinning of bone tissue and loss of bone density over time.

Osteoporosis , which is characterized by a decrease in the mass of otherwise normal bone is the most common metabolic bone disease. Normal bone is made of a hard outer shell (the cortex) and an inner network of spicules (fibers), called trabeculae, that give bone its characteristic strength. Bone mass is maintained at a progressive and then constant level until around the age of thirty-five. This maintenance is accomplished through bone remodeling, a cycle of breaking down and building up of bone. This cycle is controlled by osteoblast cells, which make bone, and osteoclast cells, which destroy bone. Beginning around age forty, the rate at which bone breaks down can exceed that at which it is built, resulting in diminished mass and a diminished amount of calcium in the bone. For women, in addition to this normal age-related bone loss, menopause and its subsequent reduction in female hormone levels (specifically estrogen ) cause a specific loss in cortical and trabecular bone. In those who develop osteoporosis, the reduction in cortical and trabecular bone can be up to 30-40 percent, resulting in fragile bones that are prone to fracture. Several factors contribute to the development of osteoporosis. Smoking, alcohol, and a sedentary lifestyle have all been shown to increase the risk of developing the disorder. Age and gender are also contributory factors. Women who have low estrogen levels (e.g., after menopause) are more likely to develop osteoporosis than others. Also, men generally maintain a higher bone density than women, making them less susceptible to the condition. Race can also play a role. Africans and people of African descent, for example, have a naturally higher bone density than Europeans and people of European descent and are therefore less likely to develop osteoporosis. A family history of osteoporosis certainly predisposes an individual to the An elderly woman exhibits a dowager's hump, which is one symptom of osteoporosis. The hump is caused by repeated compression fractures of weakened vertebrae, which cause the upper spine to curve forward. [© Lester V. Bergman/Corbis. Reproduced by permission.] condition, and research is currently underway to identify genes linked to it. Other risk factors include long-term steroid therapy, Cushing's disease, hyperparathyroidism, and hyperthyroidism. Traditionally, low intake of calcium and vitamin D , both of which are essential to bone building and maintenance, have been associated with osteoporosis as well. However, the role of dietary calcium remains controversial. Countries in Europe and North America, where the dietary intake of calcium is adequate, still show very high rates of osteoporosis. Studies have shown that high-protein diets, like those found in Europe and North America, raise the body's calcium requirement, thereby creating a calcium deficit in some. One of the difficulties in understanding and managing osteoporosis is that its signs and symptoms are not apparent until the late stages of the disease, and many people with the osteoporosis are not diagnosed or treated until a fracture occurs. Hip and wrist fractures are very common, and vertebral compression fractures can occur with as little stress as that from sneezing or bending. These compressions can cause chronic backaches or cause patients to seemingly "lose height" as the vertebrae progressively curve into what is known as the "dowager's hump." Fractures also occur in the ribs, pelvis, and humerus (upper arm bone). Hip fractures can be the most devastating, often leading to death or long-term disability. The most commonly used method to diagnose osteoporosis is to measure bone mineral density using dual energy X-ray absorbitometry (DEXA scans). This test is performed routinely in people who have risk factors or a prior diagnosis of osteoporosis. Density is usually measured in the lower spine or the hip, and the procedure is noninvasive and well tolerated. Quantitative CT (computerized tomography

Osteoporosis (literally "porous bone") is a condition characterized by bone fragility and fracturing. The World Health Organization (WHO) defines osteoporosis as a 25 percent reduction of bone mineral density (BMD) compared to that of a healthy young adult female. Eight million Americans have osteoporosis, and over 20 million have osteopenia (thin bones, or a loss of 10 to 25% of bone mineral density). Osteoporosis is most prevalent in Caucasians, less prevalent in Hispanics, and least prevalent in African Americans. Key predisposing factors are early menopause and a family history of osteoporosis. Other medical, psychological, and social factors may also contribute to the condition. Osteoporosis commonly leads to fractures. Medical, social, and environmental factors that predispose people to osteoporosis-related fractures include impairment of hearing, vision, balance and cognition; debilitating illnesses; medications; postoperative conditions; and unsafe environments. In the United States, one of three females over age sixty-five will have at least one vertebral fracture. The ratio of female to male fractures of a hip is 2.5 to one. Two hundred and fifty thousand hip or wrist fractures and 500,000 vertebral fractures occur annually in the United States. Up to 15 percent of hip fractures will result in death within one year, and one of three survivors become long-term nursing home residents. The annual cost of osteoporosis in the United States is estimated to be as high as $18 million and is projected to reach $240 million by the year 2040. There are several methods to measure bone mineral density for osteoporosis detection. The most precise is dual energy X-ray absorptiometry (DXA) of the hip. Blood and urine tests for bone resorption and formation are also used to help measure the response to therapy. The four components of treatment are nutrition, medication, exercise, and safety. Nutritional factors are particularly important during childhood and adolescence when the bones are growing. Key components are calcium and vitamin D, supplemented by magnesium; and vitamins C and K for individuals with chronic diarrhea or on a low-vegetable diet. Hormonal therapies—estrogens for postmenopausal females and testosterone for hypogonadal males—are widely utilized. Estrogens may be contraindicated by breast or uterine cancer or by susceptibility to vascular clotting, and prostatic disorders may preclude the use of testosterone. Bisphosphonates are potent antiresorptive drugs that can yield reductions in hip and vertebral fracturing. Use of calcitonin, another antiresorptive drug, has also shown reductions in vertebral fracturing. Exercise and safety are essential components of fracture prevention. Vigorous weight-bearing activities are beneficial but not feasible for the elderly or infirm. Walking has not proved efficacious. Resistive exercises increase the muscle strength and bone mineral density essential to fracture prevention. Balance–enhancing activities such as dancing, careful attention to minimizing hazards in the home and work environments, and selective use of padded hip protectors for the aged and infirm all help reduce the risk of osteoporosis-related fractures. Osteoporosis is a major and growing public health concern. Appropriate screening to identify those who are susceptible, accurate diagnosis of osteoporosis and related disorders, and prompt institution and monitoring of appropriate therapies are all essential to minimize the risks of fracture and the attendant mortality and morbidity. R OBERT L. S WEZEY ( SEE ALSO : Hip Fractures )

The word osteoporosis literally means "porous bones." It occurs when bones lose an excessive amount of their protein and mineral content, particularly calcium . Over time, bone mass, and therefore bone strength, is decreased. As a result, bones become fragile and break easily. Even a sneeze or a sudden movement may be enough to break a bone in someone with severe osteoporosis.

The word osteoporosis literally means porous bones. It occurs when bones lose an excessive amount of their protein and mineral content, particularly calcium . Over time, bone mass, and therefore bone strength, is decreased. As a result, the bones become fragile and break easily. Even a sneeze or a sudden movement may be enough to break a bone in someone with severe osteoporosis.

The word osteoporosis literally means "porous bones." It occurs when bones lose an excessive amount of their protein and mineral content, particularly calcium. Over time, bone mass, and therefore bone strength, is decreased. As a result, bones become fragile and break easily. Even a sneeze or a sudden movement may be enough to break a bone in someone with severe osteoporosis.

Osteoporosis is a disease characterized by low bone mass and deterioration of bone tissues, leading to bone fragility and, consequently, an increase in fracture risk.

Osteoporosis is a disease characterized by low bone mass and deterioration of bone tissues, leading to bone fragility and, consequently, an increase in fracture risk.

Fatigue is a feeling of weariness, tiredness, or lack of energy.

Fatigue is physical and/or mental exhaustion that can be triggered by stress , medication, overwork, or mental and physical illness or disease.

Fatigue may be defined as a subjective state in which one feels tired or exhausted, and in which the capacity for normal work or activity is reduced. There is, however, no commonly accepted definition of fatigue when it is considered in the context of health and illness. This lack of definition results from the fact that a person's experience of fatigue depends on a variety of factors. These factors include culture, personality, the physical environment (light, noise, vibration), availability of social support through networks of family members and friends, the nature of a particular fatiguing disease or disorder, and the type and duration of work or exercise . The experience of fatigue associated with disease will be different for someone who is clinically depressed, is socially isolated, and is out of shape, as compared to another person who is not depressed, has many friends, and is aerobically fit.

Fatigue is physical and/or mental exhaustion that can be triggered by stress , medication, overwork, or mental and physical illness or disease.

Fatigue may be defined as a subjective state in which one feels tired or exhausted, and in which the capacity for normal work or activity is reduced. There is, however, no commonly accepted definition of fatigue when it is considered in the context of health and illness. This lack of definition results from the fact that a person's experience of fatigue depends on a variety of factors. These factors include culture; personality; the physical environment (light, noise, vibration); availability of social support through networks of family members and friends; the nature of a particular fatiguing disease or disorder; and the type and duration of work or exercise. For example, the experience of fatigue associated with disease will be different for someone who is clinically depressed, is socially isolated, and is out of shape, as compared to another person who is not depressed, has many friends, and is aerobically fit. Fatigue is sometimes characterized as normal or abnormal. For example, the feeling of tiredness or even exhaustion after exercising is a normal response and is relieved by resting; many people report that the experience of ordinary tiredness after exercise is pleasant. Moreover, this type of fatigue is called acute since the onset is sudden and the desired activity level returns after resting. On the other hand, there is a kind of fatigue that is not perceived as ordinary; that may develop insidiously over time; is unpleasant or seriously distressing; and is not resolved by rest. This kind of fatigue is abnormal and is called chronic . Some researchers regard fatigue as a defense mechanism that promotes the effective regulation of energy expenditures. According to this theory, when people feel tired they take steps to avoid further stress (physical or emotional) by resting or by avoiding the stressor. They are then conserving energy. Since chronic fatigue is not normal, however, it is an important symptom of some mental disorders; of a variety of physical diseases with known etiologies (causes); and of medical conditions that have no biological markers although they have recognizable syndromes (patterns of symptoms and signs). Fatigue is sometimes described as being primary or secondary. Primary fatigue is a symptom of a disease or mental disorder, and may be part of a cluster of such symptoms as pain, fever, or nausea. As the disease or disorder progresses, however, the fatigue may be intensified by the patient's worsening condition, by the other disease symptoms, or by the surgical or medical treatment given to the patient. This subsequent fatigue is called secondary.

Fatigue is a feeling of exhaustion or loss of strength. The duration of fatigue for a patient with cancer has been found to last from one to two times the length of time between diagnosis and completion of treatment, so it is common for fatigue to persist beyond a patient's treatment regimen.