Sciatica is different than low back pain. Low back pain causes pain only in the back. Sciatica is pain that follows the path of the sciatic nerve, so the pain is felt in the back, buttock, back of the thigh, and the calf. Pain that moves from one area to the other is called radiating pain. Sciatica usually affects only one nerve on one side of the body.

Sciatic pain can be described as mild, severe, aching, or burning. It may feel like a sudden shock of pain and it may be triggered by coughing, sneezing, straining, lifting, or twisting. Other common symptoms of sciatica may include weakness, numbness, or tingling (“pins and needles”).

Sleeping With Sciatica

Symptoms of sciatica may be worse at night and may wake you up or keep you from falling asleep. The exact cause and severity of sciatica is different for different people, so there is no single solution to sleeping with sciatica. There is no recommendation for a specific type of mattress or pillow.

According to Cleveland Clinic, the key to sleeping with sciatica is to find the most comfortable sleeping position for you. If you usually sleep on your back, it could be the best position. Some people have less pain when the spine is straight. If that works for you, place a small pillow under your head and another under your knees.

If you are used to sleeping on your side, that could also be the best position, since some people have less pain when the spine is bent slightly forward. If this position works for you, place a pillow under your head, behind your back, and between your knees. Sleep on the side opposite your sciatic pain. The good news is that sciatica usually goes away on its own without treatment, so you should only have to make it through a few nights.

Causes, Diagnosis, and Treatment for Sciatica

You may be at higher risk for sciatica if you are overweight and inactive. The most common age for sciatica is 30 through 50. After a bulging disc, the most common cause of sciatica is a bony growth on a vertebra – called a spur – that presses on the nerve. People with diabetes may have diabetic nerve damage that affects the sciatic nerve. Rare causes include a spinal blood clot, abscess, or tumor. You may also be at higher risk of you have bad posture or if you have a job the requires a lot of lifting or sitting. In most cases, sciatic pain will go away in a few days. If you have sciatic pain more than one week, pain that is getting worse, or pain that is causing weakness or numbness, let your doctor know.

If you are sitting at a computer most of the day, sitting with correct posture is important. © Maanas | Getty Images

To find the cause and best treatment, your healthcare provider will do a physical exam and may order imaging studies of your lower spine with x-ray or MRI. Treatment may include nonsteroidal anti-inflammatory drugs for pain and inflammation, physical therapy, and home care. In rare cases, surgery to remove a bone spur or repair a herniated disc may be needed.

Sciatica Treatment at Home

Home care for sciatica pain may include:

• A short period of rest followed by movement
• Physical therapy exercises at home
• Hot or cold compresses
• Maintaining good posture
• Avoiding heavy lifting

It is important to know that resting your back too long does not help sciatica get better. Your back needs to be moving to get blood flowing to your lower back area and to prevent stiffness and loss of muscle tone. Even if it is a little painful at first, movement is the most important part of home care.

Sciatica is not a medical emergency, but some conditions that cause sciatica may be, if the spinal cord is being compressed and nerves are being damaged. Get help right away if you have complete loss of feeling or severe weakness, or if you lose bowel or bladder control.

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“The correct terminology for this condition is actually ‘radiculopathy,’ or radicular pain,” explains Jaspal Ricky Singh, MD, vice chair and associate professor in the department of rehabilitation at Weill Cornell Medicine.

Causes of Sciatic Pain

The sciatic nerves are the longest nerves in the body; they begin in the lumbar (lower back) area and extend through the buttocks down each leg to the feet. Sciatica can be acute, lasting a few weeks, or chronic, persisting for more than three months. Often, the pain resolves without treatment within a few weeks or months.

Some medical conditions that can cause these symptoms include herniated discs, lumbar spinal stenosis, and degenerative disc disease.

Often, sciatica is a result of a bulging or herniated disc in the lumbar spine. Intervertebral discs are gel- and fiber-filled structures that act as shock absorbers and prevent your vertebrae from rubbing together when you move your upper body.

“Think of the disc as a jelly donut; if the donut is squeezed or compressed, the ‘jelly’ squirts out and can come into contact with a nerve. When a bulging disc presses on one of these exiting nerves in the lower back, the patient often reports shooting pain down the leg,” explains Dr. Singh.

Symptoms and Diagnosis

A patient who has radiculopathy usually reports sharp, stabbing pain starting in the lower back and radiating down the buttock and leg. If the nerve compression is severe, the patient may report weakness in the leg. The pain can vary from mild to debilitating, depending on the degree of pressure exerted on the sciatic nerve. Other symptoms include:

• Numbness or a burning or tingling sensation in the leg or foot
• Weakness of the leg or foot
• Pain in the buttock area and leg that increases with coughing, sneezing, or straining
• Pain that increases with bending backward and with prolonged sitting or standing

An evaluation for sciatica includes a complete medical history, a physical examination, and an assessment of neuromuscular function. Imaging procedures, such as X-ray, MRI, CT scan, and electromyogram, and/or nerve conduction tests may be necessary to confirm the diagnosis and/or identify the exact location of the nerve impingement.

Treatment Options

“The first goal of treatment is to minimize the inflammation of the nerve; this may require an oral medication, such as nonsteroidal anti-inflammatory drugs (NSAIDs) or an oral steroid. In addition, it is critical to take the compression off the disc and the nerve, which can sometimes be accomplished with physical therapy and core-strengthening exercises,” says Dr. Singh. Applying ice or heat, massage, and manual manipulation may also help relieve the pain.

If conservative options do not provide relief, epidural steroid injections usually are effective in alleviating symptoms.

If symptoms persist and the patient reports any neurological problems, such as weakness or numbness, surgical intervention should be considered. Conditions that may be treated with surgery include herniated discs, lumbar spinal stenosis, spondylolisthesis, and degenerative disc disease.

Finally, Dr. Singh emphasizes the importance of doing exercises that strengthen your core muscles.

“To prevent sciatic pain or to keep it from returning once you’ve had it, keep your core strong; this will minimize the compressive forces on the discs and prevent pressure on the sciatic nerve.”

Ask your doctor for a referral to a physical therapist or other health-care provider who can teach you core exercises that are safe and effective.

The post That Literal Pain In Your Butt Might Be Your Sciatic Nerve appeared first on University Health News.

A: A variety of problems can put the squeeze on your sciatic nerve. Some of the more common culprits include:

• Herniated (slipped) discs between the vertebrae pressing on the sciatic nerve.
• Spinal stenosis, or narrowing of the spinal canal.
• Spondylolisthesis, when one of the vertebrae slips out of place.
• Piriformis syndrome, which occurs when the piriformis muscle deep in the derriere becomes tight or starts having spasms.

Don’t overdo it. Overuse of your back, such as lifting something that is too heavy, an injury from a fall, or having something hit your back, can also bring about an episode of sciatica. It can also be the result of excess body weight that increases stress on the spine, which can contribute to bone spurs and herniated discs. Other causes include a sedentary lifestyle or a job that forces you to sit for long hours.

A flare-up of sciatica differs from other types of back pain. Instead of a throbbing in one place, it can range from a mild ache to a sharp, shooting pain, or a burning sensation to an electric shock. Aside from pain, some people develop numbness, tingling, or weakness in a leg or foot, or multiple symptoms in different parts of the leg. Typically, though, people experience symptoms only on one side of their body.

Conservative Management. The good news is that mild sciatica usually dissipates over time with conservative management such as pain relievers, alternating heat and ice, avoiding lifting or bending, and physical therapy. Surgery is recommended in a small minority of cases.

To reduce your chances of flare-ups:

• Lose weight if you are overweight.
• Do warm-up stretches before participating in activities.
• Do regular aerobic exercises to strengthen your back and abdominal muscles.
• Lift properly, bending your knees and hips and keeping your back straight.
• Practice good posture.

If you experience a bout of sciatica that lasts more than a week or two, or becomes severe or progressively worse, it is time to seek out help from a physician.

Q: Since the start of the pandemic, my doctors have given me the option of scheduling tele-medicine appointments. I’m happy to use my computer to visit with friends, but I don’t feel fully comfortable with online health care. Should I?

A: Telemedicine has been around for a very long time. When it was first introduced, it referred to telephone appointments, which were particularly useful in rural areas where patients sometimes would have to travel hundreds of miles to see a specialist. Telemedicine has come a long way since then as a result of software technology that makes it safe to visit with your doctor in the privacy of your home via smartphone or computer.

Oftentimes, doctors will conduct the initial consultation visit in-person and use telemedicine only for follow-up visits. There are two benefits to this system: One is the ability to use hands-on exams to establish a diagnosis, and the other one is to establish a doctor-patient relationship prior to conducting visits by telehealth.

The short answer to your question is: Yes. You should be comfortable with virtual doctor visits and you should get on board with telemedicine because it’s here to stay. Doctors are doing everything possible to have fewer patients physically in their waiting rooms, in an effort to enforce social distancing. Virtual appointments are key to enforcing safety protocols. And many patients have embraced the convenience of seeing their doctor without leaving their home.

If you agree to a virtual visit, remember to check with your insurance provider about coverage. Insurance payments for telehealth services, especially at full cost, may only be temporary. Medicare’s coverage of a broad range of services may end when the novel coronavirus no longer poses a public health emergency.

The post Q&A: Sciatic Nerve Pain; Telemedicine Appointments appeared first on University Health News.

What Causes Sciatica? Sciatica is caused by compression of the sciatic nerve, which starts in the lower spine and branches out through the lower back and down the legs. If any part of the nerve is squeezed or pinched, you may experience what many people describe as a “lightning bolt of pain” that shoots from your lower back as far as your foot, along with tingling or numbness in the affected leg.

Houman Danesh, MD, associate professor of rehabilitation and physical medicine at Mount Sinai, says that in seniors sciatica often is caused by spinal stenosis (a narrowing of the space the spinal nerves pass through) in the lower back. Stenosis typically occurs due to osteoarthritis, which can cause bone spurs (bony outgrowths) to form on the vertebrae. “These spurs may compress the sciatic nerve roots,” Dr. Danesh explains. Another possible cause of sciatica is a herniated (also known as slipped) spinal disc. “These discs degenerate as you age,” Dr. Danesh says. “As this happens, the discs may bulge and compress or irritate the roots of the sciatic nerve.”

Comorbidities Common The study we reference (Journal of the American Academy of Orthopaedic Surgeons, May) looked at data on about 1 million Medicare recipients. Compared to people without sciatica, those with the condition were more likely to be obese, and to have heart disease, high blood pressure, a history of heart attack and stroke, and diabetes, among others.

The study doesn’t prove that sciatica caused these conditions, but Dr. Danesh notes that sciatica pain can cause people to reduce their physical activity levels, and that lack of exercise is associated with a greater risk for cardiovascular disease, diabetes, stroke, and obesity. “Sciatica also can disturb your sleep, which may decrease your immune response as well as worsen comorbidities,” he adds.

Managing the Pain Ice packs can help ease sciatica pain, and Dr. Danesh recommends you also adopt an exercise regimen to strengthen the muscles that support your lower back. Don’t forget your glutes (the muscles in the buttocks and sides of the hips), either. “Many people with sciatica have an underlying weakness in these muscles,” Dr. Danesh says. “If you have to push off from your knees or the armrests of a chair to get up from a seated position, you likely would benefit from strengthening your glutes.” Doing so may help you avoid exerting further strain on the muscles of your lower back. A physical therapist can help design an exercise program that suits you—if you use a fitness instructor, be sure to check that he or she has experience working with older adults and people who have lower back problems.

If non-drug approaches don’t bring adequate relief from sciatica pain, try acetaminophen (Tylenol®) before nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil®, Motrin®) or naproxen (Aleve®, Naprosyn®), since the latter are associated with bleeding in older adults, and also have been linked with a greater risk of heart attack and stroke. Your doctor also may prescribe muscle relaxants and/or anti-seizure drugs, such as gabapentin (Neurontin®), and pregabalin (Lyrica®). Beware that muscle relaxants may cause drowsiness and dizziness that can raise your risk of falls—anti-seizure drugs also may cause dizziness. Steroid injections are another option, and help reduce inflammation in the sciatic nerve, but the number of injections you can have is limited due to potentially serious side effects.

What About Surgery? Surgical options are available for severe sciatica, but Dr. Danesh recommends that surgery be seen as a last resort for people whose sciatica causes significant weakness of the leg, and/or interferes with bowel function. “If you are neurologically intact, start with conservative treatments and give them time to work,” he advises.

The post Is Sciatica Stopping You in Your Tracks? appeared first on University Health News.

“The correct terminology for this condition is actually ‘radiculopathy,’ or radicular pain,” explains Jaspal Ricky Singh, MD, vice chair and associate professor in the department of rehabilitation at Weill Cornell Medicine.

Causes of Sciatic Pain

The sciatic nerves are the longest nerves in the body; they begin in the lumbar (lower back) area and extend through the buttocks down each leg to the feet. Sciatica can be acute, lasting a few weeks, or chronic, persisting for more than three months. Often, the pain resolves without treatment within a few weeks or months.

Some medical conditions that can cause these symptoms include herniated discs, lumbar spinal stenosis, and degenerative disc disease.

Often, sciatica is a result of a bulging or herniated disc in the lumbar spine. Intervertebral discs are gel- and fiber-filled structures that act as shock absorbers and prevent your vertebrae from rubbing together when you move your upper body.

“Think of the disc as a jelly donut; if the donut is squeezed or compressed, the ‘jelly’ squirts out and can come into contact with a nerve. When a bulging disc presses on one of these exiting nerves in the lower back, the patient often reports shooting pain down the leg,” explains Dr. Singh.

Symptoms and Diagnosis

A patient who has radiculopathy usually reports sharp, stabbing pain starting in the lower back and radiating down the buttock and leg. If the nerve compression is severe, the patient may report weakness in the leg. The pain can vary from mild to debilitating, depending on the degree of pressure exerted on the sciatic nerve. Other symptoms include:

• Numbness or a burning or tingling sensation in the leg or foot
• Weakness of the leg or foot
• Pain in the buttock area and leg that increases with coughing, sneezing, or straining
• Pain that increases with bending backward and with prolonged sitting or standing

An evaluation for sciatica includes a complete medical history, a physical examination, and an assessment of neuromuscular function. Imaging procedures, such as X-ray, MRI, CT scan, and electromyogram, and/or nerve conduction tests may be necessary to confirm the diagnosis and/or identify the exact location of the nerve impingement.

Treatment Options

“The first goal of treatment is to minimize the inflammation of the nerve; this may require an oral medication, such as nonsteroidal anti-inflammatory drugs (NSAIDs) or an oral steroid. In addition, it is critical to take the compression off the disc and the nerve, which can sometimes be accomplished with physical therapy and core-strengthening exercises,” says Dr. Singh. Applying ice or heat, massage, and manual manipulation may also help relieve the pain.

If conservative options do not provide relief, epidural steroid injections usually are effective in alleviating symptoms.

If symptoms persist and the patient reports any neurological problems, such as weakness or numbness, surgical intervention should be considered. Conditions that may be treated with surgery include herniated discs, lumbar spinal stenosis, spondylolisthesis, and degenerative disc disease.

Finally, Dr. Singh emphasizes the importance of doing exercises that strengthen your core muscles.

“To prevent sciatic pain or to keep it from returning once you’ve had it, keep your core strong; this will minimize the compressive forces on the discs and prevent pressure on the sciatic nerve.”

Ask your doctor for a referral to a physiatrist, physical therapist, or other health-care professional who can teach you core exercises that are safe and effective.

The post That “Pain In the Butt” Might Be Your Sciatic Nerve appeared first on University Health News.

acetaminophen: The basic ingredient found in Tylenol and equivalent drugs.

alternative health care: Non-mainstream treatment instead of conventional medicine.

analgesic: A class of drugs that includes most painkillers.

anesthesia/anesthetic: Medication that causes partial or complete loss of sensation, and sometimes consciousness.

anticonvulsant: A drug used to prevent seizures that also can treat pain.

antidepressant: Medications that improve mood and functioning in people with depression by regulating the levels of neurotransmitters in the brain.

autoimmune: A condition in which a person’s immune system attacks his or her own body.

autonomic nervous system: The part of the nervous system that regulates involuntary body functions such as the heart, circulation, and body temperature.

bioelectric treatment: A procedure in which a precise dose of bioelectric current is administered through electrodes placed on the skin to cause a biological change and interrupt pain signals.

biofeedback: A complementary medicine technique that involves awareness of the physical changes that take place when you are under stress or feel pain.

biomarker: A substance in the body that indicates the presence or absence of disease or the risk for later developing a disease.

breakthrough pain: Sudden, temporary flares of severe pain that can affect people with cancer and non-cancer conditions.

capsaicin: A chemical found in chili peppers that is the primary ingredient in many pain-relieving creams.

catastrophize: To anticipate the worst-case scenario when a health problem is anticipated or exists.

CGRP monoclonal antibodies: A class of drugs that may reduce the frequency of migraine headaches.

chronic pain: Ongoing, recurrent pain that lasts months or years.

chronic pelvic-pain syndrome: Dull, sharp, steady, or intermittent pain that persists or recurs in the pelvic region over a period of weeks or months.

cognitive behavioral therapy (CBT): A form of psychotherapy that helps people address the negative and often irrational thoughts and self-defeating behaviors that may cause or perpetuate their depression.

complementary medicine: Use of non-mainstream methods in addition to conventional medicine.

corticosteroid (steroid): Medication used to treat inflammation.

cortisol: A hormone produced by the adrenal glands that decreases inflammation and is involved with the body’s stress response.

COX-2 inhibitor: A nonsteroidal anti-inflammatory drug (NSAID) that is used to treat pain and reduce inflammation.

cryoneurolysis: A procedure used to treat nerve pain by inserting a small probe to locate and freeze the nerve.

diabetic neuropathy: Nerve damage caused by diabetes.

discectomy: Surgical removal of all or part of a disc in the spinal column.

discography: A procedure to determine whether an abnormal disc is causing pain.

disease-modifying anti-rheumatic (arthritis) drugs (DMARDs): Medications that slow the progress of conditions such as rheumatic arthritis.

drug pump: A device placed under the skin to deliver extremely small doses of medication, usually to the space around the spinal cord that contains fluid.

electromyogram: A test that measures the electrical activity of nerves and muscles.

endorphins: Naturally occurring molecules that attach to receptors in the brain and spinal cord to stop pain messages.

epidural: A procedure used to provide anesthesia during childbirth and some types of surgery, and also to relieve back pain.

epigenetics: The study of changes in the expression of genes related to environmental or other factors.

evoked potential: A diagnostic test used to record the speed of nerve signal transmission to the brain.

facet joint: A joint between two adjacent vertebrae.

gout: A form of arthritis related to a buildup of uric acid in the body that causes painful clusters of urate crystals to form in certain joints. The big toe and other bones in the feet are the most commonly affected.

hydrocodone: An opioid-based pain medication.

ibuprofen: An analgesic and non-steroidal anti-inflammatory drug that is sold over the counter and by prescription.

immune system: A system that defends the body against attacks by foreign invaders, such as viruses and bacteria.

Inflammation: The response of body tissues to injury or irritation. Inflammation (swelling) occurs when trauma, bacteria, heat, or other causes injure tissues of the body.

integrative medicine: Incorporation of complementary approaches to medicine with mainstream health care.

interstitial cystitis: Chronic inflammation of the bladder wall.

intractable pain: Pain that does not respond to treatment.

intrathecal: Fluid-containing space around the spinal cord.

irritable bowel syndrome: A disorder affecting the large intestine, resulting in symptoms such as cramping, bloating, diarrhea, and constipation.

laminectomy: Surgical procedure to remove the back portion of a vertebra.

local anesthetic: A medication that blocks electrical signals and eliminates pain in a specific part of the body.

minimally invasive lumbar decompression (MILD): A treatment that can be very effective in cases of moderate-to-severe lumbar stenosis.

minimally invasive spinal surgery (MISS): A procedure that uses one or more small incisions in the back to treat conditions within the spine.

muscle strain: A tear or stretch in a muscle tendon.

muscle spasm: A sudden, involuntary, painful contraction of a muscle.

myofascial pain: Pain in the connective tissue (fascia) that covers the muscles.

narcotics (opioids): Drugs that relieve pain by preventing transmission of pain messages to the brain.

nerve block: The use of drugs, chemical agents, or a surgical procedure to interrupt the transmission of pain messages.

neuralgia: Pain that extends along nerve pathways.

neuromodulation: The alteration of nerve activity through the delivery of electrical stimulation or chemical agents to targeted sites of the body.

neuropathic pain: Pain caused by injury to, or inflammation of, the nerves.

neuroplasticity: The ability of the brain to reorganize itself by developing new neural connections throughout a person’s life.

neurotransmitter: A chemical substance produced by the body that acts as a messenger in the brain and nervous system by transmitting nerve impulses from one cell to another cell, muscle, tissue, or organ.

nociceptive (somatic) pain: Pain caused by tissue damage in which chemicals are released and perceived by the brain as pain.

nociceptor: A specialized nerve that senses unpleasant sensations; when activated, it sends pain signals to the brain.

non-restorative sleep: Restless, light, non-refreshing, or poor-quality sleep.

nonsteroidal anti-inflammatory drug (NSAID): A substance that reduces inflammation and pain, such as ibuprofen, naproxen, and aspirin.

occipital lobes: Twin areas at the back of the brain that process images from the eyes.

opioids (narcotics): Drugs that relieve pain by preventing transmission of pain messages to the brain.

osteoarthritis: The most common form of arthritis caused by a breakdown of joint cartilage.

osteoporosis: A disease in which bone density declines, making bones more fragile and vulnerable to fracture.

pain patch: A covering that contains medication that is applied externally to the skin to relieve pain; also called topical or transdermal method of pain relief.

pain receptor: A specialized nerve ending that identifies painful sensations and transmits them to a nerve.

patient-controlled analgesia (PCA): A system by which a person pushes a button and a machine delivers a dose of pain medicine into his or her bloodstream.

pelvic floor: A network of muscles that supports pelvic organs in the lower abdomen, including the bladder, urethra, and rectum, the uterus and vagina in women, and the prostate gland in men.

percutaneous electrical nerve stimulation (PENS): A type of pain-relieving therapy that delivers a low-voltage electrical current to peripheral nerves through a probe placed just under the skin.

peripheral nerve stimulation: A type of pain relief that uses electrical signals from an implanted device to stimulate nerves outside of the spinal cord and brain.

peripheral nervous system: The part of the nervous system that lies outside the brain and spinal cord.

peripheral neuropathy: Nerve damage that may result in tingling, weakness, pain, and/or a loss of feeling in the arms, legs, hands, or feet.

phantom pain: Pain following amputation that feels as if it comes from the missing limb.

placebo: An inactive substance used in randomized, controlled scientific studies, usually when testing medications.

platelet-rich plasma (PRP): A component of a patient’s own blood that has a platelet count concentrated five to 10 times higher than normal.

precision medicine: The use of genetic profiles to help make medical decisions.

prolotherapy: Injecting substances into the body with the goal of promoting healing in soft tissues, relieving pain, and improving function.

radiofrequency ablation: A procedure that uses heat produced by a small, concentrated electric current to destroy abnormal tissue.

repetitive transcranial magnetic stimulation (rTMS): A form of non-invasive brain stimulation therapy used to treat disorders such as depression and anxiety.

sciatica: A condition caused by pressure on the sciatic nerve that results in pain in the buttocks, thighs, legs, ankles, and feet.

serotonin: A chemical messenger in the brain, known as a neurotransmitter, that helps to regulate mood, sleep, and other functions.

shingles: An inflammatory response that causes skin eruptions and other symptoms. It is caused by the same virus that causes chickenpox.

smart pumps: Drug-infusion pumps equipped with safety features to alert the patient.

somatic (nociceptive) pain: Pain caused by tissue damage in which chemicals are released and perceived by the brain as pain.

spinal cord stimulation: Electrical stimulation of nervous tissues in a specific portion of the spinal cord known as the dorsal column.

selective serotonin reuptake inhibitors (SSRIs): Medications used to relieve depression that also may indirectly relieve pain.

stenosis: A narrowing or constriction of a blood vessel or other opening. It also is a narrowing of the canal surrounding the spinal cord.

steroid: A medication used to treat inflammation.

subcutaneous: Beneath the skin.

sympathetic nervous system: One of two divisions of the autonomic nervous system that controls many of the involuntary activities of the glands, organs, and other parts of the body.

syndrome: A group of symptoms that indicate a particular disorder.

transcutaneous electrical nerve stimulation (TENS): A battery-powered unit that sends electrical signals through the skin to decrease pain.

thalamus: The part of the brain that relays impulses, especially sensory impulses from the nerves, and enables people to feel pain.

tetrahydrocannabinol (THC): An active ingredient in marijuana used legally for pain treatment and to reduce side effects of cancer treatment.

thermography: A measurement of heat produced by different parts of the body.

topical drugs: Medications applied to the skin.

transdermal: A substance that enters the body through the skin.

tricyclic antidepressants: An older class of antidepressant that improves mood by increasing levels of serotonin and norepinephrine in the brain. They also may relieve pain.

trigger point: A specific spot that is painful to touch or pressure.

The post Glossary appeared first on University Health News.

anesthesia: State of partial or complete loss of sensation and, sometimes, loss of consciousness.

anesthetic: Drug that temporarily blocks pain.

arthroscopy: Minimally invasive surgical procedure.

atherosclerosis: Disease characterized by enlarging deposits (plaques) of certain fats (including cholesterol) and/or calcium on the inside surface of arteries.

biologics: Class of medications genetically engineered from living organisms to stimulate or suppress the immune system and treat rheumatoid arthritis, cancer, and other conditions.

biomarker: Characteristic that is measured and evaluated as an indicator of a normal or disease process.

biosimilars: Manufactured drugs that are highly similar to biologics but have no clinically meaningful differences in terms of quality, safety, and efficacy.

body mass index (BMI): Relation of height to weight that is used to determine whether our weight is normal or overweight or obese. A BMI between 18.5 and 24.9 is considered normal, 25 to 29.9 is overweight, and 30+ is obese.

capsaicin: Chemical found in chili peppers that is the primary ingredient in certain pain-relieving creams.

cartilage: Smooth, elastic tissue covering the ends of bones that allows for smooth movement of joints throughout the body.

central nervous system: Part of the nervous system made up of the brain and spinal cord.

chondrocytes: Cells that produce and maintain cartilage.

chronic obstructive pulmonary disease (COPD): Progressive disease in which two underlying conditions—emphysema and chronic bronchitis—impede breathing.

cognitive behavioral therapy: Method of therapy that attempts to correct ingrained patterns of negative behaviors and thoughts; sometimes used to help patients cope with pain.

collagen: Fibers of protein found in connective tissue, cartilage, and bone.

steroid: Corticosteroid medication used to treat inflammation.

crepitus: Grating sound produced by friction between bone and cartilage.

computed tomography (CT) scan: Imaging process that used a computer to control the motion of the x-ray detectors, processes the data, and produces an image.

cortisol: Steroid produced by the adrenal glands that decreases inflammation.

COX-2 inhibitor: Nonsteroidal anti-inflammatory drug (NSAlD) used to treat pain and reduce inflammation.

c-reactive protein (CRP): Substance produced by the liver in response to inflammation; high levels may indicate the presence of a wide variety of conditions, from rheumatoid arthritis to infection.

cytokine: Type of protein involved in rheumatoid arthritis and other inflammatory diseases; some are pro-inflammatory, and others have anti-inflammatory properties.

deep vein thrombosis: Blood clot in a vein of the leg.

disease-modifying antirheumatic drugs (DMARDs): Class of medications used to slow down the disease process in rheumatoid arthritis.

effusion: Excess fluid.

electrolytes: Chemicals that occur naturally in the body and can be measured in the bloodstream, including calcium, potassium, magnesium, and sodium.

endorphins: Naturally occurring molecules that attach to receptors in the brain and spinal cord to stop pain messages.

epidural: Procedure used to provide anesthesia during childbirth and some types of surgery; an injection of steroids or other medications to help relieve back pain.

erythrocyte sedimentation rate (ESR): Blood test that indirectly measures the level of inflammation in the body; high levels may indicate rheumatoid arthritis.

heart attack: Injury or death of some of the heart muscle, usually caused by a blood clot that interrupts blood circulation in the heart.

high blood pressure: Blood pressure measures the force of blood against the artery walls; high blood pressure is force at an abnormally high level.

hyaluronic acid: Viscous substance found in the synovial fluid of joints, connective tissue, and elsewhere in the body; viscosupplementation injections are used to treat osteoarthritis.

hyperuricemia: A build-up of uric acid in the blood.

hypoxia: Low oxygen level in the blood.

immune system: Network of cells, tissues, and organs that work together to defend the body against attacks by “foreign” invaders such as bacteria and viruses.

impingement: Pressure on a nerve due to a structural abnormality that causes weakness, tingling, pain, and loss of function.

inflammation: Part of the body’s immune response that aims to heal damaged tissue after injury, irritation, or infection.

interleukin: Family of small proteins that regulate inflammation and the body’s immune response.

local anesthetic: Medication that blocks electrical signals and eliminates pain in a specific part of the body; used topically or injected.

lumbar spine: Lower back.

magnetic resonance imaging (MRI): Imaging procedure used to detect soft tissue damage.

menisci: Wedges of cartilage between the thigh and shin bones.

mesenchymal stem cells: Cells that can self-renew and differentiate into other kinds of cells.

microfracture: Surgery in which small holes are drilled into bone adjacent to diseased cartilage, resulting in bleeding and seepage of bone marrow.

mindfulness meditation: Paying attention to the moment at hand, without judging or interpreting it.

monounsaturated fatty acids: Healthy fats.

neuropathic pain: Pain caused by injury to, or inflammation of, nerves.

nonsteroidal anti-inflammatory drug (NSAlD): Drug used to reduce pain and inflammation; aspirin, ibuprofen, and naproxen are examples.

opioids: Drugs that relieve pain by preventing transmission of pain messages to the brain; hydrocodone, oxycodone, and tramadol are examples.

osteolysis: Active resorption (reabsorption) of bone.

osteonecrosis: Diminished blood supply to the bones.

osteophytes: Bone spurs.

osteoporosis: Condition that occurs when the body’s bone remodeling process becomes unbalanced, and more bone is broken down than is manufactured.

pain receptor: Specialized nerve ending that identifies painful sensations and transmits them to a nerve.

peripheral neuropathy: Nerve damage characterized by numbness, tingling, or burning pain.

placebo: Harmless, inactive substance that has no direct effect on the cause of pain.

platelets: Blood cells that make blood clotting possible.

pruritis: Itching.

pulmonary embolus: Blood clot in the lung.

respiratory depression: Shortness of breath and shallow breathing.

rheumatoid factor (RF): Group of antibodies present in the blood of many people with rheumatoid arthritis.

sciatica: Condition resulting from pressure on the sciatic nerve, causing pain in the buttocks, thighs, legs, ankles, and feet.

spinal fusion: Surgical procedure that permanently joins two or more of the vertebrae to restrict movement in painful areas and provides stability in the spine.

spinal stenosis: Narrowing of the spinal canal that carries the spinal cord.

spondylolisthesis: Slippage of the vertebrae.

steroid: Corticosteroid medication used to treat inflammation.

strength (resistance) training: Exercises in which a person lifts or moves objects that create resistance to boost strength and muscle endurance.

 subchondral bone: Bone layer directly underneath the cartilage in joints; problems in this bone may contribute to osteoarthritis.

syndrome: Group of symptoms that indicates a particular disorder.

synovial fluid: Fluid produced by the synovium (joint lining) to lubricate and nourish the joint.

synovium or synovial membrane: Tissue that lines a joint.

tai chi: Ancient Chinese martial art that combines deep breathing exercises with stretching.

tophi: Soft tissue swellings that may form in the ear, fingers, toes, kneecap, and elbow; a possible symptom of gout.

topical drugs: Medications that are applied to the surface of the skin.

tumor necrosis factor: Family of cell-signaling proteins, or cytokines, involved in the systemic inflammation associated with rheumatoid arthritis.

viscosupplementation: Injection of hyaluronic acid into joints to help improve lubrication and treat osteoarthritis.

The post Glossary appeared first on University Health News.

OA is progressive because its symptoms slowly but surely get worse over a lifetime, eventually causing disability and a diminished quality of life. It often begins with a single joint (the knee or hip, for example), but for some people it progresses to other joints, such as the spine, hands, and ankles.

OA is a degenerative disease in which cartilage, the tissue that covers the ends of bones and enables smooth movement, begins to wear away. Some of it wears away naturally; some wears away because of overuse or injury. Whatever the cause, once enough cartilage wears away, there is bone-to-bone contact every time an affected joint is moved. The result is pain, swelling, and stiffness.

OA once was thought not to be an inflammatory disease. However, studies show that it does involve inflammation that may underpin its progressively worse symptoms.

According to the Arthritis Foundation, OA is the most common chronic condition involving inflammation of the joints. Once you have it, you’ll have it for the rest of your life (unless the affected joint is replaced). OA is incurable but extremely manageable.

Of all the words used to describe osteoarthritis, insidious may be the most important. OA can be described as insidious because it comes on slowly and does not at first have obvious symptoms. It may begin with just a stiff back when waking, or a sore knee after exercise. The discomfort may persist or temporarily go away. It is perfectly natural for us to brush off symptoms like these as normal aches and pains. But aches and pains may be the first noticeable signs of a progressive, degenerative, inflammatory, and chronic disease. People who ignore these warning signs put themselves at risk of more severe and harder-to-treat problems later on.

What Happens in Osteoarthritis?

In the early stages of OA, microscopic cracks appear in the cartilage. Early changes also occur in the synovial fluid, subchondral bone (the bone beneath the cartilage), the joint capsule, and other soft tissue. Chondrocytes (cells that produce and maintain cartilage) attempt to counteract this process by increasing the production of growth factors that remodel the cartilage. This repair mechanism fails in later stages and the cartilage becomes soft and irregular, especially in load-bearing joints like the spine, hips, knees, and ankles.

Eventually, areas develop where there is complete erosion of cartilage, and the space between the bones becomes so narrow that bone grates against the opposing surface. The stressed bone fights back with a proliferation of cells and blood vessels, resulting in thicker bone in the damaged area. Cysts also may develop. The synovial membrane calcifies, and osteophytes (irregular bony spurs) grow at the edges of the bone. Pieces of bone and damaged cartilage may break off and float within the joint.

Osteoarthritis Risk Factors

The main risk factor for OA is age. The disease is rare in people age 30 and younger. Conversely, at least one in three adults age 65 and older have a diagnosis of OA, while many more have early signs on x-ray but are currently without symptoms. The association with advancing age may be linked to the fact that cartilage naturally becomes less effective with age, due to declining protein levels and a diminished blood supply.

Weight is another major risk factor for OA. The greater your weight, the more stress is placed on your load-bearing joints. Being overweight also elevates levels of inflammatory chemicals.

Gender and race also play a role. Knee OA is 1.7 times more common in women, and erosive OA is 12 times more common. Women also are more likely than men to develop OA in their finger joints. OA generally is more common in Native American people than in other groups, but knee OA is most common in African-American women.

Joints are resilient structures, but consistent overuse of a joint raises the risk of OA. Athletes and people who frequently engage in leisure activities that increase the stress on certain joints are more likely to develop OA. The same is true in people with occupations that require repetitive movements and/or heavy lifting.

At least nine additional factors raise the risk of OA. These are:

• Inactivity. Chronic inactivity is associated with being overweight and obese. Both increase the load on joints. Less physical activity causes stiffness, especially in the knees, and stiffness is an early symptom of OA.
• Smoking. People who smoke experience increased inflammation, cartilage loss, and pain.
• Sex hormones. In women, low estrogen levels are associated with an increased risk of OA, as are low testosterone levels in men.
• Genetics. If you have a strong family history of OA, you may have a gene defect that impacts collagen, which is the main structural protein in bones, cartilage, and soft tissue.
• Injury. Any injury to the joint, especially if it results in deformity.
• Anatomy. Structural abnormalities may put unusual loads on joints.
• Other joint disorders. Gout and pseudogout (covered in Chapter 5), congenital dislocation of the hip, and previous RA or infections make joints more susceptible to OA.
• Bone diseases, such as Paget’s disease (abnormal bone metabolism) and avascular necrosis (lack of blood supply to the bone).
• Other conditions. People with type 2 diabetes have an increased risk of OA in the weight-bearing joints and hands. Other health issues that are associated with OA include the blood disorders sickle cell disease and thalassemia, and acromegaly, a rare condition that results from too much growth hormone.

Osteoarthritis Symptoms

OA initially manifests as stiff joints in the morning, and/or aches and pains after strenuous exercise. Over time, these symptoms become more noticeable—the pain intensifies, range of motion in the joint decreases, and swelling occurs. You also may notice crepitus: cracking, clicking, and popping noises in the joint.

Most people with OA have symptoms that do not affect quality of life—for example, in a study of 714 people with OA, only one in 10 had severe OA, compared to four in 10 with moderate OA and five in 10 with mild OA. Among study participants age 65 and older, two in 10 had severe OA, five in 10 had moderate OA, and three in 10 had mild OA. Those unfortunate enough to develop severe OA may find that their ability to function is significantly impaired in some or all areas of life.

Joints Affected by Osteoarthritis

OA is most likely to affect weight-bearing joints, such as the spine, hips, and knees. The shoulders also are vulnerable because their extensive range of motion makes them susceptible to injuries that increase the risk of OA. The disease also can affect the hands, wrists, feet, and ankles, probably because we use these joints constantly.

Shoulders: Crepitus Is Common

OA in the shoulder causes significant difficulty performing everyday tasks such as dressing, brushing your hair, reaching to get things from cabinets, and driving. Crepitus is most likely to accompany shoulder OA.

Hands: Pain, Stiffness, Weakening

Pain and stiffness are early symptoms of hand OA. Instability and deformity occur later, along with a weakening of the grip that makes it increasingly difficult to perform fine motor tasks, such as writing and opening jars. Bumps may develop on the bone ends.

Spine: Nerve Impingement a Risk

The lumbar spine (lower back) and cervical spine (neck) are particularly vulnerable to OA. Pain may occur in the neck and radiate to the shoulders and arms. Pain in the lower back may radiate to the buttocks and legs. Neck movements may become restricted, and the whole back may appear stiff and inflexible.

In severe cases, nerve impingement—pressure on a nerve caused by bone or soft tissue—occurs. This may be of slow onset, causing weakness, radiating pain, and sensory loss in the arm or leg, or it may manifest as a sudden and acute episode of severe pain and loss of function. Sciatica is a common form of nerve impingement in which pain travels along the path of the sciatic nerve, causing one-sided pain in the lower back, hip, buttock, and leg.

Hips: Radiating Pain

Hip OA causes pain that radiates to the buttocks and even the knees. Other symptoms include an unusual gait or limp, difficulty bending, groin pain upon standing, and difficulty with rotational movements, like getting in and out of a car. The hip may feel stiff, and internal rotation (the ability to roll your knee inward) may be limited.

Knees: Prone to Erosion

The knee joint is particularly susceptible to OA because of the load it supports. Joint effusion (excess fluid) and popliteal cysts (also known as Baker’s cysts, these swellings occur behind the knee) add to the problem. Late in the process, the knee may become unstable and deformed to the extent it deviates outward or inward.

Feet and Ankles: Stiffness Impacts Walking

OA pain and stiffness in the ankle and foot make walking more difficult as the disease progresses. The bones in the mid-foot and ankle are particularly prone to OA, especially the joint of the big toe, where a bunion may develop. A bunion is a bony deformity that forms when the joint becomes diseased. Because of friction from footwear, bunions often get inflamed and may cause significant pain. Lateral deviation of the big toe (movement toward the outside of the foot) also can push the other toes out of alignment, causing deformity.

Osteoarthritis Beyond the Joints

A 2017 study found that people with OA have a 24 percent greater risk of cardiovascular disease than people who don’t have OA. The reason for the link is not clear, but some experts suggest it may be due to the fact that nonsteroidal anti-inflammatory drugs (NSAIDs)—which many people with OA take to ease pain—raise cardiovascular risk. Being overweight or obese also raises cardiovascular risk, and many people with OA fall into these categories due to the fact that they find it painful to burn calories through exercise.

Diagnostic Tests for Osteoarthritis

There is no definitive test for OA, and it may mimic other forms of arthritis. To diagnose what is causing your symptoms, your doctor will take a medical history, conduct a physical exam, and order various tests. The diagnosis of arthritis is discussed in depth in Chapter 2, but here is a brief review of the testing methods:

• Blood tests. There are currently no blood tests for OA, but tests to rule out other causes of arthritis may be useful. Blood tests likely will assess your erythrocyte sedimentation rate (to determine the presence of inflammation), and check your levels of C-reactive protein and rheumatoid factor.
• Imaging tests. Subtle joint abnormalities may be seen on an x-ray before OA symptoms occur. Signs suggestive of OA include narrowing of the space between the bones in a joint, thickening or thinning of the bone, and the development of osteophytes and bone cysts. Magnetic resonance imaging (MRI) may be ordered to determine the level of soft tissue damage, while ultrasound is helpful in identifying inflammation and can help guide joint aspiration or injection. Computed tomography may be ordered to further assess bony abnormalities seen in other imaging tests.
• Arthrocentesis. Aspiration of the synovial fluid in a joint can be useful in OA because it helps exclude other causes that might benefit from specific treatment—for example, RA, gout, and infection. You may feel some temporary relief after the aspiration, due to a reduction in fluid pressure.

Osteoarthritis Treatment

The goals of OA treatment are to reduce pain and inflammation, and improve joint function. If you have mild-to-moderate OA, your treatment regimen will likely involve a combination of lifestyle changes, pain medication, and complementary approaches. In severe OA, joint surgery may be advisable.

Lifestyle: Weight, Physical Activity

If you are overweight or obese, you may find that losing weight relieves your OA symptoms. A 2018 study in Arthritis Care & Research concluded that people with knee OA should be encouraged to lose up to 20 percent of their body weight if they are overweight or obese.

You also should aim to get as much physical activity as possible. In early OA, exercise may help preserve cartilage (see “Exercise Helps Prevent Degradation of Cartilage”). Once OA has progressed, you may not feel like giving painful joints a workout. However, regular exercise can help preserve your range of motion. Choose exercises that do not aggravate your symptoms, such as walking, swimming, or gentle yoga.

If you are not sure of how to exercise without aggravating your symptoms, ask your doctor to refer you to a physical therapist who can work with you to devise an individualized exercise program.

Medications: Start with Acetaminophen

There has been some investigation into whether certain drugs that are used to treat RA also might relieve pain and disease progression in OA, but research is ongoing. In lieu of clarification on this, most people with OA are advised to relieve their pain with acetaminophen (Tylenol). Keep track of how much of the drug you are taking—acetaminophen is an ingredient in many over-the-counter cold and flu medications, and it is all too easy to inadvertently overdose on it.

If acetaminophen does not provide you with sufficient pain relief, discuss with your doctor whether you should add NSAIDs, such as ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn), to your medication regimen.

Keep in mind that oral NSAIDs are associated with serious side effects, including gastrointestinal bleeding and a raised risk of high blood pressure and heart attack. In older adults, they should be used at the lowest effective dose. Topical NSAIDs also are available, and research suggests that these may be less likely to cause side effects.

Check with your doctor about possible drug interactions if you take other medications. The American Society of Health-System Pharmacists website also has information regarding OA medications (see the Resource on page 79).

Injectable medications for OA include hyaluronic acid. Hyaluronic acid is a key component of the fluid that lubricates joints, but it may be lacking in OA-affected joints. In a procedure called viscosupplementation, a manufactured version of hyaluronic acid is injected into the joint space to provide temporary (typically up to six months) lubrication and pain relief in the joint (see “Hyaluronic Acid Injections Reduce Pain and Improve Function”).

The hyaluronic acid used to make viscosupplements may be derived from rooster combs (the fleshy red growth on a rooster’s head), and people with an allergy to poultry and eggs may not be able to receive this formulation. Newer synthetic formulations are available.

Nerve-Based Treatment: Long-Lasting Relief

For people with knee OA who can’t have or don’t want surgery, nerve blocks can provide almost immediate pain relief that may last for several months. The procedure, which can be done in a doctor’s office, involves injecting an anesthetic drug into at least three nerves that provide sensation to the knee joint.

Complementary Alternatives: Increasingly Popular

Many people with OA report that complementary therapies, such as acupuncture, massage, and spinal manipulation, help alleviate OA pain. A 2018 study found that therapeutic massage may relieve the symptoms of knee OA.

You also may wish to try a glucosamine/chondroitin supplement. Glucosamine and chondroitin are normal components of cartilage, and many people report that taking them in supplement form improves their OA symptoms. Research has been promising for decades, but is still not conclusive.

Other drug-free pain relief options include the application of heat or cold packs. A knee brace or hand/finger splints also may help by supporting and immobilizing affected joints.

If you decide to use complementary approaches to treat your symptoms, be sure to notify your physician. Research suggests that many people do not keep their doctor informed about this. However, it is a wise precaution, particularly if you are using herbal remedies that may interact with conventional medications.

See Chapter 10 for detailed information on a range of complementary treatment approaches that may ease OA.

Surgery: Last Resort

Joint surgery or replacement may be your best option if your symptoms are no longer relieved by lifestyle approaches, standard pain-relieving drugs, or complementary approaches. Surgery also may be considered if OA symptoms are affecting your ability to carry out activities of daily living and/or disturbing your sleep.

While surgery may seem like an extreme choice, most people with OA have excellent outcomes. See Chapter 8 for more information.

The post 3. Osteoarthritis appeared first on University Health News.

I have hypermobile Ehlers-Danlos Syndrome, one of 13 types of this condition that affects connective tissues. It leaves me in chronic pain with hypermobile joints that are prone to dislocations. To help me stay stable, I often use a variety of aids—from wrist, elbow, knee, and ankle braces to a sling, crutches, or a cane. In the past six years, I’ve undergone five surgeries to help tighten ligaments and repair tears.

Ehlers-Danlos Syndrome is an invisible disease, which means those who suffer from it look “fine” on the outside. Behind the chronic pain and dislocations, many feel this is the toughest part about living with EDS. Because we look healthy, our symptoms are often disregarded or shrugged off as inconsequential. The result: It can take years (26 for me, up to 60 for others) to procure a diagnosis.

What exactly is Ehlers-Danlos Syndrome, and is it curable? Read on to learn more.

What Is Ehlers-Danlos Syndrome?

Ehlers-Danlos syndromes are a group of 13 inherited disorders that affect connective tissues (collagen, in particular). Think of these tissues as a form of glue. They provide strength and support to our skin, bones, digestive system, blood vessels, and other organs. They also support the tissues (i.e., ligaments, cartilage, and tendons) in and around our joints.

In a person with EDS, the connective tissues are extremely loose, meaning they don’t hold things as stable as they should, leaving them able to stretch far beyond the normal range. The result: frequent dislocations, subluxations (partial dislocations), torn ligaments and tendons, chronic pain, fatigue, instability and, sometimes, life-threatening complications such as the rupture of large arteries.

Those suffering from EDS most often present with soft, stretchy, easily-bruised skin, hypermobile joints, and poor wound-healing. While symptoms overlap for the various types, it would be extremely rare for a person to suffer from more than one form of the condition.

Our author, Shandley McMurray, following shoulder stabilization surgery. Most people with Ehlers Danlos Syndrome are so hypermobile they suffer from frequent subluxations and dislocations which can cause other damage such as torn tendons.

Ehlers-Danlos Syndrome Affects Multiple Parts of the Body

The effects of Ehlers-Danlos Syndrome can be multi-systemic, which means shoddy connective tissues can cause problems in various parts of the body. Everything including the eyes, jaw, heart, gut, mouth, joints, spine, and skin can be affected. Other complaints include (but are not limited to) sleep problems, chronic pain, neurological issues, and chronic fatigue.

Ehlers-Danlos Syndrome Is Linked to Other Conditions

Since connective tissues exist in our skin and internal organs, some people with EDS suffer problems in their gastrointestinal systems, bladder, and autonomic nervous system (the control system that monitors such functions as our heart rate, digestion, and respiratory rate).

Many of those with EDS also suffer from comorbidities (the presence of two or more chronic diseases at a time) such as postural orthostatic tachycardia syndrome (POTS), psoriasis, chronic migraines, rheumatoid arthritis, Reynaud’s disease, chronic fatigue syndrome, and fibromyalgia, although more research is needed to prove the connection between these conditions and EDS.

Ehlers-Danlos Syndrome Is Genetic

EDS is highly heritable, which means it’s passed down through families. Those with the condition have a 50 percent chance of gifting it to their kids. Each affected relative experiences his or her own unique symptoms, which can vary from mild to severe.

It’s extremely unlikely to pass a different type of the disease down the line. For instance, people with hypermobile EDS will not pass vascular EDS to their children.

Who Has Ehlers-Danlos Syndrome?

According to the Genetics Home Reference, Ehlers-Danlos Syndromes affect 1 in 5,000 people worldwide. Hypermobile EDS (referred to as hEDS) is the most common form, affecting between 1 in 5,000 to 20,000 people. The classical type of EDS targets 1 in 20,000 to 40,000 people. That said, EDS is gravely underdiagnosed, likely due to a lack of knowledge and understanding about this condition in the medical profession, so actual numbers may be much higher.

In a recent paper published in the American Journal of Medical Genetics, researchers stated, “The hypermobile type of Ehlers-Danlos syndrome (hEDS) is likely the most common systemic inherited connective tissue disorder in humans.” They also claimed that hEDS affects 255 million people worldwide, 10 million of whom live in the US.

How is Ehlers-Danlos Syndrome Treated?

“Ehlers-Danlos Syndrome is managed by treating the individual symptoms, such as pain. Patients often need to see a variety of doctors including an orthopedic surgeon, rheumatologist and dermatologist,” explains Dr. Leonaura Rhodes, a Connecticut-based physician, contributor to University Health News and fellow EDS sufferer.

Since EDS affects so many parts of the body, each symptom must be treated separately. Physiotherapy is important to strengthen muscles around the joints to reduce the risk of dislocations. In some cases, surgery is also advisable to repair and possibly tighten damaged joints. Surgery can be risky for those with EDS due to poor wound-healing, excessive scarring, and the high risk of arterial rupture, so it should be considered carefully with the help of a medical practitioner who is well-versed in the condition.

Altering a person’s nutrition regimen can be beneficial for those suffering from gastrointestinal complaints and can help reduce joint pain and inflammation. Pain medications can also be useful, but it’s important to see a medical professional to find out which meds work best. It may be essential to avoid contact sports such as rugby, hockey, and football.

Is There a Cure for Ehlers-Danlos Syndrome?

There is currently no cure for EDS. Treatments such as physical therapy, targeted exercises, and pain relief medication can help manage symptoms.

How Is Ehlers-Danlos Syndrome Diagnosed?

Diagnosing EDS is no breeze. “Although there is a wealth of information easily accessible, it can still take a very long time [often more than 20 years] before the penny drops and someone recognizes the diagnosis and points the individual in the right directions for help,” says Dr. Alan J. Hakim, a London-based rheumatologist and acute physician as well as guru in the EDS field. “Even then, there can be reluctance among some—family members and medical personnel alike—to acknowledge the syndrome, the depth and breadth of its insult, and the psychosocial impact on an individual’s well-being.”

In March 2017, an international consortium of more than 90 EDS experts published new diagnostic criteria along with management and care guidelines in the American Journal of Medical Genetics. Diagnosis now includes measuring the hypermobility of multiple joints based on the Beighton Score (a 9-point system that measures joint laxity and hypermobility), discovering an immediate family history of the disorder, and finding widespread symptoms throughout the body, among other qualifications.

The post Ehlers-Danlos Syndrome: “The Most Neglected Disorder in Modern Medicine” appeared first on University Health News.

More than 30 percent of people age 65 and older are diagnosed with OA. However, 50 percent show signs on x-ray, suggesting that the condition is underdiagnosed.

What Happens in Osteoarthritis?

Just like any finely tuned machine, the articular surfaces of joints experience considerable friction over time. Wear and tear is the result, and for many years this was thought to be the main cause of OA. But experts now believe that OA is more than a purely mechanical condition, and that the process underlying the disease is more complicated, and may be triggered by inflammation.

In the early stages of OA, microscopic cracks appear in the cartilage. Early changes also occur in the synovial fluid, subchondral bone (the bone beneath the cartilage), the joint capsule, and other soft tissue. Chondrocytes (cells that produce and maintain cartilage) attempt to counteract this process by increasing the production of growth factors that remodel the cartilage. In later stages, however, this repair mechanism fails and the cartilage becomes soft and irregular, especially in load-bearing joints like the knees.

Eventually, areas develop where there is complete erosion of the cartilage, and the space between the bones in a joint becomes so narrow that bone grates against the opposing surface, leading to bone erosion and deformity. The stressed bone responds with a proliferation of cells and blood vessels, resulting in thicker bone in the damaged area. Cysts also may develop. The synovial membrane calcifies, and irregular bony spurs called osteophytes grow at the edges of the bone. Pieces of osteophyte and damaged cartilage are prone to breaking off and floating into the joint as intra-articular loose bodies.

The progression of OA is extremely variable and unpredictable. Some patients experience slow disease progression, requiring only simple interventions, such as painkillers and exercise. People with multiple risk factors tend to experience more aggressive disease that causes significant joint damage and disability. There also is some evidence that OA may be associated with a greater risk for cardiovascular disease—although the link is not as strong as it is for rheumatoid arthritis (RA)—and that it causes premature death in some people (see “Osteoarthritis and Premature Death”).

Osteoarthritis Risk Factors

The main risk factor for OA is age. The condition is rare in people age 30 and younger. Conversely, it is estimated that at least one in three adults age 65 and older have a diagnosis of OA, while many more have early signs on x-ray but are currently asymptomatic. The association with advancing age may be linked to the fact that cartilage naturally becomes less effective with age, due to declining protein levels and a lower blood supply.

Your weight also is key—the more weight you carry, the more stress you place on load-bearing joints (the ankles, hips, knees, and spine). Being overweight also elevates levels of inflammatory chemicals, such as interleukin-1, within the joint. Inflammation triggers the secretion of enzymes by cells in the synovial membrane and by chondrocytes, which causes cartilage breakdown.

Gender and race factor in too. For example, knee OA is 1.7 times more common in women, and erosive OA is 12 times more common. Women also are more likely than men to develop OA in their finger joints. OA generally is more common in Native American people than in white or black people, but knee OA is most common in black women.

Joints are pretty resistant, but consistent high usage of a joint raises the risk of OA. This means that athletes and people who frequently engage in leisure activities that increase the stress on certain joints are more likely to develop OA, as are people who work in occupations that require repetitive movements and/or heavy lifting. Any joint that has undergone surgery also is at increased risk.

Other potential underlying causes of OA include:

• Smoking. People who smoke experience increased inflammation, cartilage loss, and pain.
• Inactivity. Fascinating 2017 research on historical skeletal remains shows that OA incidence has doubled since World War II. The researchers hypothesized that it is not just because we are living longer and tend to be heavier, but also because many of us are chronically inactive today.
• Sex hormones. In women, low estrogen levels are associated with an increased risk of OA, as are low testosterone levels in men.
• Genetics. Mounting research suggests that multiple gene variations increase the risk of OA (especially variations in genes involved with metabolic diseases like diabetes). Scientists also have identified more than 1,700 gene variations associated with increased severity of OA. If you have a strong family history of OA, you may have a gene defect that impacts collagen (the main structural protein in bones, cartilage, and soft tissue).
• Injury. Any injury to the joint, especially if it results in deformity, increases friction and susceptibility to OA.
• Anatomy. Structural abnormalities put unusual loads through the joint.
• Other joint disorders. Gout, pseudogout, congenital dislocation of the hip, and previous RA or infections make joints more susceptible to OA.
• Bone diseases, such as Paget’s disease (abnormal bone metabolism) and avascular necrosis of the bone (lack of blood supply).
• Other medical conditions. People with type 2 diabetes have an increased risk of OA not just in the weight-bearing joints, but also in the hands. Other disorders that are associated with OA include the inherited blood disorders sickle cell disease and thalassemia, and acromegaly, a rare disorder that results from too much growth hormone.

Osteoarthritis Symptoms

The onset of OA is usually slow and subtle. It may begin with stiff joints in the morning, and/or aches and pains after strenuous exercise. Over time, these symptoms become more noticeable—the pain intensifies, range of motion in the joint becomes restricted, and swelling occurs. You also may notice a phenomenon called crepitus: cracking, clicking and popping noises in the joint.

While pain is the dominant symptom in OA, cartilage does not have nerves to create pain signals. Instead, pain occurs due to a combination of factors:

• Synovial membrane inflammation (synovitis) or stretching
• Osteophytes (bony spurs) impinging on soft tissue
• Elevated pressure in the bone due to proliferation of cells and blood vessels
• Effusion (excess fluid), which stretches the joint capsule
• Inflammation of the bursae
• Loose intra-articular bodies
• Torn menisci (wedges of cartilage between the thigh bones and shin bones)
• Muscle fatigue or spasm
• Crepitus
• Joint contracture, in which the soft tissue (muscle, tendon, ligaments, joint capsule) becomes hard and shortened, leading to rigidity and deformity of the joint. In extreme cases, the joint practically fuses, making movement very painful
• Nerve compression in the lower back caused by spinal stenosis (narrowing of the spinal canal) or spondylolisthesis (slippage of vertebrae)
• Psychological distress and chronic changes in the brain that exacerbate and prolong the experience of pain.

For the majority of people with OA, the symptoms remain a minor nuisance and quality of life is not affected. In one study looking at 714 people with OA, only one in 10 of those age 45 to 64 had severe OA compared to four in 10 with moderate OA and five in 10 with mild OA. In study participants age 65 and older, two in 10 had severe OA, while five in 10 had moderate OA and three in 10 had mild OA. Those unfortunate enough to develop severe OA symptoms may find that their ability to function is significantly impaired in some or all areas of life.

Which Joints Are Affected by Osteoarthritis?

OA is most likely to affect weight-bearing joints like the spine, hips, and knees. The shoulders also are vulnerable because their extensive range of motion makes them susceptible to injuries that increase the risk of OA. The disease also can affect the hands, wrists, feet, and ankles, likely because we use these constantly.

Osteoarthritis in the Spine

The spine works hard to keep the body erect and stable, and all that effort takes its toll. The lumbar spine (lower back) and cervical spine (neck) are particularly vulnerable to OA. Pain may occur in the neck radiating to the shoulders and arms, and in the lower back radiating to the buttocks and legs. Neck movements may become restricted and clunky. The whole back may appear stiff and inflexible.

In severe cases, nerve impingement—pressure on a nerve caused by bone or soft tissue—occurs. This may be of slow onset, causing weakness, radiating pain, and sensory loss in the arm or leg, or may manifest as a sudden and acute episode of severe pain and loss of function. Sciatica is a common form of nerve impingement in which pain radiates along the path of the sciatic nerve, causing one-sided pain in the lower back, hip, buttock, and leg.

Osteoarthritis in the Hip

The hip is commonly affected by OA that causes pain that radiates to the buttocks and even the knees. Other symptoms include an unusual gait or limp, difficulty bending, groin pain upon standing, and difficulty with rotational movements, like getting in and out of a car. The hip may feel stiff and clunky, and internal rotation (the ability to roll your knee inward) may be limited.

Osteoarthritis in the Knee

The knee joint bears a lot of strain, and this makes it particularly susceptible to OA. It is prone to cartilage erosion, osteophyte and loose body formation, joint space reduction, and bone damage. Joint effusion and popliteal cysts (also known as Baker’s cysts, these swellings occur behind the knee) add to the problem. Late in the process, the knee may become unstable and deformed to the extent that it deviates outward (varus) or inward (valgus).

Osteoarthritis in the Shoulder

You don’t realize how much you use your shoulder until it is painful and stiff. OA in the shoulder causes significant difficulty performing everyday tasks such as dressing, brushing your hair, reaching to get things from cabinets, and driving. Crepitus is common in shoulder OA.

Osteoarthritis in the Hands

Certain joints in the hands are more prone to OA. The most commonly affected are the distal interphalangeal (DIP) joints, followed by the carpometacarpal (CMC) joints, and then the proximal interphalangeal (PIP) joints.

Pain and stiffness is usual early on in hand OA. Instability and deformity occur later, along with a weakening of the grip that makes it increasingly difficult to perform fine motor tasks, such as writing and opening jars. Hypertrophic bony bumps may develop on the bone ends—at the DIP they are known as Heberden’s nodes, at the PIP as Bouchard’s nodes. At the CMC, they have no nickname.

Osteoarthritis in the Foot and Ankle

OA pain and stiffness in the ankle and foot make walking more difficult as the disease progresses. The bones in the mid-foot and ankle are particularly prone to OA, especially the metatarsophalangeal (MTP) joint of the big toe, where a bunion may develop. A bunion is formed when the MTP joint becomes diseased and lateral deviation of the big toe occurs. Because of friction from footwear, bunions often get inflamed and may cause significant pain. Lateral deviation of the big toe also can push the other toes out of alignment, causing deformity.

Osteoarthritis Beyond the Joints

Studies into possible links between OA and cardiovascular disease have produced mixed results. But one 2017 study found that people with OA have a 24 percent greater risk of cardiovascular disease than people who don’t have OA. It is unclear what underpins the link, but some experts suggest it may be due to the fact that nonsteroidal anti-inflammatory drugs (NSAIDs)—which many people with OA take to ease pain—raise cardiovascular risk. Being overweight or obese also raises cardiovascular risk, and many people with OA fall into these categories due to the fact that they find it painful to exercise.

Diagnosing Osteoarthritis

There is no definitive test for OA and it may mimic other forms of arthritis. In order to diagnose what is causing your symptoms, your doctor will take a medical history, carry out a physical exam, and order various tests. The diagnosis of arthritis is discussed in depth in Chapter 2, but let’s briefly review the tests and imaging methods your doctor may use:

• Blood tests. There are currently no blood tests for OA, but tests to rule out other causes of arthritis may be useful. Your blood tests will likely assess your erythrocyte sedimentation rate and check your levels of C-reactive protein and rheumatoid factor.
• X-rays. Subtle joint abnormalities may be seen on an x-ray before OA symptoms occur. Signs suggestive of OA include joint space narrowing, thickening or thinning of bone, osteophytes, and bone cysts. It may seem counterintuitive, but symptoms and x-ray findings often do not match: A joint that looks very abnormal in an x-ray may cause little in the way of symptoms and loss of function.
• Magnetic resonance imaging (MRI). MRI may be ordered to determine the level of soft tissue damage, including cartilage damage and loss in advanced disease.
• Ultrasound. An ultrasound may be helpful in identifying inflammation and joint damage, and can help guide joint aspiration or injection.
• Computed tomography (CT) scan. A CT scan may be ordered occasionally to further assess bony abnormalities.
• Arthrocentesis. Aspiration of the synovial fluid in a joint can be useful in OA, as it helps exclude other causes that might benefit from specific treatment—for example, RA, gout, and infection. Patients may feel some temporary relief after the aspiration, due to a reduction in fluid pressure.

Osteoarthritis Treatment

The aims of OA treatment are to reduce pain and inflammation and improve function. The methods used to achieve these aims will depend on how your OA progresses. Your primary-care physician will likely oversee your care if you have mild-to-moderate arthritis, and, if necessary, you will be referred to a rheumatologist. If you progress to severe OA, you may need to consult an orthopedic specialist.

If you have mild-to-moderate OA, your treatment regimen will likely involve a combination of lifestyle changes (see Chapters 8, 9, and 11 for more), and pain medication (covered in Chapter 6). Many people with mild-to-moderate OA also gain relief through complementary approaches (see Chapter 10). If your OA symptoms become severe, you may need to think about joint surgery or joint replacement (both covered in depth in Chapter 7).

Lifestyle Changes

If you are overweight or obese, you may find that losing weight relieves your OA symptoms (see “Weight Loss Reduces the Impact of Knee Osteoarthritis”).

You also should aim to get as much physical activity as possible. While you may not feel like giving painful joints a workout, regular exercise can help preserve your range of motion. The “no pain, no gain” approach does not apply here: Choose exercises that do not aggravate your symptoms (examples include walking or gentle yoga). If you are at all unsure about how best to exercise without aggravating your symptoms, ask your doctor to refer you to a physical therapist who can devise an individualized exercise program for you (see Chapter 8 for more).

Osteoarthritis Medication

Start with acetaminophen (Tylenol) and, if necessary, add in NSAIDs, such as ibuprofen (Advil, Motrin) and naproxen (Aleve). Where NSAIDs are concerned, check with your doctor about possible drug interactions if you take other medications (you also can check via the American Society of Health-System Pharmacists website—see the Resources section at the back of this report). Also keep in mind that NSAIDs are associated with serious side effects, including gastrointestinal bleeding, in older adults. This means they should be used at the lowest effective dose.

There has been some investigation into whether some of the drugs used to treat RA also might relieve pain and disease progression in OA, but research is ongoing (see “Hydroxychloroquine Ineffective for Osteoarthritis in the Hand”).

Another option for mild-to-moderate OA is viscosupplementation. A joint affected by OA may lack hyaluronic acid, a key component of the fluid that lubricates joints. Viscosupplementation involves injecting a manufactured version of hyaluronic acid into the joint space to provide temporary (typically up to six months) lubrication and pain relief.  

The Food and Drug Administration has approved viscosupplementation to treat knee OA only, but some people find it helpful for hip and ankle disease. The hyaluronic acid used to make viscosupplements may be derived from rooster combs, and people with an allergy to poultry and eggs may not be able to receive this formulation. However, newer synthetic formulations are available.

Complementary Pain Relief for Osteoarthritis

Many people with OA report that complementary therapies such as acupuncture, massage, and spinal manipulation help alleviate OA pain. You also may wish to try a glucosamine/chondroitin supplement. Glucosamine and chondroitin are normal components of cartilage, and many people report that taking them in supplement form improves their OA symptoms although the research is not conclusive.

Other drug-free pain relief options you may want to try include the application of heat or cold packs. A knee brace or hand/finger splints also may help by supporting and immobilizing the affected joint.

Joint Surgery or Replacement

If your OA symptoms are no longer relieved by lifestyle approaches, standard pain-relieving drugs, and complementary approaches, and if they’re affecting your ability to carry out activities of daily living and/or disturbing your sleep, joint surgery or replacement may be your best option. While surgery may seem like an extreme choice, most people with OA have excellent outcomes following surgery. The best type of surgery for you will depend on what type of arthritis you have, your age, and your general health—see Chapter 7 for more.

Ongoing Osteoarthritis Research

The search is underway for a definitive test for OA and for tests to determine who is at risk of aggressive disease. Biomarkers and genetic tests are hopeful avenues of investigation, and researchers also are investigating certain markers that may identify which OA sufferers are most likely to need joint-replacement surgery.

When it comes to OA treatment, scientists are studying whether inhibiting certain nerve-growth factors (proteins the body releases when inflammation is present) may relieve OA pain. Progress also is being made toward finding drugs that slow and possibly even reverse the erosion of cartilage that occurs in OA.

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