One of my favorite health tips drives my friends nuts when I start preaching about juicing!
Do you have enough time in your day to eat all the recommended fruits and vegetables that will keep you healthy and happy???
It's not easy! But my personal solution is MY JUICE MACHINE!
Look into getting a juicer for your own health boost! A juice machine is the best investment you can make for your health and happiness!
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A recommended 30-minute minimum of daily activity is the norm. Before starting any exercise program, it is vital that one speak to their doctor to ensure there are no unseen risks, however you will find that most doctors recommend exercise for their arthritis patients either on their own initiative or when asked. The types of exercises suggested vary; however, with all types of exercise the warm-up is the starting point. Warming up is best started with applying warm compresses to the joints, followed by mild stretching. Range of motion exercises, such as dance, are a very good start, as are low-impact aerobics. These can relieve stiffness and increase flexibility.
Never discount the effectiveness of walking as an exercise. Walking is a great exercise to improve the arthritic condition, and carrying weights as light as one pound and using your arms as you walk can involve the whole body. The "trick" is to make walking interesting enough as an exercise to stay motivated. Try walking in different settings, alternating walking with dance on different days, and of course including a partner can be much more interesting than going at it alone.
If you still want more variety, you may want to try yoga. Yoga is a general term for several stretching, and pose-oriented exercises originating in India, and is extremely beneficial toward achieving flexibility and reducing stress physically and mentally. There are gentle forms of yoga such as Hatha Yoga that are excellent to start with. Hatha Yoga comprises of gentle stretches and simple poses that help flexibility and balance, and are easy to learn and enjoy. Check your local activities paper or section of your local paper to see if there are any yoga classes near you.
Even when you cannot make it out to walk or to an aquatics or yoga class, there are exercises you can do daily to improve flexibility, strength and conditioning. You can flex your legs while sitting in a chair facing forward, simply by moving your leg outward while keeping your foot on the floor and holding it there for a few seconds, then retracting it until your foot is behind you, then alternating to the other leg. Interlocking your fingers and slowly flexing your wrists to the left and the right for a few minutes a day can help tremendously to increase flexibility and reduce pain in the wrist area.
For your upper back, you can stand upright in front of a table, then lean over and place your hands on the table and tuck your chin back toward your collarbone. Once positioned as such, lift your upper back upward and simultaneously take a deep breath. Hold that position for 5-10 seconds and then relax while exhaling. While doing this, lower your spine slowly as you move both shoulder blades forward as if toward each other. Repeat this exercise for 10-15 repetitions. For the shoulders and middle back, start again from an upright position standing as straight as you can, reach back and lock the fingers of both hands together. Breathe slowly and deeply and lift upward with your shoulders while at the same time, exhaling. Be sure to keep your chest up and your chin in. Repeat this for about 10-15 sets.For the shoulders and upper chest, choose a free corner of the room to stand in and place your hands on the opposite sides of the corner. Take a step back about 18 inches from the corner. You now should be facing the corner directly with your hands on both of the walls with your body some distance from the wall itself. Keeping your chest up after inhaling, lean in toward the corner while exhaling. Repeat this exercise for 10-15 sets.
Whatever exercise program you choose, be sure to breathe properly when exercising. Oxygenation is important to any exercise regimen as it promotes a healthy heart rate and reduces fatigue; additionally oxygenation helps circulation, which is vital to achieving the flexibility and strength that you are trying to achieve in battling arthritis. Also, listen to your body. It is natural to feel a little fatigue and soreness when starting a new exercise regimen, However if the pain of soreness persists for more than one hour, or you have a decrease in mobility that lasts longer than an hour, then the regimen should be reduced until the soreness desists.Also, look for signs of increased swelling of joints or any persistent increase of weakness; these are signs of activities that are too strenuous and a reduction in activity will be necessary. Just remember to take all new exercise regimens slowly at the start. The idea is to increase flexibility not train for the Olympics.
There are three main types of exercises to include in a basic exercise program:
Range-of-motion exercises - These lessen stiffness and help with improving flexibility. "Range of motion" refers to the area within which the joints move naturally or on a daily basis. Although these range-of-motion exercises can be performed every day, it is recommended that they be done at least every other day.
Strengthening exercises - There are two types of strengthening exercises; isometric or tightening the muscles without moving the joints, and isotonic, moving of the joints for strengthening muscle movements. It is recommended to do these sets of exercises every other day, unless you are suffering from more than mild joint pain or swelling.
ndurance exercises - The objective of these is to increase stamina. They also help with improving your inner personal / mental strength and with improving weight control and sleep. Some of the most popular endurance exercises are stationary bike riding, walking and water exercising. And unless you are suffering from more than mild joint pain or swelling, a 20- to 30-minute workout or two to three short 10-minute bouts during the day is what is recommended, an average of three times each week. Be kind to your body, and it will be kind to you.
Arthritis Exercise Tips Let's sum up arthritis exercise with a few tips for all:
- Establish your own unique, exercise program so that it meets you personal health needs, budget and environment. Make sure it is safe by checking with your own professional healthcare advisor and workout trainer. And take it slow and steady like Aesop's turtle in the race.
- Be kind to yourself. Stop if something hurts. And experiment with applying heat before exercising and warming up. Then cool off afterwards with cold packs.
- Enjoy exercising by making it a real part of your life during the week. Include range-of-motion, strengthening and endurance exercises in your routines. And vary your activities; try a new class at a health club one quarter. Next time, go elsewhere or join a naturalist group for weekly hikes in local parks. Keep an active folder with pockets of gyms and health clubs near you with their schedules and up-dated classes and coupon specials. And check newspapers, local bulletin boards, postings at the gyms and clubs, etc. for healthy activities like walk-a-thons and bike-a-thons for nonprofits and evening / weekend hikes in which you can participate. You'll meet new friends, have fun, get out more and exercise all at the same time.
- Exercise activities are available all around you, too. No need to spend time and money elsewhere. You can borrow exercise videos, cassettes, DVDs and books from public libraries. You can get active by washing windows, cleaning your house, car, pet, children's closets, your closets, anything...You can even earn money doing activities like walking and distributing flyers, local newspapers and coupons (check with companies who place these in and around your mailbox and door - -they often need help).
As always, before you attempt to self medicate or try a new health regimen or program we suggest you retain the services of a qualified health care professional.
The Burden of Arthritis
According to the Centers for Disease Control and Prevention (CDC), self-reported doctor-diagnosed arthritis collectively affects nearly 43 million Americans--or about 1 in 5 adults. Another 23 million have chronic musculoskeletal symptoms that suggest they, too, may have arthritis. This makes arthritis one of the most common illnesses in the United States and a leading cause of disability. As the population ages, the CDC says that the number of Americans affected will increase dramatically.
Each year, arthritis results in 750,000 hospitalizations and 36 million outpatient visits.
"People ignore arthritis both as public and personal health problems because it doesn't kill you," says Capt. Charles G. Helmick, M.D., a medical epidemiologist at the CDC. "But what they don't realize is that, as people work and live longer, arthritis can affect their quality of life and lead to limitations in activities and work and eventually disability."link to long descriptionArthritis limits everyday activities for 8 million Americans, according to statistics compiled by the CDC. In 1997, medical care for arthritis cost over $51 billion. The disease affects people of all ages. Nearly two-thirds of those with arthritis are younger than 65. Arthritis may affect people of all racial and ethnic groups. It is more common among women and older Americans.
Arthritis symptoms include joint pain, stiffness, inflammation, and limited movement of joints. When a joint is inflamed, it may be swollen, tender, red, or warm to the touch. In a healthy joint, the ends of the bones are covered by cartilage, a spongy material that allows almost frictionless motion between bones. In fact, Birbara says the amount of heat produced when bones normally meet is less than when two pieces of ice are rubbed together. The joints are enclosed in a capsule and lined with tissue called the synovium. This lining releases a slippery, lubricating fluid that helps the joint move smoothly and easily. Muscles and tendons support the joint and help it move. With arthritis, the cartilage may be damaged or worn away by degenerative processes or by inflammation, making movement painful and difficult. If left undiagnosed and untreated, arthritis may progress to cause irreversible damage to the joints.
Some rheumatic diseases are systemic, meaning they can affect the whole body. Diseases such as systemic lupus erythematosus (SLE) can cause arthritis as well as damage to virtually any bodily organ or system, including the heart, lungs, kidneys, blood vessels, skin, and brain, and may result in debilitating, and often life-threatening, complications.
According to the Arthritis Foundation, the most common form of the disease--osteoarthritis (OA)--affects about 21 million people in the United States. Also called "degenerative joint disease," OA is caused by the breakdown of cartilage and bones from the wear and tear of life, resulting in pain and stiffness. OA usually affects weight-bearing joints such as the knees and hips, but an inherited form commonly affects the hands and spine. Pain and stiffness are the earliest symptoms in OA, which affects both men and women and usually occurs after age 45. Other risk factors include joint trauma, obesity, and repetitive joint use. In most cases, OA can be detected by X-rays. Treatments include medications, education, physical activity or exercise, heat or cold, joint protection, pacing activities, weight loss if overweight, self-care skills, and sometimes surgery.
Shirley has the second most common type--rheumatoid arthritis (RA)--an autoimmune disease that occurs when the body's immune system mistakenly attacks the synovium and can lead to damage of both cartilage and the adjacent bone. RA may affect any joint but most commonly starts with inflammation in the hands and feet.While the cause remains elusive, doctors suspect that genetic factors are important in RA. Recent studies have begun to tease out those specific genetic characteristics that make a person susceptible to developing RA. However, the inherited trait alone does not appear to fully account for the development of the illness. Researchers think this trait, along with some other unknown factor--probably in the environment--triggers the disease.But RA can be difficult to diagnose early because it may begin gradually with subtle symptoms that usually wax and wane. According to the Arthritis Foundation, this form of arthritis affects more than 2 million people in the United States and is more common in women than men. Ironically, even when the disease appears to be relatively inactive--as measured by the patient's pain, swelling, and stiffness--joint deterioration is likely to be progressing.
In early disease, most of the disability that patients experience is due to inflammation. In later disease, however, it is the loss of joint integrity that creates disability. This often necessitates surgical joint reconstruction or replacement procedures. Treatments for RA also include medications, exercise, rest, joint protection, and self-care skills. Managing Arthritis and Rheumatic Conditions
For years, the pain and inflammation of arthritis have been treated using medications, local steroid injections, and joint replacement--all with varying success. Seldom did the therapies make the pain go away completely or for very long, nor did they affect the underlying joint damage.Today's researchers are working to improve diagnostic tools and develop treatments to forestall joint erosion. Even people whose joints are already damaged by arthritis can benefit from the knowledge generated by today's research. Patients should consult with their doctors to determine which treatments are the most appropriate for their conditions.
Most arthritis medications fall into three categories: those that relieve pain; those that reduce inflammation or the body process that causes swelling, warmth, and redness; and those that slow the disease process and limit further damage to the joints--so-called disease-modifying agents.Pain relievers such as Tylenol (acetaminophen) and NSAIDs such as Motrin (ibuprofen) are used to reduce the pain caused by many rheumatic conditions. NSAIDs have the added benefit of decreasing the inflammation associated with arthritis. But a common side effect of NSAIDs is stomach irritation, which can often be reduced by changing the dosage or medication. Even acetaminophen has risks when taken in large doses, Kweder says.
Before safety concerns about Vioxx, Celebrex, and Bextra emerged in December 2004, these newer COX-2 NSAIDs were used primarily to reduce gastrointestinal side effects and offered an additional option for treatment.Depending on the type of arthritis, a person may use a disease-modifying anti-rheumatic drug (DMARD). This category includes several unrelated medications that are intended to slow or stop disease progress and prevent disability and discomfort. DMARDs include Rheumatrex (methotrexate), Azulfidine (sulfasalazine), and Arava (leflunomide).
Someone diagnosed with RA today is likely to be prescribed a DMARD fairly early in the course of the disease, as doctors have found that starting these drugs early can help prevent irreparable joint damage that might otherwise occur.
Corticosteroids, such as prednisone, cortisone, methylprednisolone, and hydrocortisone, are used to treat many rheumatic conditions because they decrease inflammation and suppress the immune system. The dosage of these medications will vary depending on the diagnosis and the patient. Corticosteroids can be given by mouth or by direct injection into a joint or tendon sheath.
For Shirley, any minor relief he experienced over the 25 years was due to injections of corticosteroid preparations into his joints. The injections would relieve his pain, stiffness, and swelling temporarily. Unfortunately, corticosteroids given orally and for prolonged periods and at higher doses may carry side effects such as brittle bones, cataracts, elevated blood sugar, and an increased susceptibility to infections throughout the body.
During this time, he or she should discuss all of the any potential risks involved with the procedure as well as all of the alternative measures. However, a decision is made to continue with the surgery, the doctor will recommend a procedure that he feels is best suited for the patient's condition and then will explain what that procedure entails.
Some benefits of going the surgery route can include the stabilization, improved alignment or replacement of a joint so that you can have greater mobility, flexibility, overall use and range-of-motion. Surgery may also be able to provide some level of pain relief where other treatment options might have failed.Be aware there are possible risks with surgery, though, like blood clots resulting. And your healthcare specialist may advise against surgery if, for example, you have existing health problems that could pose possible unwanted risks. Some of these problems could include sickness or infections that would need to be healed first, being over weight, which could cause more stress and delayed recovery, lung problems or heart disease.
Common types of surgery used in the treatment of arthritis follow:
Arthrodesis - This is the joining together or fusion of joint bones. Arthrodesis helps stop the progression of the disease at the point of fusion, ending the pain. Loss of the joint's flexibility can result. However, the area will be better able to handle weight and offer general movement. In other words, the joint may not be 360-degree-flexible any longer, but there will be some lesser-degree of flexibility overall without pain.Arthroplasty - This is the replacement or rebuilding of an entire joint. And it is intended for those with high-level pain and movement impairment. It is discussed in much more detail in the section immediately following this one, offering a focus with regards to hip replacement.
Arthroscopy - Growing more popular with the improved use of technology, this procedure is when specialized instruments are inserted into the joint by means of tiny incisions. During this surgery, the operating physician has helping staff members who aid the computerized monitoring and some handling of the instruments. The doctor can see the joint on closed-circuit television and make repairs to it, while talking through a microphone. Then not only are there physical results, but the patient has a video with audio record of the entire occurrence for insurance and other records. Arthroscopy is often performed on an outpatient basis. And recovery time is generally much less than with other "open" surgery.
Osteotomy - This is a medical procedure that makes an actual cut in the bone, most generally to correct youth deformities like in the knee or hip. Osteotomy helps with re-alignment, stabilization, pain relief and the delaying of joint replacement alternatives for up to 10 years.Synovectomy - This procedure, generally done via arthroscopy, involves the removal of diseased joint tissue lining or synovium. Results can include swelling decrease, pain relief, improved but not completely healed joint health.
Joint Replacement There are currently many options in orthopedic (bone) surgery for people with arthritis. Joint replacement is the most common option. According to the National Joint Replacement Foundation, (NJRF) over 435,000 Americans underwent this procedure last year. These numbers have boosted joint replacement to one of the most successful medical discoveries and the absolute most significant surgery in the field of arthritis treatment. Joint replacement is the process of removing one's entire joint as well as any damaged tissue and replacing it with a metal prosthesis.
This prosthesis provides the patient with much need relief from pain. This surgery most effective on the weight bearing joints such as the knees, hips, and ankles, however, it has been used for all joints with successful results.Hip replacement surgery consists of removing the entire hip joint and replacing it with artificial components. These components function in the same manner as the natural hip, with the same type of motion. When a patient elects to undergo hip replacement surgery, they have an option to use their own blood. There is a great loss of blood during the procedure, and patients are prepared for this ahead of time. They can elect to have their own blood taken and stored ahead of time so that when they need a transfusion, they can use blood from their own body, eliminating many of the risks associated with transfusions.
This particular procedure begins with an initial incision. The surgeon will then proceed to remove the entire hip joint, including the ball, socket, and top of the femur. Once the joint, and all damaged tissue is removed, a metal cup is adhered to the pelvic bone. Then, a metal stem is inserted into the femur; leaving a portion exposed at the end for several inches. The doctors place a ball on the end of the exposed portion of the metal rod, and all of the exposed parts are lined with another antifriction material. The hip is reassembled, placing the ball joint into the socket and the incision is then closed.
Fusion Arthrodesis, or bone fusion, is another optional procedure where the bones are fused together in order to prevent them from moving independently. This can be done two ways:
1. Bone Grafting is the method of stimulating fusion between two bones by placing a small piece of bone, from another region of the body, in between. This small piece of bone encourages growth for the surrounding bones, thus fusing them in place.
2. Implantation of a metal or ceramic piece, which is adhered to each of the two bones, using either screws or a special glue, thus preventing movement of the bones. Fusion is a common procedure and is used in conjunction with joint replacement surgery, which is more extreme of a procedure then bone fusion alone.
During a procedure called Ostheo, doctors can evaluate the injured tissue and eliminate any loose material with the use of instruments that are inserted into the joint through little incisions in the skin. During the procedure, the surgeon can observe any damage to the joint on a closed-circuit television, and further remove any loose growths that could be the origin of pain. This sort of surgery can often be executed on an outpatient basis, and typically involves a shorter recovery stage than open/inpatient surgery.
Rehabilitation times for joint replacement surgery vary from one person to the next. However, the average person has been shown to regain most functions within three weeks. A positive attitude can help to facilitate recovery. It is important for patients to participate in this by reassuring themselves as well as seeking support from support groups, family, and friends.
Regardless of they type of surgery recommended, most people recommend getting at least one other opinion before proceeding. In addition, check out books, conduct your own online research, ask questions through health chat rooms, call your own local providers and learn all you can about your health condition. And if you do decide upon surgery, look and plan ahead, too. Will you need time off work? Someone to help around the house? Someone to run errands? Line up help with neighbors, friends, church members, family, co-workers and local services to pick up groceries, bring in the mail, clean house and basically keep things running in the interim. In short, take charge and reach out.
Maybe pain occurs, like when trying to open a jar. What's it all about? Let's look at the basics and learn more.
Arthritis actually means "joint inflammation" and has over 100 related conditions or type / forms of disease. Left untreated, it can advance, resulting in joint damage that cannot be undone or reversed. So early detection and treatment are important. The two most common types of arthritis are osteoarthritis (OA) and rheumatoid arthritis (RA). Although both have similar symptoms, both happen for different reasons. When joints are overused and misused, the results can be OA. What happens is that the cushioning cartilage that protects the joint breaks down, resulting in the bones rubbing together. This generally happens in the knees, but can be found in the hips, spine and hands often, too. And only in later stages will a person most often feel pain, after quite a bit of cartilage is lost.
The second type, RA, refers to the body's immune system attacking joint tissue. Still not fully understood in the medical community, this condition most often starts in a person's hands, wrists and feet. Then it advances to shoulders, elbows and hips.Similar symptoms include pain, stiffness, fatigue, weakness, slight fever and inflamed tissue lumps under the skin. And both OA and RA generally develop symmetrically, i.e. affecting the same joints on both the left and right sides of the body.
A difference in OA and RA to note is with swelling. With RA, people report "soft and squishy" swelling. While with OA, people report "hard and bony" swelling. Another difference is that a person is more likely to develop RA if a sibling or parent had it. While a person with a history of joint damage, either an injury or chronic strain, runs a higher risk for developing OA.There is no specific age for arthritis sufferers. While it can affect every age group, it seems to focus on those over 45 years of age.And while neither gender is immune, a reported 74 percent of OA cases (or just over 15 million) occur with women and a slightly lower percentage of RA cases occur with women. People with excess weight tend to develop OA, especially in the knees when reaching over 45 years of age. However, losing weight can turn the odds around almost by half. Regular activity combined with exercise also reduces risk, strengthening joint muscles and reducing joint wear.
Although there are no cure-alls for arthritis, there are a variety of pain relief treatment strategies. Aside from medications, remedies, replacement alternatives and other helpful treatment options and alternatives, the four main arthritis relief aids are gentle exercise, good nutrition, a positive attitude and rest. And each will be discussed further in subsequent sections, because education can play a huge role to dispel "old wives tales" and myths that "nothing can be done about arthritis." Notable is that today, only a small percentage of those afflicted with arthritis become crippled. And most never need canes, wheelchairs, or other ambulatory devices.
Also note if you suspect you may have arthritis, it is advisable to seek medical advice. Because healthcare providers can help to determine if the symptoms are not something else like a virus or tendonitis or other similar problem that cold potentially worsen if left untreated.
Types Of Arthritis
There are many ways to effectively manage arthritic pain today to find relief. Available are arthritic diets, exercise programs, over-the-counter and prescription medications, relaxation and positive emotion coping techniques. Also available are surgeries, supplements, home remedies, natural and other alternative therapies. When arthritis is first suspected, it would be wise to seek a medical opinion first. Then as time and resources allow, check out the other options. After osteoarthritis (OA) and rheumatoid arthritis (RA), three other major types of arthritis are systemic lupus erythematosis, ankylosing spondylitis and gout. Let's take a look at each:
Systemic Lupus Erythematosis (SLE) - This form of arthritis mainly affects women. It develops in the skin, internal organs and joints.
Ankylosing Spondylitis - This form or arthritis affects the spine and can also affect the ankles, knees, lungs, heart, shoulders and eyes.
Gout - This is a painful affliction mainly for men, about one million of them in the United States alone. Uric acid build up, due to an internal chemical malfunction, forms crystals that get stuck in a joint, generally the big toe, and become inflamed.
Science Of Arthritis
Joints can handle some heavy pressure. For example, knees handle a force of three to four times a person's total body weight on average just talking a walk. The force of a deep knee bend during a squat can increase to nine times the body weight. So just imagine multiplying weight of more than 150 pounds times a minimum of three or four, and then even more. That can sure add up to a lot of heavy work on knee joints over time.
Now for the science of this scenario. Where two bones meet, called the joint, the bone ends are covered with cartilage, also known as gristl
This cartilage is sturdy, elastic and spongy or compressible, and keeps the bones from moving against each other at the joint. The cells of this cartilage, called chondrocytes, are thought to be the longest living cells of the body. Surrounding the bones and cartilage is strong, fibrous capsule lined with synovium, a thin membrane that lubricates the joint area with fluid. The end result is less friction or smoother rubbing together of the bones. This fluid also feds the cartilage cells, keeping them healthy, and is "pumped" into them during joint movement. Thus lack of movement (activity / exercise) can be unhealthy.
Other parts of the body features involved with this arthritic scenario include muscles, tendons, ligaments, bursea and mental activity. Muscles, attached to bones with tendons and ligaments, move bones by contracting. They also cushion movement, absorbing impact or shock. Throughout the muscle and tendon areas are bursae or sacs filled with fluid. These also help cushion movement. And throughout all the coordination of these parts during movement, the brain is a part. The brain communicates via nerves throughout the body, in particular the muscles for this scenario, to prepare joints for activity.
The exact science of what actually causes arthritis is still being researched. For most of the 100-plus forms of arthritis, the causes are unknown. Injury, overuse of joints and mechanical issues with joints (like skeletal abnormalities, worn out joint muscles) can lead to arthritis. And many point to issues relating to bacteria and germs as some of the problem. Heredity, stress, drugs, food allergies and viruses have also been linked to some forms of arthritis. So have diet, poor circulation and lack of movement.
INFLAMMATION Arthritic joints can be affected with inflammation when bacteria or a virus (or other undesirable element) enters the joint area or when an injury occurs. What happens is when foreign matter enters this area or the area sustains injury, white blood cells, antibodies and other natural "fighting" mechanisms automatically kick in internally to help. These fighters cause swelling, redness and heat as the body fluid moves around. Symptoms of inflammation, one of the uncomfortable issues associated with arthritis, are redness, swelling and tender joints.
But what if joint pain and stiffness are inevitable if you don't take the medication, yet heart problems could occur if you do? Health officials say that, as with any drug, only you and your doctor can determine the level of risk that is acceptable with medications currently available to treat arthritis.
Water is an excellent aid because it provides resistance that builds muscle in the entire body while reducing shock to the joints at the same time. Additionally, because the whole body tends to become involved in aquatic exercise the added benefit of cardiovascular exercise is enjoyed. If at all possible, find a heated pool to work out in. Warm water is soothing to the joints and will cause the blood vessels to dilate, increasing circulation. With that in mind, it is often beneficial to add using a spa to your regimen, perhaps after your workout, in order to provide some soothing jets of water to your muscles and even more help with increased circulation, which is always vital when dealing with arthritis.
The unsettling news in late 2004 that the popular anti-inflammatory arthritis drugs Vioxx (rofecoxib), Celebrex (celecoxib), and Bextra (valdecoxib) could cause a heart attack or stroke or aggravate high blood pressure has left some patients wondering whether they should keep taking them.
Data from clinical trials showed that cyclooxygenase-2 selective agents, better known as COX-2 inhibitors, may be associated with an increased risk of serious cardiovascular problems, especially when used in high doses or for long periods in patients with existing cardiovascular disease, or in very high-risk situations, such as immediately after heart surgery. COX-2 inhibitors are the newest subset of non-steroidal anti-inflammatory drugs (NSAIDs). COX-2 inhibitors were developed specifically to decrease the well-recognized gastric side effects and intolerance associated with the use of some NSAIDs.
Traditional NSAIDs, such as aspirin or ibuprofen, act by blocking the production of a family of chemicals known as prostaglandins, which are not only important in the development of inflammation, but also play an important role in maintaining the integrity of the stomach lining. At least two enzymes are involved in this inflammation, namely cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2). Traditional NSAIDs inhibit both COX-1 and COX-2. Unfortunately, this non-selective inhibition of both COX enzymes also inhibits those prostaglandins involved in some of the important "housekeeping" functions of the body, such as helping blood to clot and protecting the stomach from ulceration.
It is this non-selective inhibition of both enzymes by aspirin and other non-selective NSAIDs that increases the risk of stomach ulcers and consequent bleeding. In theory, the newer COX-2 selective inhibitors only inhibit the enzyme involved in inflammation, leaving the other functions alone.
But Sandra Kweder, M.D., deputy director of the Food and Drug Administration's Office of New Drugs, says that new studies have had a surprising twist. "The downside of the COX-2 selective inhibitors is that they appear to be associated--particularly when used for many consecutive months to years--with an increased risk of cardiovascular problems," she says. Moreover, COX-2 inhibitors, like other NSAIDs, don't influence the course of the disease--which doctors say is a common misconception among patients--because these drugs only provide for symptom relief.
Coincidentally, preliminary results from a three-year trial on the non-selective NSAID Aleve (naproxen) also suggested that long-term use may be associated with an increased risk for cardiovascular problems.Since the results of studies on both non-selective and selective NSAIDs are preliminary and conflict with data from earlier studies of the same drugs, the FDA issued a public health advisory in December 2004 concerning use of all NSAIDs, pending further review of data that continue to be collected. The agency has recommended, among other things, that physicians limit the use of COX-2 inhibitors until further review.
"Monitoring the drug safety of marketed products requires close collaboration between our clinical reviewers and drug safety staff to evaluate and respond to adverse events identified in ongoing clinical trials or reported to us by physicians and their patients," says Kweder. "The most recent actions concerning [NSAIDs] illustrate the vital importance of the ongoing assessment of the safety of a product once it is in widespread use." Others Weigh In
The concerns with the safety of so many pain relievers used to treat arthritis underscores the importance of arthritis as a major health care issue in the United States. Arthritis experts, patient advocacy groups, and other health organizations also are weighing in on the uncertainty of NSAIDs, and are recognizing the need for developing new and safer medications.The American College of Rheumatology is advising physicians to follow current treatment guidelines and manufacturers' dosage recommendations for NSAIDs. Treatment guidelines exist to help doctors choose the best options for their patients, based on current scientific studies.The Arthritis Foundation said in a statement that the findings about the drugs should not have any immediate impact on the clinical use of them.
"Non-steroidal anti-inflammatory drugs continue to play an important role in the management of arthritis pain," says John H. Klippel, M.D., president and CEO of the Arthritis Foundation. "Patients who derive benefit from these drugs should remain on their treatment regimen, and discuss concerns with their physicians," he says.But Charles A. Birbara, M.D., a rheumatologist and associate professor of medicine at the University of Massachusetts Medical School in Worcester, Mass., says that he has prescribed COX inhibitors cautiously in older people or those with cardiovascular or renal disease ever since early clinical studies discovered a possible risk in this patient population.
"I'm not always willing to take a risk with my patients, because we clearly don't have a complete understanding of all the potential clinical issues associated with use of these drugs," he says. Even before the controversy, Birbara notes that the long-term effects of COX-2 agents were unknown. Besides, he says, there are other treatment options available that are equally effective.
"There are so many wonderful things happening with respect to current therapies of arthritis," he says. "Clearly, we are so much better able to control inflammatory arthritis with new biologic agents." Birbara adds that so many people whose lives were diminished by joint disease can now look forward to an unrestricted lifestyle, which was "not even imaginable just a few short years ago."
Richard Shirley, 64, an avid birdwatcher from Wrentham, Mass., battled rheumatoid arthritis in nearly every joint in his body for more than 25 years before he saw Birbara. He couldn't button his shirt cuffs, walk frontward down a flight of stairs, or get in and out of a car without a struggle. At times, his hands were so swollen he couldn't grasp small objects or make a closed fist. Shirley had his wedding ring resized so it would fit.
"Richard had seen a number of physicians and had been on many medications to treat his disease," Birbara says. "However, the aggressive nature of his arthritis was not very responsive to standard medications." According to Birbara, X-rays of Shirley also showed evidence of joint destruction.
"Doctor Birbara has a zero tolerance for hot and inflamed joints," Shirley says, "because that's when the damage is done." Shirley also believes, from his own experience, that each person needs to work with his or her physician to find the appropriate medicine. For him, a new biologic product made the difference.
Finding the right treatments for those at greatest risk for the potential complications of arthritis and other rheumatic conditions, Birbara says, hopefully will lessen the burden of this disease, not only in the United States, but for the entire world.
Arthritis Medication - When it comes to your dog in your life there are many people that will do anything to help them out. If you find that your dog has arthritis in his or her bones you may need some information of what you need to do. Believe it or not there is arthritis medication for dog just like there is for humans.
Arthritis More Treatment - In a recent survey on pain conducted by the Stanford University Medical Center, arthritis pain was cited as the chief complaint among America's seniors, with thirty-two percent of the senior population listing arthritis as the specific cause of their suffering.
Arthritis Pain Relief - Acupuncture is a form of pain relief that is actually a Chinese remedy. What is acupuncture? Acupuncture is based in the Chinese cultures that allow you to reduce your pain by specific points. These points are located by having a needle placed in your skin for several minutes. They claim that by using this method, you can release your pain neurologically.
Pauciarticular Juvenile Arthritis - A number of are hoping for developments from the natural health area for an arthritis remedy. One specific area which is attracting the interest of researchers is glucosamine chondroitin supplements.
Relieve Arthritis Pain - Many people have arthritis symptoms and don't realize it. It takes a while to get full blown arthritis. It's something that gradually builds up and before you know it, you have arthritis and are seeing your doctor for medication. Any medication you take does not address the cause of arthritis and will not improve your condition.
Rheumatic Pains Joint - Sore, aching knees, hips, fingers, backrest. Pain after excessively much activity. Pain after overly little. Eventually, almost everyone gets degenerative arthritis. Sometimes it's the result of decades of wear-and-tear on the shock-absorbing cartilage that prevents bone from rubbing against bone.
Rheumatoid Arthritis - My name is Cathy Posner and I live in Wauchope which is on the Mid North Coast of New South Wales, Australia. I was born in 1957 and in late 2004 was told that the aches in my joints were Rheumatoid Arthritis.
Rheumatoid Arthritis Exercises - For individuals suffering from arthritis, the simplest tasks can be both difficult and painful. This condition inflames the tissues around the joint, creating pain and stiffness that can limit both your mobility and your daily life.
Spinal Cord Level - A great place to begin taking charge of you arthritis pain relief and prevention planning is by making an appointment with your healthcare provider and finding out more about your condition and treatment options.
Ovarian Cancer - The symptoms of ovarian cancer come into notice mostly when it grows for some time and the cancer mass becomes large enough.
Lung Cancer Mesothelioma - Experts believe that smoking does not seem to be a directly related risk for developing the disease only by its own, but its combination with asbestos exposure increases the risk of Mesothelioma, so stop smoking if you are exposed to asbestos in your workplace.
Ovarian Cancer - Whilst it is impossible to generalize emotional and energetic responses, she highlights the issue of rage in ovarian cancers.
Pain Relief Glucosamine - Many people have arthritis symptoms and don't realize it. It takes a while to get full blown arthritis. It's something that gradually builds up and before you know it, you have arthritis and are seeing your doctor for medication. Any medication you take does not address the cause of arthritis and will not improve your condition.
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