What Is Sjogren's Syndrome?

Sjogren's syndrome is a condition which is often misdiagnosed or undiagnosed. Awareness and recognition of Sjogren's syndrome is important.

Experts believe 1 to 4 million people have the disease. Of this group, 90% are women. Sjogren's syndrome can occur at any age, but it usually is diagnosed after age 40 and can affect people of all races and ethnic backgrounds. Sjogren's syndrome is rare in children, but it can occur.

Many women have the disease but do not recognize the symptoms which are similar to those of other conditions including menopause.

It has been suggested that many more people suffer with Sjogren's syndrome than have been diagnosed. Sjogren's syndrome is considered to be:

an autoimmune diseasea rheumatic diseasea connective tissue disorder

Abnormal production of autoantibodies in the blood which turn against various tissues in the body cause the disease. Inflammation in the glands of the body results from this abnormality.

Sjogren's syndrome is characterized by:

A survey done by Bruskin/Goldring Research indicated that while three of four women over 35 years old suffer at least two of the possible symptoms associated with Sjogren's syndrome, over half of these women do not bring it to the attention of their physician, choosing instead to ignore the problem.

When only gland inflammation and resulting dry eyes and mouth are involved the disease is known as primary Sjogren's syndrome. There can also be extraglandular problems associated with Sjogren's syndrome which may include:

The disease is known as secondary Sjogren's syndrome when the gland inflammation exists in combination with another connective tissue disease or autoimmune disease such as:

The diagnosis of Sjogren's syndrome is based largely on the detection of dry eyes and mouth. Helpful diagnostic tools that serve in making the diagnosis include:

Schirmer's test for dry eyesradiologic salivary scanssalivary flow testingbiopsy of salivary glandsblood tests

Treatment of Sjogren's syndrome is different for each person, depending on what parts of the body are affected. Although there is no cure for Sjogren's syndrome, mouthwashes, saliva substitutes, sprays, gels, and gum can relieve oral symptoms. Medications and drug treatment options for dry mouth associated with Sjogren's syndrome may include saliva and mucus stimulating drugs such as:

Artificial tears and eye ointments can help relieve chronic dry eyes. Medications and drug treatment options for dry eye associated with Sjogren's syndrome may include:

Extraglandular problems, such as joint pain or muscle pain involvement, are often treated with NSAIDs (non-steroidal anti-inflammatory drugs). Lung, kidney, blood vessel, or nervous system problems may be treated with:

A person suffering with symptoms which may be due to Sjogren's syndrome must be aware of the need for medical assessment and the treatments available. Ignoring Sjogren's syndrome symptoms prolongs the suffering. Awareness leads to available help.

Sources

April Is National Sjogren's Syndrome Awareness Month, PRNewswire

Questions and Answers About Sjogren's Syndrome, NIAMS, January 2001

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What Is an Ankle Fusion?

When conservative treatments for arthritis fail to satisfactorily relieve pain in an affected ankle, it may be time to consider joint surgery. It's important to learn about the various types of joint surgery and understand your options. Ankle fusion, also known as ankle arthrodesis, is one surgical option.

Three bones make up the ankle joint -- the lower end of the tibia (shinbone), the fibula (small bone of the lower leg), and the talus (bone that fits into the socket formed by the tibia and fibula). The talus rests on the heelbone. Articular cartilage lines the inside of the ankle joint. Normally, the cartilage is about a quarter of an inch thick. If injury occurs, or if the cartilage is damaged by arthritis, pain can be quite severe.

An ankle fusion is a surgical procedure that removes the surfaces of the ankle joint for the purpose of promoting a fusion between the tibia and the talus. "Fusion" refers to bones growing together. Fusion is not only performed on the ankle, but also on other joints in the body that are severely painful.

There are a couple of methods for the ankle fusion procedure, but the goal of each is the same -- to fuse the ankle joint.

The Open Method an incision is made to open the skin and access the jointthe joint is openeda surgical saw is used to remove articular cartilage surfacesonce the articular cartilage is removed, the body will heal by fusing the jointthe cuts must be precise so that the bones are at the proper angle when they are brought together to fusescrews and sometimes plates are used to hold bones together until they fuseusually screws or pins are under the skin and not removedin some cases, an external fixator (pins on outside of skin) can be used

The Arthroscopic Method

This method employs an arthroscope. Through a small incision, the arthroscope (which contains a tiny TV camera) is inserted into the ankle joint. Using other instruments, cartilage is removed through the tiny incision while the arthroscope is used to observe the progress of the procedure. After the surfaces are prepared, screws are placed to hold bones together until they heal. This method is not much different than the open method other than smaller incisions are used.

Patients who have severe ankle damage from arthritis or past injury may be candidates for ankle fusion. Candidates usually have ankle pain that is unrelenting even after being treated with medications or other treatment options. When pain is so severe that it interferes with walking and usual daily activities, it's time to discuss the option of ankle fusion with an orthopedic surgeon.

The goal of ankle fusion is to relieve pain and restore function to the affected ankle. Though some may be concerned that there is motion lost with a fusion, many patients tend to forget that they have already lost range of motion in the severely damaged ankle.

A fusion should last a lifetime compared to an ankle replacement, which may wear out at some point.

Consider your goals when deciding if ankle fusion is the best option for you.

Pros: pain reliefthe fused joint is stable againpatients will be able to bear weight on the fused joint without painability to walk and perform usual activities is restored

Cons: ankle replacement may still be a better option for certain patients (very active individuals)there is loss of flexibility and motion with a fused jointslight possibility of wound healing complications

There are potential complications, as with any surgery. There may be risks associated with anesthesia, as well as risk of nerve or blood vessel injury, post-op infection, nonunion (bones don't fuse), and malunion (bones heal in the wrong position). If nonunion or malunion occurs, another surgery may be required.

The operated leg is wrapped in a padded plaster cast after surgery. After 2 weeks, a shorter cast replaces the padded plaster cast. The patient cannot bear weight on the ankle for 8 to 12 weeks, at which time there should be x-ray evidence of fusing.

Keeping your leg elevated is important to prevent or reduce leg swelling. Crutches are usually necessary while the patient refrains from putting weight on the ankle. X-rays, taken often, will show if the fusion is becoming stronger and solid. At that point, the patient is allowed to put more weight on the ankle as she walks. Some patients may want special shoe inserts to help them walk more normally, while many simply wear flat shoes and do just fine.

Sources:

A Patient's Guide to Ankle Fusion. eOrthopod. Medical Multimedia Group, LLC. July 22, 2002.
http://www.eorthopod.com/public/patient_education/6464/ankle_fusion.html

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The Facts Of Robaxin

BRAND NAME: Robaxin GENERIC DRUG NAME: Methocarbamol

INDICATIONS AND USAGE:

Robaxin (Methocarbamol) is indicated as an adjunct to rest, physical therapy, and other measures for the relief of discomfort associated with acute, painful musculoskeletal conditions. The mode of action of methocarbamol has not been clearly identified, but may be related to its sedative properties. Robaxin does not directly relax tense skeletal muscles in man.

CONTRAINDICATIONS:

Robaxin is contraindicated in patients hypersensitive to methocarbamol or to any of the tablet components.

WARNINGS:

Since methocarbamol may possess a general CNS depressant effect, patients receiving Robaxin should be cautioned about combined effects with alcohol and other CNS depressants.

Safe use of Robaxin has not been established with regard to possible adverse effects upon fetal development. There have been reports of fetal and congenital abnormalities following in utero exposure to methocarbamol. Therefore, Robaxin should not be used in women who are or may become pregnant and particularly during early pregnancy unless in the judgment of the physician the potential benefits outweigh the possible hazards.

Robaxin may impair mental and/or physical abilities required for performance of hazardous tasks, such as operating machinery or driving a motor vehicle.

PRECAUTIONS:

Patients should be cautioned that Robaxin may cause drowsiness or dizziness, which may impair their ability to operate motor vehicles or machinery. Because Robaxin may possess a general CNS-depressant effect, patients should be cautioned about combined effects with alcohol and other CNS depressants.

ADVERSE REACTIONS:

Adverse reactions reported coincident with the administration of methocarbamol include:

Body as a whole: Anaphylactic reaction, angioneurotic edema, fever, headacheCardiovascular system: Bradycardia, flushing, hypotension, syncope, thrombophlebitisDigestive system: Dyspepsia, jaundice (including cholestatic jaundice), nausea and vomitingHemic and lymphatic system: LeukopeniaImmune system: Hypersensitivity reactionsNervous system: Amnesia, confusion, Diplopia, dizziness or lightheadedness, drowsiness, insomnia, mild muscular incoordination, nystagmus, sedation, seizures (including grand mal), vertigoSkin and special senses: Blurred vision, conjunctivitis, nasal congestion, metallic taste, pruritus, rash, urticaria

DRUG INTERACTIONS:

Robaxin may inhibit the effect of pyridostigmine bromide. Therefore, Robaxin should be used with caution in patients with myasthenia gravis receiving anticholinesterase agents.

DRUG / LABORATORY TEST INTERACTIONS:

Methocarbamol may cause a color interference in certain screening tests for 5-hydroxyindoleacetic acid.

CARCINOGENESIS, MUTAGENESIS, IMPAIRMENT OF FERTILITY:

Long-term studies to evaluate the carcinogenic potential of Robaxin have not been performed. No studies have been conducted to assess the effect of Robaxin on mutagenesis or its potential to impair fertility.

PREGNANCY:

Animal reproduction studies have not been conducted with methocarbamol. It is also not known whether methocarbamol can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity. Robaxin should be given to a pregnant woman only if clearly needed.

Safe use of Robaxin has not been established with regard to possible adverse effects upon fetal development. There have been reports of fetal and congenital abnormalities following in utero exposure to methocarbamol. Therefore, Robaxin should not be used in women who are or may become pregnant and particularly during early pregnancy unless in the judgment of the physician the potential benefits outweigh the possible hazards.

NURSING MOTHERS:

Methocarbamol and/or its metabolites are excreted in the milk of dogs; however, it is not known whether methocarbamol or its metabolites are excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when Robaxin is administered to a nursing woman.

PEDIATRIC USE:

Safety and effectiveness of Robaxin in pediatric patients below the age of 16 have not been established.

OVERDOSAGE:

Limited information is available on the acute toxicity of methocarbamol. Overdose of methocarbamol is frequently in conjunction with alcohol or other CNS depressants and includes the following symptoms:

nauseadrowsinessblurred visionhypotensionseizurescoma

In post-marketing experience, deaths have been reported with an overdose of methocarbamol alone or in the presence of other CNS depressants, alcohol or psychotropic drugs. Management of overdose includes symptomatic and supportive treatment.

Store Robaxin at controlled room temperature, between 20°C and 25°C (68°F and 77°F).

Robaxin (Methocarbamol)Muscle Relaxers (Muscle Relaxants)When Are Muscle Relaxers Prescribed For Arthritis Patients?Muscle Pain

Source: U.S. Food and Drug Administration, NDA 11-011/S-070/071

Related Resources - Robaxin / MethocarbamolRelated Resources - Robaxin / MethocarbamolRelated Resources - Robaxin / Methocarbamol

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Is It Lupus?

When symptoms appear, it’s called a “flare.” These signs may come and go. You may have swelling and rashes one week and no symptoms at all the next. You may find that your symptoms flare after you’ve been out in the sun or after a hard day at work.

Even if you take medicine for lupus, you may find that there are times when the symptoms become worse. Learning to recognize that a flare is coming can help you take steps to cope with it. Just before a flare, many people with lupus:

feel very tiredhave painhave a rashhave a feverhave stomach discomforthave headachesfeel dizziness

Steps to prevent flares, such as limiting the time you spend in the sun and getting enough rest and quiet, can also be helpful.

Learn to recognize that a flare is coming.Talk with your doctor.Try to set realistic goals and priorities.Limit the time you spend in the sun.Maintain a healthy diet.Develop coping skills to help limit stress.Get enough rest and quiet.Moderately exercise when possible.Develop a support system by surrounding yourself with people you trust and feel comfortable with (family, friends, etc.)

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Facts Of Corticosteroids

Corticosteroids or glucocorticoids, often just called "steroids", where once thought to be almost miraculous. In 1948, at the Mayo Clinic in Rochester, Minnesota a group of arthritis patients were given daily injections of a corticosteroid. The results were so striking and the improvement so dramatic that it was thought that the "cure" for arthritis had been discovered. However, as the use of corticosteroids expanded over the years, side effects emerged and it was realized that high doses given over prolonged periods of time turned steroids into "scare-oids". Patients were warned of the potential problems, the use of corticosteroids became more conservative, and some patients were so frightened of them they even declined treatment.

Corticosteroids are powerful drugs that can have valuable effect if administered within proper guidelines. Understanding how they work and how they can be safely taken is very important.

Corticosteroids are drugs closely related to cortisol, a hormone which is naturally produced in the adrenal cortex (the outer layer of the adrenal gland).

Corticosteroid Drugs Include:

Cortisol plays an important part in controlling salt and water balance in the body, and regulating carbohydrate, fat, and protein metabolism. When the body becomes stressed, the pituitary gland at the base of the brain releases ACTH, adrenocorticotropic hormone, which stimulates adrenals to produce cortisol. The extra cortisol allows the body to cope with the stress such as infection, trauma, surgery, or emotional problems. When the stressful situation ends, adrenal hormone production returns to normal.

The adrenal glands usually produce about 20 milligrams of cortisol per day, mostly in the morning, but can produce five times that much when needed.

Corticosteroids act on the immune system by blocking the production of substances that trigger allergic and inflammatory actions, such as prostaglandins. However, they also impede the function of white blood cells which destroy foreign bodies and help keep the immune system functioning properly. The interference with white blood cell function yields a side effect of increased susceptibility to infection.

Corticosteroids are widely used for many conditions. They are also used to control inflammation of the joints and organs in diseases such as:

Corticosteroids are not used systemically for osteoarthritis, though they are sometimes used as a local injection into an affected joint.

Corticosteroids are versatile in their mode of application. They can be given:

orallyinjected into the vein or muscleapplied locally to the skininjected directly into inflamed joints

Corticosteroid drugs can also be used as ingredients contained in:

eye products (to treat various eye conditions)inhalers (to treat asthma or bronchial disease)nasal drops and sprays (to treat various nasal problems)topical creams, ointments, etc. (to treat various skin problems)

Corticosteroids can be used in conjunction with other drugs, and are prescribed for short-term and long-term use.

Prednisone (brand names include: Cortan, Deltasone, Liquid Pred, Meticorten, Orasone, Panasol-S, Prednicen-M and Sterapred) is the most commonly prescribed synthetic corticosteroid for arthritis. Prednisone is four to five times as potent as cortisol. Therefore, five milligrams of prednisone is the equivalent of the body's daily output of cortisol. There are other synthetic corticosteroids available which differ in potency and half-life.

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Neither Executive adopts Arthritis Care goals

Northern Ireland Executive’s Draft Programme for Government was revealed on November 17, and it included two important commitments which will make a difference for people with arthritis and for which Arthritis Care has been campaigning hard.

The two commitments are to provide better access to anti-TNF (biologic) treatments for people with severe rheumatoid arthritis and to ensure that people with long term conditions have access to self management training and other education, information and support programmes to help them manage their conditions effectively.

Arthritis Care has campaigned long and hard, with the active participation of members and others with arthritis, for better access to anti-TNF’s, which can be life transforming for people with severe RA, and which are much more readily available in other parts of the UK than in NI. The Programme for Government now pledges to ‘enhance access to life-enhancing drugs for conditions such as rheumatoid arthritis, cancer, inflammatory bowel disease and psoriasis…’. Minister for Health Edwin Poots MLA has said that he hopes to reduce the waiting time for access to anti TNF’s from 9 months to 3 months.

Arthritis Care has also pressed hard, though the Long Term Conditions Alliance Northern Ireland, for recognition of the value of the self management training and information work which the organisation and other groups in the Alliance carry out. The programme for Government now makes the commitment to make such training and information available for those who want it, and to work with stakeholders to secure appropriate support programmes to help people manage their long term condition effectively.

Steve McBride, Arthritis Care’s Policy Adviser for Scotland and Northern Ireland, said ‘These proposals are a big step forward, and will have real benefits for many people with arthritis. There is still work to be done in ensuring the full and effective implementation of these policies, but the Programme for Government pledges are a real success and everyone who has taken part in helping to bring them about can take real satisfaction in this very positive outcome.'

The full Programme for Govenment document can be read at:
http://www.northernireland.gov.uk/draft-pfg-2011-2015.pdf
The draft document is now open for consultation until February 22, 2012.

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2011 quality of rheumatoid arthritis services in the NHS survey

The consultation, launched on World Arthritis Day is aimed at patients, clinicians and commissioners and seeks to assess the progress that has been made in improving services for patients with rheumatoid arthritis since the publication of the 2009 National Audit Office report Services for people with rheumatoid arthritis which outlined a number of concerns about the provision and quality of services for patients.

The consultation asks participants for feedback on the state of services in their area, the information and support available to patients and whether patients are getting access to the treatment and care they need to manage their condition.

Upon launching the consultation Federico Moscogiuri, Head of Policy and Public Affairs for Arthritis Care said: "Over two years since the National Audit Office published its findings into the state of services for people with rheumatoid arthritis, Arthritis Care remains concerned at the current quality of these services in England, particularly against the current backdrop of NHS 'efficiency savings'. That is why this World Arthritis Day we are launching this survey with clinicians, commissioners and people with rheumatoid arthritis across England, to determine how services have changed over the past two years and get an understanding of where further progress is needed to improve services for people with rheumatoid arthritis. This survey will feed into our newly-launched ArthritisWatch project, which will gather evidence of changes and cuts to services for all people with arthritis in England. For too long musculoskeletal conditions such as rheumatoid arthritis have not been a priority for the NHS: we hope this initiative can help to change that."

You are not obliged to answer any of the questions, but the more information you are able to provide, the stronger our evidence will be. We will not contact you and your answers will remain anonymous.

Survey for people with rheumatoid arthritis

Survey for doctors and comissioners

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