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Rheumatoid Arthritis

Rheumatoid Arthritis

Rheumatoid arthritis (RA) is an autoimmune disease in which your body’s immune system – which protects your health by attacking foreign substances like bacteria and viruses – mistakenly attacks your joints. The abnormal immune response causes inflammation that can damage joints and organs, such as the heart. Early diagnosis and prompt treatment is the key to preventing joint destruction and organ damage.


About 1.5 million people in the United States have rheumatoid arthritis (RA). Nearly three times as many women have the disease as men. In women, RA most commonly begins between ages 30 and 60. In men, it often occurs later in life.



The severity of the disease can vary from person to person. Symptoms can change from day to day. Sudden increases in symptoms and illness are called flares. A flare can last for days or months. Key rheumatoid arthritis symptoms are pain, fatigue and warm, swollen, reddish joints. Long periods of joint stiffness in the morning are common. Inflammation in the small joints of the wrist and hand is typical. If a joint on one side of the body is affected, the same one on the other side is usually affected, too.



There is no cure for RA, but there are a number of medications available to help ease symptoms, reduce inflammation, and slow the progression of the disease. No one drug works for everyone but many people find treatments that are very effective. The goal of treatment is remission, a state when inflammation is gone or is very low. A doctor, likely a rheumatologist – a specialty doctor who treats people with arthritis – should monitor your levels of disease activity, or inflammation, on a regular basis through exams and blood tests that reveal how well treatment is working. The doctor may add or change your medications or adjust the dosage after a few months, if the disease is still active. 



Self-management is an important part of rheumatoid arthritis care. Staying physically active is the key to keeping joints flexible. Too little movement can lead to joint stiffness. Strong muscles protect joints. Overall fitness improves health in many ways. Managing your weight, eating a nutritious diet and getting a good balance of rest and activity each day are important, too.

Rheumatoid Arthritis Diet


Diet won’t cure rheumatoid arthritis (RA), but the right food choices can help by controlling the inflammation, delivering nutrients your body needs and helping you maintain a healthy weight. That’s important because excess weight adds to pressure on achy joints and can make certain RA meds less effective. What’s more, body fat produces proteins called cytokines that promote inflammation.

Aim to eat a healthy diet with:

  • Lots of whole grains, vegetables, and fruits. They should make up two-thirds of your plate.

  • Low-fat dairy and lean proteins, which should make up one-third

  • Small amounts of saturated and trans fats

  • A little sugar

  • Limited alcohol



  • Citrus fruits: Oranges, grapefruit, lemon and limes are good source of vitamin C and a source of inflammation fighting antioxidants. Consult with your doctor before consuming citrus fruits if you are on Methotrexate.

  • Blueberries, blackberries, strawberries, cranberries, raspberries are rich in anti-oxidants.

  • Avocados

  • Watermelon


Fish oil 

The polyunsaturated omega-3 fatty acids found in fish have potent anti-inflammatory properties. Omega-3 fats seem to work better for rheumatoid arthritis than for osteoarthritis, most likely because rheumatoid arthritis is mainly driven by inflammation.

When you buy fish oil, make sure the supplement lists the EPA and DHA content, and that you take at least one gram each of EPA and DHA. These are the omega-3 forms that have the majority of the health benefits.



In the body, it acts as a powerful anti-inflammatory agent, blocking the same inflammation-promoting enzyme as the COX-2 inhibitor drug, celecoxib. 

A 1,500 mg daily dose of curcumin extract can be as effective as 1,200 mg a day of ibuprofen, without the gastrointestinal side effects. This supplement also appears to relieve RA swelling and tenderness. 

One downside to curcumin is that it’s hard for the body to absorb. “You want to take it with a source of fat. Some of the supplements will be in an oil base, which is really important.

In addition, some medicinal herbs can help you manage or even minimize uncomfortable symptoms.

It’s important to note that you should never use herbs or supplements in place of standard medical care for RA. Always consult with your doctor before starting on any supplement, as some can pose harmful interactions with medications.



Aim for taking 1,500 milligrams (mg) of ginger daily. Try stir-frying a chicken or veggie dish with chopped fresh ginger, eating fresh pickled ginger, or adding grated ginger to soups or smoothies.



A fragrant herb that has high antioxidant capabilities. A sprig of fresh thyme or the fresh leaves can be flavorful additions to meat, poultry, bean, tomato, or egg dishes, as well as soups and stews.



Besides having anti-inflammatory properties, turmeric and curcumin (the active ingredient that gives turmeric its yellow color) also have analgesic effects.

Want to try turmeric? Add it to soups, stews, and curry dishes. Helpful hint: Combining turmeric with black pepper helps your body absorb the yellow spice even better


Green Tea

Treat yourself to a daily tea break with a cup of hot green tea, iced green tea, or even a cup of matcha, using a powder made from ground green tea leaves. You’ll do your health, and perhaps your joints, a world of good.



A delicious spice, cinnamon has powerful antioxidant properties that help inhibit cell damage from free radicals. Cinnamon has been found to significantly decrease in blood levels of C-reactive protein (a marker of inflammation), as well as reduced disease activity, including tender and swollen joints.

Dried cinnamon can be added to oatmeal, smoothies, soups, stews, or even oranges for a delicious and healthy dessert. Cinnamon sticks can be added to teas or ciders for an extra flavor infusion.



This serious, painful condition is the most common form of arthritis and can affect any joint.

Osteoarthritis is a degenerative joint disease that can affect the many tissues of the joint. It is by far the most common form of arthritis.

Historically, osteoarthritis (OA) was known as a “wear and tear” condition, generally associated with aging. But we know now that it is a disease of the entire joint, including bone, cartilage, ligaments, fat and the tissues lining the joint (the synovium). Osteoarthritis can degrade cartilage, change bone shape and cause inflammation, resulting in pain, stiffness and loss of mobility.

OA can affect any joint, but typically affects hands, knees, hips, lower back and neck. Its signs and symptoms typically show up more often in individuals over age 50, but OA can affect much younger people, too, especially those who have had a prior joint injury, such as a torn ACL or meniscus. It typically develops slowly over time, but after such an injury, it can develop much more rapidly, within just a few years. OA is not an inevitable aging disease; some people never develop it.

There is no cure for OA, but there are ways to manage OA to minimize pain, continue physical activities, maintain a good quality of life and remain mobile.


Factors that may contribute to the development of OA include 

  • Age - The risk of developing OA increases with age.

  • Injury - A bone fracture or cartilage or ligament tear.

  • Overuse - Excessive joint use such as for a job or sport.

  • Obesity. Excess weight adds stress and pressure on a joint, plus fats cells promote inflammation.

  • Musculoskeletal Abnormalities. Malalignment of bone or joint structures can contribute to faster development of OA.

  • Weak muscle - If muscles don’t provide adequate joint support, poor alignment can result, which can lead to OA

  • Genetics - People with family members who have OA are more likely to develop it.

  • Gender -  Women are more likely to develop OA than men.

  • Environmental Factors - Modifiable environmental risk factors include things like someone’s occupation, level of physical activity, quadriceps strength, presence or absence of prior joint injury, obesity, diet, sex hormones, and bone density.



Symptoms tend to build over time rather than show up suddenly. They include

  • Pain or aching in a joint during activity, after long activity or at the end of the day.

  • Joint stiffness usually occurs first thing in the morning or after resting.

  • Limited range of motion that may go away after movement.

  • Clicking or popping sound when a joint bends.

  • Swelling around a joint.

  • Muscle weakness around the joint.

  • Joint instability or buckling (as when a knee gives out).


OA may affect different parts of the body in different ways.

  • Hip Pain in the groin area or buttocks and sometimes on the inside of the knee or thigh.

  • Knees. A “grating” or “scraping” feeling when moving the knee. 

  • Fingers. Bony growths (spurs) at the edge of joints can cause fingers to become swollen, tender and red, sometimes with pain at the base of the thumb.

  • Feet. Pain and tenderness in the big toe, with possible swelling in the ankles or toes.


Potential Consequences

Pain, reduced mobility, side effects from medications and other factors associated with osteoarthritis can lead to health complications that are not caused by the disease itself.

Obesity, Diabetes and Heart Disease

Painful joints, especially in the feet, ankles, knees, hip or back, make it harder to exercise. But physical activity is not only key to managing OA symptoms, it also can help prevent weight gain, which can lead to obesity. Being overweight or obese can lead to the development of high cholesterol, type 2 diabetes, heart disease and high blood pressure.


Research indicates people with OA experience more falls and risk of fracture than those without OA. Although study results vary, some research shows they may have up to 30% more falls and have a 20% greater risk of fracture.


Medical history, a physical examination and lab tests help to make up the OA diagnosis. 

A primary care doctor may be the first person you talk to about joint pain.

Joint aspiration. After numbing the area, a needle is inserted into the joint to pull out fluid. This test will look for infection or crystals in the fluid to help rule out other medical conditions or other forms of arthritis.

  • X-ray. X-rays can show joint or bone damage or changes related to osteoarthritis.

  • MRI. Magnetic resonance imaging (MRI) gives a better view of cartilage and other parts of the joint.


There is no cure for OA, but medication, assistive devices and other therapies that don’t involve drugs can help to ease pain. As a last resort, a damaged joint may be surgically fused or replaced with one made of a combination of metal, plastic and/or ceramic.


Pain and anti-inflammatory medicines for osteoarthritis are available as pills, syrups, patches, gels, creams or injectables. They include:  

  • Analgesics. These are pain relievers and include acetaminophen and opioids. Acetaminophen is available over the counter (OTC); opioids must be prescribed by a doctor.

  • Nonsteroidal anti-inflammatory drugs (NSAIDs). These are the most commonly used drugs to ease inflammation and pain. They include aspirinibuprofennaproxen and celecoxib, available either OTC or by prescription. The OTC versions help with pain but not inflammation.

  • Counterirritants. These OTC products contain ingredients like capsaicin, menthol and lidocaine that irritate nerve endings, so the painful area feels cold, warm or itchy to take focus away from the actual pain. 

  • Corticosteroids. These prescription anti-inflammatory medicines work in a similar way to a hormone called cortisol. The medicine is taken by mouth or injected into the joint at a doctor’s office.

  • Viscous Hyaluronic Acid. Hyaluronic acid (HA) is a substance already in the fluid of your joints. When you have OA, the HA in your joints becomes lower and less effective. HA Injection is used to relieve knee pain due to osteoarthritis.

  • Platelet-rich plasma (PRP). Available from a doctor by injection, this product is intended to help ease pain and inflammation. This is not approved by the Food & Drug Administration and evidence is still emerging, so discuss it with your doctor before trying it.

  • Other drugs. The antidepressant duloxetine (Cymbalta) and the anti-seizure drug pregabalin (Lyrica) are oral medicines that are FDA-approved to treat OA pain.

Nondrug Therapies


Movement is an essential part of an OA treatment plan. Getting 150 minutes of moderate-to-vigorous exercise per week should be the goal, according to the U.S. Department of Health and Human Services. A good exercise program to fight OA pain and stiffness has four parts:

  • Strengthening exercises build muscles around painful joints and helps to ease the stress on them. 

  • Range-of-motion exercise or stretching helps to reduce stiffness and keep joints moving.

  • Aerobic or cardio exercises help improve stamina and energy levels and reduce excess weight.

  • Balance exercises help strengthen small muscles around the knees and ankles and help prevent falls.

Weight Loss

Excess weight puts additional force and stress on weight-bearing joints, including the hips, knees, ankles, feet and back, and fat cells promote inflammation. Losing extra weight helps reduce pain and slow joint damage. Every pound of weight lost removes four pounds of pressure on lower-body joints.


Physical Therapies and Assistive Devices
Physical therapists, occupational therapists and chiropractors can provide:

  • Specific exercises to help stabilize your joints and ease pain.

  • Information about natural treatments and products that can ease pain.

  • Instruction to make movement easier and to protect joints. 

  • Braces, shoe inserts or other assistive devices.



Joint surgery can improve pain and function. Joint replacement surgery replaces damaged joints to restore mobility and relieve pain. Hips and knees are the joints most commonly replaced. An orthopedic surgeon can determine the best procedure based on how badly damaged the joint is.


Practicing these habits can slow down OA, keep you healthier overall and delay surgery as long as possible. It is important to pursue a number of different self-care approaches simultaneously. They are listed below.

Maintain a Healthy Weight

Excess weight worsens OA. Combine healthy eating with regular exercise to maintain a healthy weight.

Control Blood Sugar

Many people have diabetes and OA. Having high glucose levels can make cartilage stiffer and more likely to break down. Having diabetes causes inflammation, which also weakens cartilage.

Maintain Range of Motion

Movement is medicine for joints. Make a habit of putting your joints through their full range of motion, but only up to the point where it doesn’t cause more pain. Gentle stretching, raising and lowering legs from a standing or seated position, daily walks and hobbies such as gardening can help. But listen to your body and never push too hard.

Protect Joints

Make sure to warm up and cool down when doing exercise. If you play sports, protects joints with the right gear. Use your largest, strongest joints for lifting, pushing, pulling and carrying. Watch your step to prevent falls. Balance rest and activity throughout the day.

Psoriatic Arthritis

Psoriatic Arthritis


What Is It?

Arthritis is a complex family of musculoskeletal disorders consisting of more than 100 different diseases or conditions that destroy joints, bones, muscles, cartilage and other connective tissues, hampering or halting physical movement. Psoriatic arthritis (PsA) is a type of chronic inflammatory arthritis associated with the chronic skin condition psoriasis, which is believed to be an inherited condition. Psoriasis, which affects about 2 percent of the U.S. population, most often causes patches of thick, reddened, irritated skin with flaky, silver-white patches called scales.

Psoriatic arthritis typically appears about 10 years after the onset of psoriasis, which can manifest at any age, though most people are diagnosed between the ages of 15 and 35. The main symptoms of psoriatic arthritis are:

  • painful, swollen joints

  • tenderness where muscles or ligaments attach to bones, particularly the heel and bottom of the foot

  • back pain

  • nail changes such as separating from the nail bed, or becoming pitted or infected-looking

  • morning stiffness

  • general fatigue

  • reduced range of motion

  • redness and pain in tissues surrounding the eyes (conjunctivitis)


What Are The Effects?

Psoriatic arthritis is an autoimmune disease that for unknown reasons causes the body’s own immune system to turn against itself. Inflammation can occur causing the synovium--tissue that lines the joint capsule and produces synovial fluid, which lubricates the joint and keeps it moving smoothly—to thicken resulting in a swollen joint.

Over time, the synovium invades the cartilage, elastic tissue that covers the ends of the bones in a joint. The cartilage in turn erodes, causing bones to rub together. As the joint weakens, so do its the surrounding structures, such as muscles, ligaments and tendons. Because this joint damage can occur early in the disease process, diagnosing psoriatic arthritis as quickly as possible and treating it properly are important.


How Is It Diagnosed?

Psoriatic arthritis can develop slowly, with mild symptoms, or onset can be sudden and severe. There is no easy way to diagnose psoriatic arthritis – no definitive lab or physical test exists to pinpoint it. If you have psoriasis and develop joint pain, your best bet is to have a rheumatologist, an internist who specializes in diagnosing and treating arthritis and related diseases, check you out. Many dermatologists and primary care physicians aren’t that familiar with PsA, which can mimic everything from osteoarthritis to rheumatoid arthritis to gout, and early diagnosis and treatment is critical to prevent damage later on. Doctors first look for common signs and symptoms:

  • general fatigue

  • tenderness, pain and swelling over tendons

  • swollen fingers and toes

  • stiffness, pain, throbbing, swelling and tenderness in one or more joints

  • reduced range of motion

  • morning stiffness and tiredness

  • nail changes – for example, the nail separates from the nail bed and/or becomes pitted and mimics fungus infections

  • redness and pain of the eye, such as conjunctivitis

The next step is to conduct a physical exam of your joints and skin. Your doctor may also order a MRI or CT scan to examine joints in greater detail. Or he might take skin, joint fluid or blood samples to rule out other forms of arthritis such as gout or RA.


What Are The Treatment Options?

There is no cure for psoriatic arthritis. The goal of treatment is to reduce joint pain and swelling, preserve joint function, slow or prevent joint damage and control psoriasis on the skin. Treating PsA centers in part on managing the symptoms. Nonsteroidal anti-inflammatory drugs (NSAIDs) do a good job of reducing pain, swelling and inflammation. However, they can cause stomach distress and ulcers. They may increase the risk of heart attack in some people. Oral and injectible corticosteroids control inflammation, but aren’t recommended for frequent or long-term use.

Other drugs address the disease process itself – disease-modifying antirheumatic drugs (DMARDs) are frequently prescribed, as are biologic response modifiers. Your physician may recommend using two or more together. Some medications affect the immune system or have other side effects, making careful monitoring very important. Engaging in physical activity is an important component of treatment because it can limit the pain and swelling of arthritis that results in stiff joints. Heat and cold treatments may be another option.



What Is It?

Arthritis is a complex family of musculoskeletal disorders consisting of more than 100 different diseases or conditions that destroy joints, bones, muscles, cartilage and other connective tissues, hampering or halting physical movement. Gout is a form of inflammatory arthritis that causes sudden, severe pain, swelling and tenderness – most often in the large joint of the big toe. However, gout isn’t limited to the big toe; it can affect other joints including the feet, ankles, knees, hands, wrists, elbows and sometimes soft tissue and tendons. It usually affects only one joint at a time, but it can become chronic and, over time, affect several joints.

A gout attack can last anywhere from a few days to two weeks, if untreated.  The disease most commonly affects men and can manifest anywhere from age 30 onward. Women get gout too, although they are at a slightly lower risk, and it usually appears after menopause.


What Are The Effects?

For many people, the first symptom of gout is excruciating pain and swelling in the big toe – often following a trauma, such as an illness or injury. Subsequent attacks may occur off and on in other joints, primarily those of the foot and knee, before becoming chronic. In its chronic stage, gout can affect many joints, including those of the hands. Other problems related to gout can include the formation of tophi, or lumps of crystals under the skin, in the joints and in bone; kidney stones; and impaired kidney function.


How Is It Diagnosed?

A doctor who has experience with gout attacks may be able to recognize this type of inflammatory arthritis simply by evaluating signs and symptoms.

The only way for your doctor to make a definite diagnosis of gout is to examine synovial fluid – a lubricating liquid found inside your joints – under a microscope. The presence of uric acid crystals signifies gout. Blood tests can determine if your uric acid levels are elevated, but not everyone with a high level of uric acid develops gout.


What Are The Treatment Options?

Although gout is chronic, it can be controlled – and you can get on with living your life. Once your doctor has confirmed a gout diagnosis, you’ll work together to come up with a treatment plan likely involving both medication and lifestyle changes.

The first objective will be to relieve the pain and inflammation of the current gout attack. Once the gout attack is under control, which can take a few hours or a couple of days, you and your doctor will focus on managing the disease long-term. Your efforts will center on preventing future attacks, avoiding the long-term damage to your joints and chronic pain associated with uncontrolled gout.

Healthy Lifestyle Changes

The foods you eat aren't the cause of gout. But a high-purine diet can trigger gout attacks if you already have a high uric acid level. Maintaining a healthy weight and getting regular exercise is an important part of your overall health. So it makes sense to talk with your doctor about how improving your diet and getting more exercise can help make a difference for you.


Make sure you discuss your whole health picture with your doctor. If you notice that you have gout attacks after different foods and drinks, it's a good idea to avoid those choices. You should be aware that changing your diet alone isn't usually enough to reduce uric acid levels. In fact, even when people followed the strictest low-purine diet, they generally don't reduce their uric acid levels by much more than 1 mg/dL. Any reduction in uric acid level is positive, but you'll most likely need to do more to lower your level to the recommended target level of less than 6 mg/dL.

Healthy Tips

The role that diet plays in gout is often misunderstood, but here are some good tips that you can discuss with your doctor:

  • Drink plenty of liquids, like water. Fluids like water help remove uric acid from the body.

  • Add low-fat dairy products to your diet. Eating more of these dairy products is associated with a lower risk of gout.

High-Purine Foods

A high-purine diet is one of many things that can trigger gout attacks if you already have a high uric acid level. Limiting or avoiding these foods may help avoid triggering an attack:

Talk to your doctor about a comprehensive treatment plan that addresses healthy lifestyle changes, including diet and exercise, pain management for gout attacks, and the long-term treatment of high uric acid that causes gout.




What Is It?

Osteoporosis can cause bones to become brittle and weak, putting a person a risk of fracture. 

Bones, made up of calcium and other minerals, are constantly being broken down and rebuilt. In people with osteoporosis, bone tissue breaks down faster than it is replaced. The bones become less dense (thinner) and brittle and are more likely to break (fracture) with pressure or after a fall. Bone loss happens without any warning signs. Therefore, osteoporosis is called a “silent disease.” Osteoporosis is different from osteoarthritis, a form of arthritis in which joint cartilage, the rubbery material that covers the ends of bones, wears away. 

During and after menopause, when estrogen (hormone) levels drop, women lose bone mass faster. About five to 10 years after menopause starts, women can lose up to one-third of their bone mass. Men also lose bone mass as they age, but women tend to lose it faster. 

Each year, in the United States, osteoporosis contributes to more than 1.5 million fractures of the back/spine, wrists and hips.


The amount of bone mass a person has as a young adult, and the rate at which it is lost with aging, determines one's risk for osteoporosis. In addition to age, gender, family history, certain medical conditions and procedures, lifestyle habits and medication use also play a role.
Osteoporosis is more common in:

  • Women, especially those who are past menopause or who are elderly.

  • Women who have had their ovaries removed through a hysterectomy.

  • Women who don’t exercise regularly or who exercise so much that menstrual periods stop.

  • Men with low levels of testosterone.

  • Individuals who are thin or have small body frames.

  • Individuals with a family history of osteoporosis, or who are of Caucasian or Asian ancestry.

  • Individuals with a history of bone fractures after a minor injury.

  • Individuals with an inflammatory form of arthritis, such as rheumatoid arthritispsoriatic arthritislupusankylosing spondylitis or reactive arthritis

  • Individuals who take drugs that reduce bone mineral density such as corticosteroids (cortisone, prednisone or methylprednisolone), anticonvulsants (anti-seizure medications), a class of antidepressants known as selective serotonin reuptake inhibitors (SSRIs) or heparin, a blood thinner.

  • Individuals with celiac disease (allergy to gluten), inflammatory bowel disease (IBD), hyperthyroidism, chronic obstructive pulmonary disease (COPD), multiple myeloma (bone marrow cancer), thyroid or parathyroid disease.

  • Individuals who have had bariatric surgery

  • Individuals who smoke or drink three or more alcoholic beverages a day

  • Individuals with a history of anorexia nervosa or other eating disorders

  • Individuals who have had long periods of immobility or bed rest

People who have one or more of these risk factors should talk to a doctor about ways to reduce the risk of osteoporosis and whether a bone density test is needed.


Osteoporosis is a silent disease that causes few outward signs or symptoms. Because osteoporosis develops over the years, a person may not be aware they have it until there is a broken bone, loss of height, or noticeable hump in the upper back. 
Other symptoms of osteoporosis are:

  • Tooth loss. This may be a sign that osteoporosis has affected the jawbone.

  • Back pain. A fracture or a collapsed vertebra in the spine may mean you have developed spinal osteoporosis.


Osteoporosis develops slowly over the years. Symptoms such as tooth loss or back pain may be mistakenly attributed to something else. Anyone who has a family history of osteoporosis or risk factors for the disease should discuss their chances of getting it with a doctor

The doctor will make a diagnosis of osteoporosis by considering several factors, including: 

  • Health history and physical -- The doctor will perform a physical examination and ask questions about the patient's personal and family medical history, medications, diet and fracture history.

  • Blood and urine tests.  These tests help to rule out other diseases that weaken bones.

  • Bone density scan -- Bone-density measurement is quick and painless. The most accurate test is called a dual-energy X-ray absorptiometry (DEXA) scan.


The United States Preventive Services Task Force recommends an initial bone density test at age 65, or age 60 if you are taking corticosteroids. People with rheumatoid arthritis should have a baseline bone density test when diagnosed with that condition.

Bone-density tests should be also done for:

  • Women as early as age 50 if they have a high risk for osteoporosis

  • Individuals who are taking, or have taken, long-term corticosteroids or expect to do so

  • Individuals with a personal history or family history of fractures

  • Individuals who have diseases that affect calcium absorption or bone strength


Treatment for osteoporosis involves slowing the rate of bone lose or increasing the rate of bone formation. There are two types of medications for this.  

  • Drugs that slow the rate of bone loss are called antiresorptive medications.

  • Drugs that increase the rate of bone formation are called anabolic medications.

Until somewhat recently, estrogen hormone replacement therapy (HRT) was the traditional way to prevent osteoporosis as well as treat menopausal symptoms. However, recent evidence suggests estrogen can increase the risk of breast cancer, stroke and heart attack. Because of this, estrogen supplementation after menopause is usually not used to prevent osteoporosis.

Antiresorptive Medications include:

Alendronate (Binosto, Fosamax)

Ibandronate (Boniva)

Risedronate (Actonel)

Zoledronic acid (Reclast)

Denosumab (Prolia)

This is a naturally occurring hormone that decreases bone breakdown. It is FDA-approved for osteoporosis treatment but not prevention. Calcitonin controls bone breakdown and may ease pain in people with spine fractures. It’s available as a nasal spray or an injection (Miacalcin, Fortical). 

These drugs work like estrogen, but with fewer side effects. Raloxifene (Evista) is an FDA-approved SERM for the treatment and prevention of postmenopausal osteoporosis. In 2013, the FDA approved Duavee, a combination product containing the SERM bazedoxifene and conjugated estrogens for menopausal symptoms and osteoporosis. 

Anabolic Medications include:

Teriparatide (Forteo)

Abaloparatide (Tymlos)

Romosozumab (Evenity)



Self Care

  • Taking a proactive part in osteoporosis treatment is important.

  • Vitamin D level should be in the range 40-100. Talk to you doctor about the right amount of daily supplementation or the need for vitamin D prescription.

  • Smoking cessation

  • Calcium supplementation in smokers and breast feeding women.

  • Exercises or other physical activities that strengthen bones can help maintain bone mass. Weight-bearing and resistance exercises are especially beneficial.

Ankylosing Spondylitis

Ankylosing Spondylitis

Axial spondyloarthritis (axSpA) mostly affects the spine. It can cause damage visible on X-ray (ankylosing spondylitis) or damage that doesn’t show up on X-rays (nonradiographic axSpA).

Axial spondyloarthritis (axSpA) is a type of arthritis. It mostly causes pain and swelling in the spine and the joints that connect the bottom of the spine to the pelvis (sacroiliac joint). Other joints can be affected as well. It is a systemic disease, which means it may affect other body parts and organs. The disease tends to run in families. 
There are two types of axSpA:

  • Radiographic axSpA (also called ankylosing spondylitis or AS) includes damage to the sacroiliac joints and spine that can be seen on X-rays.

  • Nonradiographic axSpA (nr-axSpA) does not include damage you can see on X-rays but it may show up on magnetic resonance images (MRIs).

The disease can occur at any age, but typically begins between ages 20 and 40. AS is more common in men than in women. However, nr-axSpA may be just as common in women as in men. It is less common among African Americans than people of other racial backgrounds.


What Are The Symptoms?

Low back, buttocks and hip pain are usually the first symptoms. Children, however, may have pain in the hips, knees or heels before the back. 

Symptoms of axSpA include:

  • Pain in the low back, buttocks and hips that develops slowly over weeks or months.

  • Pain, swelling, redness and warmth in the toes, heels, ankles, knees, rib cage, upper spine, shoulders and neck. 

  • Stiffness when first waking up or after long periods of rest.

  • Back pain during the night or early morning. 

  • Fatigue.

  • Appetite loss. 


What Are The Health Effects?

Joints:   Over time, the joints and bones of the spine may grow together (fuse). This usually happens at the base of the spine first. This causes the back to become stiff and hard to move. The rib cage may also fuse, making chest expansion difficult. 

Eyes: Chronic eye inflammation (uveitis) causes dryness, pain, redness, sensitivity to light and vision problems. The white part of the eye may also get inflamed and red (called scleritis).

Digestive Tract: Inflammation may cause abdominal pain and diarrhea.

Heart: Though uncommon, inflammation may affect the largest artery that leads to the heart (aorta). People with axSpA also have an increased risk for heart attack and stroke.
Lungs: Complications affecting the lungs are rare. Inflammation may cause shortness of breath and impaired lung function.



The most common symptom of axSpA, which often affects the joints where the spine meets the pelvis, is pain in the lower back, buttocks and hips.


It can also affect shoulders, knees, toes and fingers, as well as the eyes and gastrointestinal tract, and symptoms often begin in the teen and young adult years.


No single test can detect axSpA. It may involve a physical exam, blood and imaging tests and the doctor’s judgment.

Other signs of axSpA might include:

  • Symptoms that come on gradually.

  • Pain that lasts at least three months.

  • Nighttime pain and morning stiffness.

  • Less pain with movement.

  • Blood tests that indicate bodywide inflammation.

  • A positive HLA-B27 gene test and X-rays or MRIs showing changes in the pelvic joints may also point to axSpA but don’t confirm it.


There is no cure for axial spondyloarthritis but treating it quickly and aggressively can.

  • Ease back pain and help maintain your posture

  • Prevent joint damage

  • Help you maintain mobility and quality of life

Symptoms vary widely.

Treatment may include activities and medications:

  • Exercise, which is essential for pain relief and range of motion in your neck and back.

  • Posture training.

  • Nonsteroidal anti-inflammatory drugs (or NSAIDS), commonly used for axSpA, include over-the-counter or prescription medications.

  • Corticosteroid (steroid) shots may ease joint pain and swelling but are not used in the spine.

  • Biologics tamp down inflammation that drives the disease. Biologics used for axSpA include tumor necrosis factor (or TNF) blockers and interleukin-17 (or IL-17) blockers, but not everyone with axSpA needs these powerful drugs.

Steps you can take to relieve symptoms include:

  • Regular, low-impact physical activity, such as walking

  • Quitting smoking, which can worsen disease and make some medications less effective

  • Hot and cold therapy

  • Relaxation, such as deep breathing and mindful meditation.

Systemic Lupus Erythematosus (SLE)

Systemic Lupus Erythematosus (SLE)


What Is It?

Arthritis is a complex family of musculoskeletal disorders consisting of more than 100 different diseases or conditions that destroy joints, bones, muscles, cartilage and other connective tissues, hampering or halting physical movement. Lupus is one of many disorders of the immune system known as autoimmune diseases. In autoimmune diseases, the immune system turns against the body it's designed to protect for unknown reasons. Most often when people speak of lupus, they are speaking of systemic lupus erythematosus (SLE) and it is what this article primarily is about. SLE is an inflammatory, autoimmune disease that affects nearly every organ system in the body, including the skin, joints, kidneys, heart, lungs, and central nervous system. SLE is only one type of lupus.


What Are The Effects?

There are myriad symptoms associated with systemic lupus erythematosus (SLE or lupus). Every organ system is affected and each system can be affected in different ways. Fatigue is one of the most prominent and life-affecting symptoms. Nearly everyone with lupus experiences fatigue, and it can be debilitating. Pacing your activities and getting adequate rest can help to ease fatigue and not allow it to take over your day. Joint pain, another prominent symptom, is what most commonly initiates the first doctor visit.

How Is It Diagnosed?

Because systemic lupus erythematosus (SLE or lupus) affects so many different organ systems and because different symptoms are manifest at different times, the diagnosis of lupus can take a long time and may be frustrating for both you and your doctor. When diagnosing lupus, it is important to rule out other diseases, such as rheumatoid arthritis, that have similar features. Your doctor may complete a family and medical history, do a physical exam, take x-rays and complete laboratory tests in order to diagnose you.

What Are The Treatment Options?

The treatment plan for systemic lupus erythematosus (SLE or lupus) starts with teaching yourself about the disease and about ways you can help yourself and help your doctor. Make sure your doctor knows about any other diseases or conditions that you have, because they may affect your lupus symptoms or the medications that can be prescribed. Likewise, be sure your doctor knows about all the medications you take (prescription and over the counter), as well as all the vitamins and supplements you take. A well-rounded treatment plan may include medications, diet and exercise.


Lupus is an autoimmune disease, which means that the body’s immune system attacks healthy tissues by mistake. This response can cause inflammation to occur throughout the body, including the blood vessels, heart, skin, kidneys, joints, lungs, and brain. 

While lupus can affect different people in different ways, the inflammation that causes these symptoms is chronic.

Long-term inflammation is also where your diet can help make a difference. An anti-inflammatory diet pattern may help cut back on flares.


What Foods Should You Avoid with Lupus?

There are some foods that may induce flares in people with lupus, but good research on this is lacking. Many recommendations are based on small studies or anecdotal reports.


Alfala sprouts: Some research in animals links alfalfa sprouts with lupus flares, thanks to a compound called L-canavanine that can stimulate the immune system. As a result, many doctors recommend that people with lupus stay away from alfalfa sprouts on salad bars, sandwiches, and wherever else they might be found.

Garlic: Garlic is another food that some experts suggest staying away from if you have lupus. The flavorful herb contains compounds that rev up the immune system and may cause an unwanted response in people with lupus who already have an overactive immune system.

Nightshade vegetables: Since lupus is a very individual disease, you may also find certain foods can trigger your symptoms while other people with lupus can eat them without an issue. Some report that nightshade vegetables like eggplant, potatoes, and tomatoes can be detrimental, however there is no research to suggest avoiding them unless you find they impact you personally.

If you have lupus, you should also avoid:

  • Bactrim and Septra: These are antibiotics that contain sulfamethoxazole and trimethoprim. However, it is very important that you avoid Bactrim and Septra, because these antibiotics are known to cause an increase in sun sensitivity and lower blood counts in people with lupus, resulting in lupus flares.

  • Echinacea: It is often used as a dietary supplement to boost the immune system against colds and other illnesses. However, because Echinacea boosts your immune system, it may cause flares in people with autoimmune diseases such as lupus.

  • Melatonin: It is also not recommended if you have an autoimmune disease or are an older adult with dementia. In some studies, melatonin has shown a tendency to stimulate inflammation in people with certain autoimmune disorders


Anti-Inflammatory Foods to Eat with Lupus

Here are some of the top anti-inflammatory foods to focus on:

Fish: The omega-3 fatty acids EPA and DHA that are found in fatty fish like salmon and mackerel can inhibit inflammation in several different ways. 

Walnuts, flaxseeds, canola oil: These foods provide the vegetarian form of omega-3 fatty acid, known as ALA. While your body converts ALA to EPA and DHA at a relatively slow rate, you may still get some benefit from these foods, particularly if you don’t eat fish. If you don’t eat fish at all due to an allergy or being vegetarian, you may also want to consider an algae-based omega-3 supplement.

Fruits and vegetables: Colorful produce like spinach, collard greens, blueberries, and oranges contain antioxidants and polyphenols, natural plant compounds that may help counter inflammation. Aim for at least five servings each day, and try to get a range of colors in your diet.

Whole grains: Grains are made of three parts: the bran, germ, and endosperm. Unfortunately many of the carbohydrate foods we eat are made from grains that have been stripped of the nutritious bran and germ. Research links a high intake of refined grain foods with higher levels of inflammatory markers in the body. Instead, focus on foods like brown rice, quinoa, and whole grain bread that are good sources of fiber and antioxidants.




Scleroderma, which means “hard skin,” is a rare disease that affects the skin and connective tissue (fibers that provide structure and support to the body). There are two types of scleroderma – localized and systemic (sometimes called

systemic sclerosis). 

Localized scleroderma mainly affects the skin and is more common in children; systemic scleroderma may affect many body parts and is more common in adults. Roughly 300,000 people in the United States have scleroderma and about one-third of those people have the systemic form. It is more common in women than men.


What Are The Causes?

People with scleroderma produce too much collagen, a key part of connective tissue. Too much collagen makes the skin thicken and harden. In some cases, it may also cause organ tissues to harden, which can affect the way the organ works. Experts aren’t sure what causes excess collagen, but they suspect an improperly working immune system plays a role

What Are The Symptoms?

Localized Scleroderma

This type mainly affects the skin, but also can affect tissues beneath the skin. There are two types of localized scleroderma: 

  • Linear scleroderma causes lines or streaks of thickened skin to form over an area of the body, such as an arm, leg or the head. It may cause ulcers on the skin when the tissues are damaged. 

  • Morphea causes one or more hard, oval-shaped, whitish or darkened patches of skin. 

In many cases, the skin will soften, and patches will clear up on their own within three to five years.

Systemic Scleroderma

This type can affect many parts of the body, including the skin and internal organs. There are two types of systemic scleroderma: 

Limited Scleroderma affects the skin on the face, fingers, hands, and lower arms and legs. The first signs of systemic scleroderma are often cold sensitivity ( and puffy fingers. . This can cause numbness, pain and a white or bluish appearance to the fingers (Raynaud’s phenomenon). Symptoms worsen in cold weather or when handling cold objects.  These symptoms can begin several years before other symptoms. The effect on internal organs tends to be mild. Some patients with limited scleroderma have CREST syndrome, which involves 

  • Calcinosis (calcium deposits in the skin). 

  • Raynaud's phenomenon (fingers and/or toes become white or bluish and cold or numb). 

  • Esophageal dysmotility (difficulty swallowing). 

  • Sclerodactyly (tight skin on the fingers). 

  • Telangectasias (red spots on the skin).


Diffuse Scleroderma

Diffuse scleroderma involves widespread skin thickening over any part of the body, especially the hands, arms, thighs, chest, abdomen and face. Blood vessels, heart, joints, muscles, esophagus, intestines and lungs may also be damaged. The severity of internal organ involvement varies.

Sjogren’s Syndrome causes dryness in the eyes, mouth and vagina. Approximately 20 percent of people with systemic scleroderma develop this condition.

  • Hardening of the skin, muscle and bone can limit range of motion in the joints.  

  • Hardening of tissues of the digestive tract can cause heartburn, difficulty swallowing, problems with nutrient absorption, and constipation.

  • Hardening of heart tissues can cause a variety of heart troubles, including abnormal heartbeat, heart failure, and increased pressure in the heart.

  • Scarring of lung tissue can make it hard to breathe. Pulmonary hypertension (high blood pressure in the arteries to your lungs) is also possible.

  • Scarring of the kidney tissue may cause high blood pressure and, if left untreated, kidney failure.

How Is It Diagnosed?

Because the disease can take many forms, scleroderma may be difficult to diagnose. A medical history, physical exam and laboratory tests can help rule out other conditions. The doctor may remove a small tissue sample (biopsy) of the affected skin to check for abnormalities. A variety of lab and imaging tests may be used to check for signs of organ damage.

How Is It Treated?

There is no cure for scleroderma, but treatment can help manage symptoms. Because symptoms vary greatly, treatment options are broad, and include a range of medications and self-care practices. Depending on which body parts are affected, several specialists may be involved in care, including a rheumatologist (a doctor who specializes in musculoskeletal diseases), a dermatologist (skin doctor), and those who treat specific organs.

Can Medications Help?

There is no drug to treat the underlying cause of scleroderma — too much collagen. But several medications can control symptoms and prevent complications. Medications for internal organ problems depend on the organ involved. 

  • Topical creams. Medications and moisturizers treat hardened skin and prevent it from drying out.   

  • Vasodilators/ blood pressure medications. Drugs to open blood vessels can improve circulation to treat Raynaud’s phenomenon and manage hypertension.   

  • Anti-inflammatory medications. Nonsteroidal anti-inflammatory drugs and corticoste/Drug-Guide/Corticosteroids/Corticosteroidsroids reduce joint, muscle, heart and lung inflammation.  

  • Immunosuppressive drugs. Drugs that suppress the immune system may help in some cases but are still under investigation.

Physical Therapy

Physical therapists can help keep skin and joints flexible by teaching strengthening and range-of-motion exercises. 

Phototherapy, which involves brief exposure to artificial UV light, may help soften skin and reduce severe skin symptoms.

Sjögren's Syndrome

Sjögren's Syndrome

What Is It?

Arthritis is a complex family of musculoskeletal disorders consisting of more than 100 different diseases or conditions that destroy joints, bones, muscles, cartilage and other connective tissues, hampering or halting physical movement.


Sjögren’s syndrome is an autoimmune disease. A healthy immune system normally protects the body from harm, but in a person with an autoimmune disease, the body’s immune system attacks its own tissues and cells. Sjögren’s syndrome affects the salivary and lacrimal glands, which supply moisture to the eyes and mouth. It causes a reduction in the production of saliva and tears, leading to uncomfortable dryness in the mouth and eyes.

Sjögren’s syndrome is classified as either primary or secondary. The secondary form is diagnosed in people who already have another autoimmune disease such as systemic lupus erythmatosus or rheumatoid arthritis. Sjögren’s syndrome cases are fairly equally divided between primary and secondary.

What Are The Effects?

Primary Sjögren’s syndrome moves more quickly and causes decreased function in the lacrimal and salivary glands. Secondary Sjögren’s syndrome generally causes less severe dryness in the mouth and eyes; however, patients must manage both the effects of their primary disease in addition to secondary Sjögren’s.

Because it is a systemic condition, Sjögren’s syndrome affects the entire body. It can also cause fatigue, dry skin, chronic dry cough and vaginal dryness. Some people with Sjögren’s syndrome will experience joint pain, stiffness and swelling or numbness and tingling in their extremities. Less common symptoms include rashes and inflammation of the lungs, kidneys or liver. Sjögren’s syndrome that manifests more than just moisture-producing glands is called extraglandular.

One of the most serious concerns facing people with Sjögren’s syndrome is an elevated risk of developing lymphoma, cancer involving the lymphatic system. Though only a small percentage of people with Sjögren’s syndrome develop lymphoma, your doctor should pay particular attention if your major salivary gland is enlarged or rapidly changes size.  Lymphoma can involve the salivary glands, lymph nodes, the gastrointestinal tract and the lungs.

How Is It Diagnosed?

There is no single test to definitively diagnose Sjögren’s syndrome. Because Sjögren’s symptoms mimic those of many other diseases, it can often take years to make a proper determination.


To accurately diagnose Sjögren’s syndrome, your doctor will review your medical history, complete a physical exam and perform some lab tests. She will evaluate your overall health, your family’s medical history and ask questions about your lifestyle, including alcohol and tobacco use. Side effects of certain medications can mimic the dry eyes and dry mouth symptoms of Sjögren’s syndrome, so be sure to tell your doctor if you’re taking any medications.

What Are The Treatment Options?

Currently, there is no cure for Sjögren’s syndrome; however, effective treatments are available to manage its symptoms. You will likely see a rheumatologist, a doctor specializing in rheumatic diseases, who will coordinate your care, possibly along with an entire team of healthcare providers.

You should see an ophthalmalogist to manage your eye care and an otolaryngologist to care for your mouth and throat. It’s important to understand that no two patients experience Sjögren’s syndrome in the same way; therefore, a personalized and closely monitored treatment plan is essential.

Various over-the-counter eye drops are available to help ease eye dryness. Your doctor might also prescribe lubricating ointments. Joint pain or inflammation can be treated with nonsteroidal anti-inflammatory drugs (NSAIDs). She may administer corticosteroid medications, which mimic natural anti-inflammatory hormones, to contain organ inflammation in the lungs, liver or kidneys.

If your doctor determines that your overactive immune system needs to be controlled further to prevent organ damage, he may prescribe disease-modifying anti-rheumatic drugs (DMARDs) – medications that actually impede disease progress.



What Is It?

Arthritis is a complex family of musculoskeletal disorders consisting of more than 100 different diseases or conditions that destroy joints, bones, muscles, cartilage and other connective tissues, hampering or halting physical movement. Myositis is defined as the inflammation of muscles (“myo” means muscle and “itis” means inflammation). The inflammatory myopathies are a group of disorders characterized by inflammation and weakness mainly of the muscles closest to the trunk of the body (proximal muscles). These disorders include polymyositis, dermatomyositis and inclusion body myositis. Myositis may be associated with inflammation in other organs, including the joints, heart, lungs, intestines and skin. In dermatomyositis, a rash develops in addition to the muscle inflammation.

What Are The Effects?

Each of the disorders associated with Myositis have different effects.

Characteristics of Polymyositis can include:

  • Flares: Flares usually are recognized by increasing symptoms of muscle weakness, fatigue, skin changes or arthritis.

  • Proximal muscle weakness: Symmetric weakness of the large muscles closest to the trunk of the body is the main symptom of polymyositis. Initially, hips, thighs and shoulders are commonly affected. Shoulder and pelvic girdle muscles are most severely affected. The weakness may make it difficult to lift heavy objects, climb stairs, or lift your arm to comb hair or put on a coat.

  • Lung problems: Polymyositis can cause weakness of the muscles required for breathing. It may also cause fibrosis (build up of excessive scars tissue) of the lungs, which results in coughing and shortness of breath.

  • Systemic symptoms: You may experience fever, weight loss, general malaise and Raynaud’s phenomenon (an extreme sensitivity and discoloration to cold, especially in your fingers).

  • Joint pain: Pain in the joints commonly occurs during periods when the disease is active, but the joints are not usually warm or swollen.

Dermatomyositis is an inflammatory muscle disease, like polymyositis; however, it has a somewhat severe onset and affects both children and adults. Clinical features of dermatomyositis include all those of polymyositis, plus a variety of skin manifestations.

Juvenile dermatomyositis differs from the adult form because of the coexistence of vasculitis (inflammation of blood vessels), calcium deposits and defective metabolism of fat. In juvenile dermatomyositis, the skin lesions and weakness almost always occur at the same time, but the severity and progression of each symptom varies from patient to patient.

Inclusion body myositis mainly affects older individuals. The symptoms begin and progress slowly. Symptoms often are present for five to six years before diagnosis. Swallowing difficulties are noted in more than 20 percent of patients. As muscle weakness becomes severe, it is accompanied by muscle wasting and diminished deep-tendon reflexes. Unlike polymyositis and dermatomyositis, the muscle weakness is often not as symmetric, and may be prominent in the smaller muscles of the forearms and calfs

How Is It Diagnosed?

To diagnose myositis, your doctor will ask you a series of questions about your symptoms, perform a physical exam and order several laboratory tests.

What Are The Treatment Options?

Treatments can include rest, physical therapy and medications such as corticosteroids or DMARDS

Polymyalgia Rheumatic

Polymyalgia Rheumatic

Polymyalgia rheumatica (sometimes referred to as PMR) is a common cause of widespread aching and stiffness that affects adults over the age of 50, especially Caucasians. Because polymyalgia rheumatica does not often cause swollen joints, it may be hard to recognize. It may occur with another health problem, giant cell arteritis.

The average age when symptoms start is 70, so people who have PMR may be in their 80s or even older. The disease affects women somewhat more often than men. It is more frequent in whites than nonwhites, but all races can get PMR.


What Is It?

Polymyalgia rheumatica is an inflammatory disorder that causes muscle pain and stiffness, especially in the shoulders and hips. Symptoms tend to come on quickly, over a few days or weeks, and sometimes even overnight.

The signs and symptoms of polymyalgia rheumatica usually occur on both sides of the body and might include:

  • Aches or pain in your shoulders

  • Aches or pain in your neck, upper arms, buttocks, hips or thighs

  • Stiffness in affected areas, particularly in the morning or after being inactive for a time

  • Limited range of motion in affected areas

  • Pain or stiffness in your wrists, elbows or knees

You might also have more-general signs and symptoms, including:

  • Mild fever

  • Fatigue

  • A general feeling of not being well (malaise)

  • Loss of appetite

  • Unintended weight loss

  • Depression

This condition is related to another inflammatory condition called giant cell arteritis. Giant cell arteritis can cause headaches, vision difficulties, jaw pain and scalp tenderness. It's possible to have both conditions together.

What Causes Polymyalgia Rheumatica?

The cause of polymyalgia rheumatica (PMR) is unknown. PMR does not result from side effects of medications. The abrupt onset of symptoms suggests the possibility of an infection but, so far, none has been found. “Myalgia” comes from the Greek word for “muscle pain.” However, specific tests of the muscles, such as a blood test for muscle enzymes or a muscle biopsy (surgical removal of a small piece of muscle for inspection under a microscope), are all normal.

Recent research suggests that inflammation in PMR involves the shoulder and hip joints themselves, and the bursae (or sacs) around these joints. So, pains at the upper arms and thighs, in fact, start at the nearby shoulder and hip joints. This is what doctors call “referred pain.”

PMR should not be confused with fibromyalgia, a different syndrome that unlike PMR does not elevate typical markers of inflammation.


Monitoring for giant cell arteritis:

Your doctor will monitor you for signs and symptoms that can indicate the onset of giant cell arteritis. Talk to your doctor immediately if you have any of the following:

  • New, unusual or persistent headaches

  • Jaw pain or tenderness

  • Blurred or double vision or visual loss

  • Scalp tenderness


How Is Polymyalgia Rheumatica Diagnosed?

Polymyalgia rheumatica may be hard to diagnose. Because rheumatologists are experts in diseases of the joints, muscles and bones, they can recognize the diagnosis of PMR and expertly manage its treatment.

In PMR, results of blood tests to detect inflammation are most often abnormally high. One such test is the erythrocyte sedimentation rate (ESR), also called “sed rate.” Another test is the C-reactive protein, or CRP. Both tests may be very elevated in PMR but, in some patients, these tests may have normal or only slightly high results. Your health care providers should rule out other similar health problems, such as rheumatoid arthritis.

How Is Polymyalgia Rheumatica Treated?

  • Corticosteroids: If your doctor strongly suspects PMR, you will receive a trial of low-dose corticosteroids. Often, the dose is 10–15 milligrams per day of prednisone. If PMR is present, the medicine quickly relieves stiffness. The response to corticosteroids can be dramatic. Sometimes patients are better after only one dose. Improvement can be slower, though. But, if symptoms do not go away after two or three weeks of treatment, the diagnosis of PMR is not likely, and your doctor will consider other causes of your illness.


Nonsteroidal anti-inflammatory drugs (commonly called NSAIDs), such as ibuprofen, (Advil, Motrin, etc.) and naproxen (Naprosyn, Aleve) are not effective in treating PMR.

When your symptoms are under control, your doctor will slowly decrease the dose of corticosteroid medicine. The goal is to find the lowest dose that keeps you comfortable. Some people can stop taking corticosteroids within a year. Others, though, will need a small amount of this medicine for 2–3 years, to keep aching and stiffness under control. Symptoms can recur and often do if medicine is decreased too quickly. Because the symptoms of PMR are sensitive to even small changes in the dose of corticosteroids, your doctor should direct the gradual decrease of this medicine.


  • Calcium and vitamin D: Your doctor will likely prescribe daily doses of calcium and vitamin D supplements to help prevent bone loss as a result of corticosteroid treatment. The American College of Rheumatology recommends 1,000 to 1,200 milligrams of calcium supplements and 600 to 800 international units of vitamin D supplements for anyone taking corticosteroids for three months or more.

  •  Methotrexate: Joint guidelines from the American College of Rheumatology and the European League Against Rheumatism suggest using methotrexate (Trexall) with corticosteroids in some patients. This is an immune-suppressing medication that's taken by mouth. It might be useful early in the course of treatment or later, if you relapse or don't respond to corticosteroids.

  •  Kevzara has been used to treat rheumatoid arthritis. In 2023 it received a new FDA approved indication to treat PMR inpatients who do not respond to corticosteroids, cannot taper down Predniosne below 7.5 mg daily or can not tolerate corticosteroids.


Living with Polymyalgia Rheumatica

Once the stiffness has gone away, you can resume all normal activities, including exercise. Even low doses of corticosteroids can cause side effects. These include higher blood sugar, weight gain, sleeplessness, osteoporosis (bone loss), cataracts, thinning of the skin and bruising. Checking for these problems, including bone density testing, is an important part of follow-up visits with your doctor. Older patients may need medicine to prevent osteoporosis.

PMR can occur with a more serious closely related condition, giant cell arteritis. As such, you should see your doctor right away if you have PMR and you notice symptoms of headache, changes in vision, jaw pain, or fever.



What Is It?

Vasculitis is an autoimmune disease that causes inflammation and narrowing of blood vessels (arteries, veins and capillaries).  These vessels carry blood to and from the heart and the body’s organs.  

In severe cases, the condition can cause organ damage or death.  

Types of vasculitis are grouped according to the size of the blood vessels affected. Most types of vasculitis are rare and include: 

  • Large vessel – Polymyalgia rheumatic, Takayasu's arteritis, temporal arteritis (giant cell arteritis

  • Medium vessel – Buerger's disease, cutaneous vasculitis, Kawasaki disease, polyarteritis nodosa 

  • Small vessel – Behçet's syndrome, Churg-Strauss syndrome, cutaneous vasculitis, Henoch-Schönlein purpura, microscopic polyangiitis, granulomatosis with polyangiitis, Golfer's vasculitis, cryoglobulinemia 

Vasculitis symptoms may occur once or several times over several years. The disease  affects people of all ages, races and gender.

What Are The Causes?

Vasculitis occurs when the immune system mistakenly sees blood vessels as a foreign invader and attacks them. What causes this to happen isn't fully understood. These conditions can occur by themselves or with other rheumatic diseases, such as rheumatoid arthritis, systemic lupus erythematosus (SLE/ lupus) or Sjogrens syndrome. Other possible triggers include an infection (hepatitis B or C) or a medication side effect. Vasculitis also may be linked to certain blood cancers, such as leukemia and lymphoma.


What Are The Symptoms?

Signs and symptoms of vasculitis vary and can range from mild to life-threatening. They depend on the type of vasculitis, the organs involved and how severe the condition is. Some people may have few signs and symptoms. Other people may become very sick. Sometimes symptoms develop slowly, over months, while at other times, the signs and symptoms start quickly, over days or weeks.

Common symptoms include:

  • Fever.

  • Loss of appetite.

  • Weight loss.

  • Fatigue.

  • General aches and pains.

Vasculitis can affect  organs and body systems, causing a range of signs and symptoms including:

  • Skin – purple or red spots or bumps; clusters of small dots, splotches, bruises, or hives; itching.

  • Joints – aching or arthritis in one or more joints.

  • Lungs – shortness of breath; coughing up blood.

  • Gastrointestinal tract – sores in the mouth; stomach pain; in severe cases, blockage of blood flow to the intestines that can cause weakening or rupture of intestines.

  • Sinuses, nose, throat and ears – sinus or chronic middle ear infections; sores in the nose; in some cases, hearing loss.

  • Eyes – red, itchy, burning eyes; light sensitivity; blurred vision; rarely, blindness.

  • Brain – headaches; problems thinking clearly; changes in mental function; stroke-like symptoms, such as muscle weakness and paralysis.

  • Nerves – numbness, tingling and weakness in various parts of the body; loss of feeling or strength in hands and feet; shooting pains in arms and legs.

In severe cases, vasculitis can cause blood vessels to close off, so blood can’t flow through or they bulge and possibly burst (aneurysm).

How Is It Diagnosed?

Vasculitis is diagnosed based on signs and symptoms, medical history, a physical exam and test results.

  • Laboratory tests – blood and urine tests may show abnormal levels of certain blood cells and antibodies (proteins) in the blood.

  • Biopsy – this is often the best way to make a firm diagnosis of vasculitis. During a biopsy, the doctor takes a small sample of an affected blood vessel or organ to study under a microscope, looking for signs of inflammation or tissue damage.

Other possible tests and examinations the doctor may perform will depend on the symptoms and may include:

  • Angiography.

  • Urinalysis.

  • Echocardiogram.

  • Chest X-ray.

  • Lung function tests.

  • Abdominal ultrasound.

  • Computed tomography (CT) scan.

  • Magnetic resonance imaging (MRI).

  • Blood pressure measurement.

  • Electrocardiogram (EKG).

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