QUOTE FOR THURSDAY:

Jul23

“Juvenile arthritis (JA), also known as pediatric rheumatic disease, isn’t a specific disease.

JA is an umbrella term for various inflammatory and rheumatic diseases affecting children under 16, with juvenile idiopathic arthritis (JIA) being the most common type.  These conditions affect hundreds of thousands of kids and teens in the United States.

Most kinds of JA are autoimmune or autoinflammatory diseases. That means the immune system, which is supposed to fight against foreign invaders like viruses and germs, instead releases inflammatory chemicals that attack healthy cells and tissue. In most JA cases this causes joint inflammation, swelling, pain and tenderness, but some types of JA have few or no joint symptoms or only affect the skin and internal organs.

The exact causes of JA are unknown, but researchers believe that certain genes may cause JA when activated by a virus, bacteria or other external factors. There is no evidence that foods, toxins, allergies or lack of vitamins cause the disease.”

Arthritis Foundation (Juvenile Arthritis: Symptoms, Diagnosis, and Treatment | Arthritis Foundation)

 

Part I Juvenile Arthritis (JA)-What is actually is vs Adult Arthritis, the several types of JA, and if left untreated what can happen!

Jul23

What is Juvenile Arthritis (JIA) and how different is it than adults with a type of arthritis?

Like adults, children can develop arthritis. The most common type of chronic, or long-lasting, arthritis that affects children is called juvenile idiopathic arthritis (JIA). JIA broadly refers to several different chronic disorders involving inflammation of joints (arthritis), which can cause joint pain, swelling, warmth, stiffness, and loss of motion. The various forms of JIA have different features, such as the pattern of joints involved and inflammation of other parts of the body besides the joints. JIA may last a limited time, such as a few months or years, but in some cases it is a lifelong disease that requires treatment into adulthood.

JIA is “idiopathic,” meaning that its origins are not understood. While the exact causes of JIA are unknown, it begins when the immune system becomes overactive and creates inflammation.

With treatment, most children achieve periods of wellness (remission), and sometimes the disease goes away permanently with no further need for medications. It is important to see a doctor early if your child has swollen or stiff joints because delaying therapy can lead to joint damage, a lesser response to treatment, and other problems.

Who Gets Juvenile Idiopathic Arthritis (JIA)?

By definition, JIA begins in children and adolescents before the 16th birthday. Most types of the disease are more frequent in girls, but enthesitis-related JIA, a form of the disease that involves inflammation of the places where ligaments and tendons (flexible bands of tissue) attach to bones, is more common in boys. Systemic JIA, a rare type of JIA that features fever and rash, affects boys and girls equally. Children of all races and ethnic backgrounds can get the disease.

It is very rare for more than one member of a family to have JIA, but children with a family member with chronic arthritis, including JIA, are at a slightly increased risk of developing it. Having a family member with psoriasis is a risk factor for a form of JIA called psoriatic JIA.

There are many types of Juvenile Arthritis (JIA)with distinct features:

Generally, they all share arthritic symptoms of joint pain, swelling, warmth, and stiffness that last at least 6 weeks.

The types of JIA:

  • Oligoarticular juvenile idiopathic arthritis. This is the most common and mildest form, affecting four or fewer joints. It is considered persistent if symptoms continue for 6 months or longer, and extended if five or more joints become involved after 6 months of illness. Commonly affected joints are knees or ankles. A form of eye inflammation called chronic (long-lasting) uveitis can develop in children with this form of JIA. About half of children with JIA have this type.
  • Polyarticular juvenile idiopathic arthritis–rheumatoid factor negative. This is the second most common type, affecting five or more joints in the first 6 months. Tests for rheumatoid factor are negative. The rheumatoid factor blood test checks for autoimmune disease, especially rheumatoid arthritis, which is an adult form of arthritis. Some of these children develop chronic uveitis.
  • Polyarticular juvenile idiopathic arthritis–rheumatoid factor positive. A child with this type has arthritis in five or more joints during the first 6 months of the disease. Tests for rheumatoid factor, a marker for autoimmune disease, are positive. It tends to occur in preteen and teenage girls, and it appears to be essentially the same as adult rheumatoid arthritis.
  • Enthesitis-related juvenile idiopathic arthritis. This form of JIA involves both arthritis and enthesitis. Enthesitis happens when inflammation occurs where a ligament or tendon attaches to a bone. The most common locations for enthesitis are the knees, heels, and bottoms of the feet. Arthritis is usually in the hips, knees, ankles, and feet, but the sacroiliac joints (at the base of the back) and spinal joints can also become inflamed. Some children get episodes of acute anterior uveitis, a sudden onset of inflammation of the front of the eye. Unlike most other forms of JIA, enthesitis-related JIA is more common in boys.
  • Psoriatic juvenile idiopathic arthritis. Children with this type have psoriasis, a skin condition, as well as inflammation of the joints. The skin condition usually appears first, but sometimes painful, stiff joints are the first sign, with the skin disease occurring years layer. Pitted fingernails and dactylitis (swollen fingers or toes) are also signs of the disease.
  • Systemic juvenile idiopathic arthritis. Systemic means the disease can affect the whole body, not just a specific organ or joint. Systemic JIA usually starts with fever and rash that come and go over the span of at least 2 weeks. In many cases, the joints become inflamed, but sometimes not until long after the fever goes away, and sometimes not at all if treatment is started quickly. In severe forms, inflammation can develop in and around organs, such as the spleen, lymph nodes, liver, and linings of the heart and lungs. Systemic JIA affects boys and girls with equal frequency.
  • Undifferentiated arthritis. This category includes children who have symptoms that do not fit into any of the other types or that fit into more than one type.

If left untreated, uveitis can lead to eye problems such as cataracts, glaucoma, and vision loss, so it is important for children with JIA to have frequent eye exams.

  • Skin changes. Depending on the type of JIA a child has, he or she may develop skin changes. Children with:
    • Systemic JIA who have fevers can get a light red or pink rash that comes and goes.
    • Psoriatic JIA can develop scaly red patches of skin. Psoriatic JIA can also cause pitted nails and dactylitis (swollen fingers or toes).
    • Polyarticular JIA with rheumatoid factor can get small bumps or nodules on parts of the body that receive pressure, such as from sitting.
  • Fever. Patients with systemic JIA typically have daily fevers when the disease begins or flares. The fever usually appears in the evening, and the rash may move from one part of the body to another, usually happening with the fever. Patients with other types of JIA do not generally develop fevers.
  • Growth problems. Inflammation in children with any type of JIA can lead to growth problems. Depending on the severity of the disease and the joints involved, bones near inflamed  joints may grow too quickly or too slowly. This can cause one leg or arm to be longer than the other, or can result in a small or misshapen chin. Overall growth also may be slowed if the disease is severe. Growth normally improves when inflammation is well-controlled through treatment.

Tune in tomorrow on the causes, how its diagnosed and treated!

QUOTE FOR WEDNESDAY:

Jul22

“The causes of fibromyalgia are not known. But certain things can increase someone’s risk of developing it.

Risk factors or triggers

Risk factors or triggers may include:

  • Stressful or traumatic events, accidents, or injuries.
  • Repeat injuries, such as repeated joint stress from sports or physical jobs.
  • Illness, including viral infections.

Some people may be more likely to develop fibromyalgia

These include:

Center for Disease Control – CDC (facts about fibromyalgia – Search)

Part III Fibromyalgia – the treatment!

Jul22

How is Fibromyalgia treated?

There is no cure for fibromyalgia. However, symptoms can be treated with both non-drug and medication based treatments. Many times the best outcomes are achieved by using multiple types of treatments.

Non-Drug Therapies: People with fibromyalgia should use non-drug treatments as well as any medicines their doctors suggest. Research shows that the most effective treatment for fibromyalgia is physical exercise. Physical exercise should be used in addition to any drug treatment. Patients benefit most from regular aerobic exercises. Other body-based therapies, including Tai Chi and yoga, can ease fibromyalgia symptoms. Although you may be in pain, low impact physical exercise will not be harmful.

Cognitive behavioral therapy is a type of therapy focused on understanding how thoughts and behaviors affect pain and other symptoms. CBT and related treatments, such as mindfulness, can help patients learn symptom reduction skills that lessen pain. Mindfulness is a non-spiritual meditation practice that cultivates present moment awareness. Mindfulness based stress reduction has been shown to significantly improve symptoms of fibromyalgia.

You can also try other complementary therapies such as:

  • Massage therapy.
  • Movement therapy.
  • Chiropractic therapy.
  • Acupuncture.
  • Diet supplements.

Other complementary and alternative therapies (sometimes called CAM or integrative medicine), such as acupuncture, chiropractic and massage therapy, can be useful to manage fibromyalgia symptoms. Many of these treatments, though, have not been well tested in patients with fibromyalgia.

It is important to address risk factors and triggers for fibromyalgia including sleep disorders, such as sleep apnea, and mood problems such as stress, anxiety, panic disorder, and depression. This may require involvement of other specialists such as a Sleep Medicine doctor, Psychiatrist, and therapist.

Medications: The U.S. Food and Drug Administration has approved three drugs for the treatment of fibromyalgia. They include two drugs that change some of the brain chemicals (serotonin and norepinephrine) that help control pain levels: duloxetine (Cymbalta) and milnacipran (Savella). Older drugs that affect these same brain chemicals also may be used to treat fibromyalgia. These include amitriptyline (Elavil) and cyclobenzaprine (Flexeril). Other antidepressant drugs can be helpful in some patients. Side effects vary by the drug. Ask your doctor about the risks and benefits of your medicine.

The other drug approved for fibromyalgia is pregabalin (Lyrica). Pregabalin and another drug, gabapentin (Neurontin), work by blocking the over activity of nerve cells involved in pain transmission. These medicines may cause dizziness, sleepiness, swelling and weight gain.

It is strongly recommended to avoid opioid narcotic medications for treating fibromyalgia. The reason for this is that research evidence shows these drugs are not of helpful to most people with fibromyalgia, and will cause greater pain sensitivity or make pain persist. Tramadol (Ultram) may be used to treat fibromyalgia pain if short-term use of an opioid narcotic is needed. Over-the-counter medicines such as acetaminophen (Tylenol) or nonsteroidal anti-inflammatory drugs (commonly called NSAIDs) like ibuprofen (Advil, Motrin) or naproxen (Aleve, Anaprox) are not effective for fibromyalgia pain. Yet, these drugs may be useful to treat the pain triggers of fibromyalgia. Thus, they are most useful in people who have other causes for pain such as arthritis in addition to fibromyalgia.

For sleep problems, some of the medicines that treat pain also improve sleep. These include cyclobenzaprine (Flexeril), amitriptyline (Elavil), gabapentin (Neurontin) or pregabalin (Lyrica). It is not recommended that patients with fibromyalgia take sleeping medicines like zolpidem (Ambien) or benzodiazepine medications.

Always confirm with your doctor which RX is best and not contraindicated for you, for your safety!

QUOTE FOR TUESDAY:

Jul21

“Fibromyalgia affects an estimated 3.4% of women and 0.5% of men in the United States, or 3 million to 6 million Americans. It most commonly affects women of childbearing age or older. In fact, some estimates suggest that more than 7% of women in their 70s have fibromyalgia. Many people with fibromyalgia also have psychiatric problems such as depression, anxiety, or eating disorders, although the relationship between fibromyalgia and mental health disorders remains unclear.

While not a deadly disease, fibromyalgia can significantly impact one’s emotional well-being and overall quality of life. It strikes people of all ages, but it’s more common in women than men. It also runs in families. The risk of developing fibromyalgia is much higher if a first-degree relative, such as a parent or sibling, also has the condition.”

Harvard Health Publishing (Fibromyalgia – Harvard Health)

Part II Fibromyalgia – The symptoms and how its diagnosed!

Jul21

 

Signs and Symptoms of Fibromyalgia:

Fibromyalgia is a physical disorder, not a psychological condition. The most common constellation of Fibromyalgia symptoms (widespread chronic muscle pain, sleeplessness, relentless fatigue, cognitive dysfunction, and a host of other overlapping conditions like TMJD, IBS, migraine, interstitial cystitis, metabolic syndrome, endometriosis, and vulvodynia) can wax and wane over time.

Symptoms include:

  • Tenderness to touch or pressure affecting muscles and sometimes joints or even the skin
  • Severe fatigue
  • Sleep problems (waking up unrefreshed)
  • Problems with memory or thinking clearly

Some patients also may have:

  • Depression or anxiety
  • Migraine or tension headaches
  • Digestive problems: irritable bowel syndrome (commonly called IBS) or gastroesophageal reflux disease (often referred to as GERD)
  • Irritable or overactive bladder
  • Pelvic pain
  • Temporomandibular disorder – often called TMJ (a set of symptoms including face or jaw pain, jaw clicking, and ringing in the ears)

How Fibromyalgia is diagnosed:

A doctor will suspect fibromyalgia based on your symptoms. Doctors may require that you have tenderness to pressure or tender points at a specific number of certain spots before saying you have fibromyalgia, but they are not required to make the diagnosis (see the Box). A physical exam can be helpful to detect tenderness and to exclude other causes of muscle pain. There are no diagnostic tests (such as X-rays or blood tests) for this problem. Yet, you may need tests to rule out another health problem that can be confused with fibromyalgia.

Because widespread body pain is the main feature of fibromyalgia, health care providers will ask you to describe your pain. This may help tell the difference between fibromyalgia and other diseases with similar symptoms. Other conditions such as hypothyroidism (underactive thyroid gland) and polymyalgia rheumatica sometimes mimic fibromyalgia. Blood tests can tell if you have either of these problems. Sometimes, fibromyalgia is confused with rheumatoid arthritis or lupus. But, again, there is a difference in the symptoms, physical findings and blood tests that will help your health care provider detect these health problems. Unlike fibromyalgia, these rheumatic diseases cause inflammation in the joints and tissues.

 

Part I Fibromyalgia

Jul21

 

What is this disorder?

Fibromyalgia is a common neurologic health problem that causes widespread pain and tenderness (sensitivity to touch).  This invisible, life-altering condition causes 2-4% of women, men and children of all backgrounds worldwide to suffer. (That’s 10 million Americans alone.) The disorder can strike suddenly or occur as a gradual increase in symptoms, indicating changes in the central nervous system (neuroplasticity). Sensory information (such as light, sound, and touch) becomes amplified by the CNS, causing the brain to respond with increasing pain and symptoms. FM severity often increases over time and may become disabling.

The pain and tenderness tend to come and go, and move about the body. Most often, people with this chronic (long-term) illness are fatigued (very tired) and have sleep problems. The diagnosis can be made with a careful examination.

Fibromyalgia is most common in women, though it can occur in men. It most often starts in middle adulthood, but can occur in the teen years and in old age. You are at higher risk for fibromyalgia if you have a rheumatic disease (health problem that affects the joints, muscles and bones). These include osteoarthritis, lupus, rheumatoid arthritis, or ankylosing spondylitis.

Fibromyalgia is a disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory and mood issues. Researchers believe that fibromyalgia amplifies painful sensations by affecting the way your brain processes pain signals.

 Women are more likely to develop fibromyalgia than are men. Many people who have fibromyalgia also have tension headaches, temporomandibular joint (TMJ) disorders, irritable bowel syndrome, anxiety and depression.

Causes:

The causes of fibromyalgia are unclear. They may be different in different people. Current research suggests involvement of the nervous system, particularly the central nervous system (brain and spinal cord). Fibromyalgia is not from an autoimmune, inflammation, joint, or muscle disorder. Fibromyalgia may run in families. There likely are certain genes that can make people more prone to getting fibromyalgia and the other health problems that can occur with it. Genes alone, though, do not cause fibromyalgia.

There is most often some triggering factor that sets off fibromyalgia. It may be spine problems, arthritis, injury, or other type of physical stress. Emotional stress also may trigger this illness. The result is a change in the way the body “talks” with the spinal cord and brain. Levels of brain chemicals and proteins may change. More recently, Fibromyalgia has been described as Central Pain Amplification disorder, meaning the volume of pain sensation in the brain is turned up too high.

Although Fibromyalgia can affect quality of life, it is still considered medically benign. It does not cause any heart attacks, stroke, cancer, physical deformities, or loss of life.

While there is no cure for fibromyalgia, a variety of medications can help control symptoms. Exercise, relaxation and stress-reduction measures also may help.

Stay tune for Part II Monday on Signs, Symptoms and more!

QUOTE FOR MONDAY:

Jul20

“Soft tissue sarcomas form in cartilage, fat, muscle, blood vessels, tendons, nerves, and around joints. Osteosarcomas develop in bone; liposarcomas form in fat cells. Rhabdomyosarcomas form in muscle, and Ewing sarcomas form in bone and soft tissue.

About 22% of bone and joint cancer cases are diagnosed in those under age 20, while soft tissue cancers are more often diagnosed in those 55 years or older.”

American Association for Cancer Research – AACR (https://www.aacr.org/patients-caregivers/awareness-months/sarcoma-and-bone-cancer-awareness-month/)

QUOTE FOR MONDAY:

Jul20

“Fibromyalgia is a long-term condition that causes widespread muscle pain, fatigue and brain fog. It happens when your nervous system becomes more sensitive to pain signals. There isn’t a cure. But lifestyle changes, therapy and medication may help you manage flare-ups and improve daily life.

Research shows it involves changes in how your central nervous system processes pain. This system becomes more sensitive and amplifies pain signals. This means your body feels pain more strongly.

Symptoms often come and go in periods called flare-ups. There isn’t a cure, but treatment could help manage symptoms.”

Cleveland Clinic (Fibromyalgia: What It Is, Symptoms & Treatment)

 

Part II Sarcoma Awareness Month – Learn the symptoms, how its diagnosed, and the treatment!!

Jul20

Soft tissue sarcoma symptoms:

Like many forms of cancer, soft tissue sarcoma symptoms may appear at a more advanced stage of the disease, or you might not notice any symptoms at all. Symptoms, if they are present, will also vary depending on the type of sarcoma and its location.

Signs of soft tissue sarcoma include:

A lump or mass is the most common soft tissue sarcoma sign. The lump will form in the area in which the tumor is growing, and it may be accompanied by some pain if it is pressing on a nerve or muscle. Even if the lump isn’t painful, if it continues to grow, or if it is located deep within an extremity or body cavity, consult your doctor.

Uncomfortable swelling is another sign of soft tissue sarcoma, especially when it is located in the arms and legs.

Limited mobility may be a symptom of soft tissue sarcoma. Some tumors can restrict motion, such as those found in the hip, knee, shoulder or hands.

Skin lesions can occur when a sarcoma tumor breaks through the skin.

Other symptoms may be signs of soft tissue sarcoma, because a sarcoma tumor can form almost anywhere in the body and can therefore affect a variety of organs. For example, sarcomas in the abdomen may cause abdominal pain, vomiting or constipation, while sarcomas in the uterus may cause vaginal bleeding and/or abdominal pain. With gastrointestinal stromal tumors (GISTs), you may feel full after eating only very small meals, or you may vomit blood or have dark bowel movements.

Diagnosing Sarcoma:

If your doctor thinks you may have a sarcoma, you’ll probably need a full exam and tests, including: A sample of cells from the tumor, called a biopsy. A plain x-ray to imaging tests, such as a CT scan, an ultrasound, an MRI, a PET (Positron Emission Tomography) to help see inside your body. A bone scan, if you might have osteosarcoma.  Also a biopsy-several types of biopsies are used to diagnose sarcomas..

Treatment of Soft Tissue Sarcoma:

Surgery is typically the primary treatment for soft-tissue sarcoma, used to remove tumors. Chemotherapy, radiation therapy and/or targeted therapy may also be recommended, either alone or in combination with surgery, depending on the stage and extent of the disease, along with other factors.

Surgery

The goal of surgery is to locate and completely remove the soft tissue sarcoma tumor. Our pathologists then examine the tumor to determine whether or not additional treatment is necessary, and to reduce the risk of recurrence.

Chemotherapy

Chemotherapy may be used in combination with surgery and radiation therapy to treat advanced-stage soft tissue sarcoma. Chemotherapy drugs work to either destroy cancer cells or impede their ability to grow and reproduce.

At our hospitals, we are developing innovative therapies personalized to the care of each soft tissue sarcoma patient. Our medical oncologists work closely with soft tissue sarcoma patients to determine if chemotherapy is an appropriate treatment option. Throughout your soft tissue sarcoma treatment, your care team continually monitors the effect of chemotherapy on the disease, with physical exams, blood tests, CT scans, MRI scans and chest X-rays and imaging.

Radiation therapy

Depending on the type of soft tissue sarcoma you have and the extent of the disease, your soft tissue sarcoma treatment plan may include radiation therapy. Though surgery is usually the main treatment approach for soft tissue sarcoma, radiation treatments may also be used before (neoadjuvant therapy) or following surgery (adjuvant therapy).

Targeted therapy

Unlike standard chemotherapy drugs, which may affect all cells in the body, targeted therapy drugs are designed to seek out and kill specific cancer cells while sparing surrounding healthy cells. Targeted cancer therapies may be used alone, in combination with other targeted therapy treatments or with other soft tissue sarcoma treatments, such as chemotherapy, radiation therapy and surgery. Among the drugs used in targeted therapy are so-called kinase inhibitors, which target specific protein receptors that help regulate cell growth.