What is Felty's syndrome

What is Felty's syndrom?

Felty's syndrome is a complication of long-standing rheumatoid arthritis. Felty's syndrome is defined by the presence of 3 conditions: rheumatoid arthritis, an enlarged spleen (splenomegaly), and an abnormally low white blood count. Felty's syndrome affects less than 1% of patients with rheumatoid arthritis.

What are the symptoms of Felty's syndrome?

Some patients with Felty's syndrome have more infections, such as pneumonia or skin infections, than the average person. This increased susceptibility to infections is attributed to the low white blood counts. Ulcers in the skin over the legs can complicate Felty's syndrome.

What causes Felty's syndrome?

The cause of Felty's syndrome is not known. White blood cells are produced in the bone marrow. There seems to be an active bone marrow function in patients with Felty's syndrome despite the low white blood counts. White cells may be stored excessively in the spleen of a patient with Felty's syndrome. This is especially true in patients with Felty's syndrome that have antibodies against the particular white blood cells usually affected (called granulocytes or neutrophils).

How is Felty's syndrome diagnosed?

There is no single test for Felty's syndrome. It is diagnosed based on the presence of the three conditions mentioned above. Most patients do have rheumatoid arthritis antibodies (rheumatoid factor) in the blood.

How is Felty's syndrome treated?

Treatment of Felty's syndrome is not always required. The underlying rheumatoid arthritis is managed in the standard fashion. Treatments used for patients with recurring infections, active arthritis, or ulcer in the legs include rheumatoid disease modifying drugs, such as gold salts, methotrexate, azathioprine, and penicillamine. Patients with severe infectious diseases may benefit by weekly injections with a stimulating factor (granulocyte stimulating factor/GSF) that acts to increase the amount of white blood cells. Surgical removal of the spleen has been performed for the same reasons, but has not been evaluated by long-term research studies.

Churg Strauss Syndrome

Churg Strauss syndrome is a type of vasculitis (blood vessel inflammation) that occurs throughout the body. The American College of Rheumatology defined criteria for a diagnosis of Churg Strauss syndrome:

• Asthma
• High numbers of eosinophils, a type of white blood cell, in the blood
• Pain, numbness, or tingling in the arms and legs (called mononeuropathy)
• Lung abnormalities
• Sinus problems such as abnormal growths (polyps)
• A tissue sample showing a blood vessel with eosinophils around it

A person with Churg Strauss syndrome may have some or all of these symptoms.

Are there other symptoms?
Besides the criteria for diagnosis listed above, the person with Churg Strauss syndrome may have:

• Lumps (nodules) or raised patches (purpura) in the skin
• Kidney, abdominal, or heart problems because of blood vessel inflammation
• Weakness and fatigue (malaise)
• Loss of appetite (anorexia) and weight loss
• Other symptoms specific to the part of the body affected in the person

Who gets it?
Usually, a person already has asthma when he or she develops Churg Strauss syndrome. What brings on the syndrome is not yet clear, but research indicates it is an autoimmune disorder, meaning the body's white blood cells, which usually fight off diseases, begin attacking healthy tissue. It affects males and females equally.

How is it treated?
Since the syndrome seems to be caused by a problem with an overactive immune system, medications are given to slow down (suppress) its activity. Prednisone is the medication usually used, but other immunosuppressive drugs such as azathioprine (Imuran), mycophenolate (CellCept), methotrexate, or cyclophosphamide (Cytoxan) may be added if needed. High doses of medication can be given intravenously in severe cases. Symptoms usually start to resolve quickly after starting medication, but treatment can last for 1 or 2 years depending upon how severe the syndrome is in the individual.

What is the future for research?
Discovering what causes Churg Strauss syndrome will help doctors find a way to control it, or even prevent it from occurring. It does not seem to occur in families, so although genetics may play a part in its development, it does not seem to be inherited. It is possible that exposure to environmental toxins may play a role, as it does in other autoimmune disorders. The syndrome may be caused by an overactive immune system that was set in motion by some kind of infection. Some or all of these factors may be involved; it will be up to research to identify the precise cause(s) of the disorder.

Kawasaki Disease

Kawasaki Disease is an illness that involves the skin, mouth, and lymph nodes, and typically affects children who are under the age of 5. The cause of Kawasaki Disease is unknown, but if the symptoms are recognized early, kids with the disease can fully recover within a few days. If it goes untreated, it can lead to serious complications that can involve the heart.

Kawasaki disease occurs in 19 out of every 100,000 kids in the United States. It is most common among children of Japanese and Korean descent, but the illness can affect all ethnic groups.

This illness can't be prevented, but you can help your child by learning the telltale symptoms and signs, which typically include a fever that lasts for at least 5 days, red eyes, a body rash and severely-chapped lips and mouth. If your child shows these symptoms it's a good idea to call the doctor.

Signs and Symptoms of Kawasaki Disease

The symptoms of Kawasaki Disease typically appear in phases.

The first phase, which can last for up to 2 weeks, usually involves a persistent fever that is higher than 104 degrees Fahrenheit (39 degrees Celsius), and lasts for at least 5 days. The other symptoms that typically develop include:

• severe redness in the eyes
• a rash on the child's stomach, chest, and genitals
• red, dry, cracked lips
• swollen tongue with a white coating and big red bumps
• sore, irritated throat
• swollen palms of the hands and soles of the feet with a purple-red color
• swollen lymph nodes

During the second phase of the illness, which usually begins within two weeks of when the fever first begins, the skin on the child's hands and feet may begin to peel in large pieces. The child may also experience joint pain, diarrhea, vomiting, or abdominal pain.

Complications of Kawasaki Disease

Doctors can manage the symptoms of Kawasaki disease if they catch it early. The symptoms typically disappear within just two days of when treatment begins. Usually, if Kawasaki disease is treated within 10 days of when the first symptoms begin, no heart problems develop.

But if the illness goes untreated (time period can vary, but likely for 10-14 days and sooner in young infants), it can lead to more serious complications that involve the child's heart. Kawasaki disease can lead to vasculitis, which is an inflammation of the blood vessels. This can be particularly dangerous because it can affect the coronary arteries, which supply blood to the heart.

In addition to the coronary arteries, the heart muscle, lining, valves, or the outer membrane that surrounds the heart can become inflamed. Arrhythmias (changes in the normal pattern of the heartbeat) or abnormal functioning of some heart valves can also occur.

Diagnosing Kawasaki Disease

There is no one test to detect Kawasaki disease, so a doctor typically diagnoses it by evaluating the child's symptoms and ruling out other conditions.

Typically, a child who is diagnosed with this illness will have a fever lasting 5 or more days and at least 4 of the following symptoms:

• redness in both eyes
• changes around the lips, tongue, or mouth
• changes in the fingers and toes, such as swelling, discoloration, or peeling
• a rash in the trunk or genital area
• a large swollen lymph node in the neck
• red, swollen palms of hands and soles of feet

If Kawasaki disease is suspected, a doctor may order tests to monitor the child's heart function, which can include an echocardiogram, and other tests of heart function. A doctor may also take blood and urine samples to rule out other conditions, such as scarlet fever, measles, Rocky Mountain Spotted Fever, Stevens-Johnson syndrome, juvenile rheumatoid arthritis, and an allergic drug reaction.

Treating Kawasaki Disease

Treatment should begin as soon as possible, ideally within 10 days of when the fever first begins. Usually, a child is treated with intravenous doses of gamma globulin (purified antibodies), an ingredient of blood that helps the child's body fight off infection. The child may also be given a high-dose of aspirin to reduce the risk of heart problems.

What is Legg-Calvé-Perthes Disease

Legg-Calvé-Perthes disease is a temporary condition in children in which the ball-shaped head of the thigh bone, referred to as the femoral head, loses its blood supply. As a result, the femoral head collapses. The body will absorb the dead bone cells and replace them with new bone cells. The new bone cells will eventually reshape the femoral head of the thigh bone. Legg-Calvé-Perthes disease causes the hip joint to become painful and stiff for a period of time.

Legg-Calvé-Perthes disease goes through four phases of changes that affect the head of the femur. The phases include:

• Phase 1 - Blood supply is absent to the femoral head and the hip joint becomes inflamed, stiff, and painful. Portions of the bone turn into dead tissue. The ball of the thigh bone becomes less round in appearance on x-rays. This phase can last from several months up to one year.
  
  
• Phase 2 - The body cleans up the dead bone cells and replaces them with new, healthier bone cells. The femoral head begins to remodel into a round shape again. The joint is still irritated and painful. This phase can last from one to three years.
  
  
• Phase 3 - The femoral head continues to model itself back into a round shape with new bone. This phase lasts for one to three years.
  
  
• Phase 4 - Normal bone cells replace the new bone cells. This last phase can last a few years to complete the healing process.

What causes Legg-Calvé-Perthes disease?

The cause of Legg-Calvé-Perthes disease is unknown. It is four times more likely to occur in boys than girls.

Legg-Calvé-Perthes disease commonly affects first-born children and is typically seen in children 4 to 8 years of age. The majority of cases affect only one hip.

What are the symptoms of Legg-Calvé-Perthes disease?

The child typically complains of pain in his/her hip that is aggravated by activity. Sometimes, they will also experience pain in their thigh or knee area. The child usually walks with a limp and reports that rest will alleviate the pain.

The symptoms of Legg-Calvé-Perthes disease may resemble other conditions or medical problems of the hip. Always consult your child's physician for a diagnosis.

How is Legg-Calvé-Perthes disease diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for Legg-Calvé-Perthes disease may include:

• x-rays - a diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
  
  
• bone scans - a nuclear imaging method to evaluate any degenerative and/or arthritic changes in the joints; to detect bone diseases and tumors; to determine the cause of bone pain or inflammation.
  
  
• magnetic resonance imaging (MRI) - a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.
  
  
• arthrograms - a diagnostic imaging test to study the non-bony structures of joints.
  
  
• blood tests

Treatment for Legg-Calvé-Perthes disease:

Specific treatment for Legg-Calvé-Perthes disease will be determined by your child's physician based on:

• your child's age, overall health, and medical history
• the extent of the condition
• your child's tolerance for specific medications, procedures, or therapies
• expectations for the course of the condition
• your opinion or preference

The goal of treatment is to preserve the roundness of the femoral head and to prevent deformity while the condition runs its course. Treatment options are dependent upon the amount of hip pain, stiffness, and x-ray changes over time, as well as how much of the femoral head has collapsed.

Typically, the first step of treatment is to regain hip motion and eliminate pain that results from the tight muscles around the hip and the inflammation inside the joint. Treatment may include:

• rest
  
  
• activity restrictions
  
  
• medications
  
  
• bed rest and traction
  
  
• casting or bracing (to hold the femoral head in the hip socket, permit limited joint movement, and allow the femur to remold itself into a round shape again)
  
  
• surgery (to hold the femoral head in the hip socket)
  
  
• physical therapy (to keep the hip muscles strong and to promote hip movement)
  
  
• crutches or wheelchair (in some cases)

Long-term outlook for a child with Legg-Calvé-Perthes disease:

The ultimate goal in Legg-Calvé-Perthes disease is to diagnose the condition early in order to allow as much time as possible to let the femoral head remodel back into a round shape. Other treatment goals include controlling pain, maintaining hip motion, and preventing continued hip deformity.

The two most critical factors that determine the outcome are the child's age and how much of the femoral head is affected by this condition.

The more severe the case, the greater the likelihood that the child may experience limited hip motion, differences in leg lengths, and further hip problems in adulthood.

What is Behcet's syndrome

Behcet's syndrome is classically characterized as a triad of symptoms that include recurring crops of mouth ulcers (apthous ulcers), genital ulcers, and inflammation of a specialized area around the pupil of the eye (the uvea). The inflammation of the area of the eye that is around the pupil is called uveitis. Behcet's syndrome is also sometimes referred to as Behcet's disease.

The cause of Behcet's syndrome is not known. The disease is more frequent and severe in patients from the Eastern Mediterranean and Asia than those of European descent. Both inherited (genetic) and environmental factors, such as microbe infections, are suspected to be factors that contribute to the development of Behcet's syndrome. Behcet's syndrome is not felt to be contagious.

What are symptoms of Behcet's syndrome?

The symptoms of Behcet's syndrome depend on the area of the body affected. Behcet's syndrome can involve inflammation of many areas of the body. These areas include the arteries that supply blood to the body's tissues. Behcet's syndrome can also affect the veins that take the blood back to the lungs to replenish the oxygen content. Other areas of body that can be affected by the inflammation of Behcet's syndrome include the back of the eyes (retina), brain, joints, skin, and bowels.

The mouth and genital ulcers are generally painful and recur in crops (many shallow ulcers at the same time). They range in size from a few millimeters to 20 millimeters in diameter. The mouth ulcers occur on the gums, tongue, and inner lining of the mouth. The genital ulcers occur on the scrotum and penis of males and vulva of women and can leave scars.

Inflammation of the eye, which can involve the front of the eye (uvea) causing uveitis, or the back of the eye (retina) causing retinitis, can lead to blindness. Symptoms of eye inflammation include pain, blurred vision, tearing, redness, and pain when looking at bright lights. It is very important for patients to have this sensitive area monitored by an eye specialist (ophthalmologist).

If the arteries become inflamed (arteritis) in patients with Behcet's syndrome, it can lead to death of the tissues whose oxygen supply depends on these vessels. This could cause at stroke if affecting the brain, belly pain if affecting the bowel, etc. When veins become inflamed (phlebitis), the inflammation can involve large veins that develop blood clots which can loosen to cause pulmonary embolism.

Symptoms of inflammation of the brain or tissue that covers the brain (meninges) include headaches, neck stiffness, and is often associated with fever. Inflammation of the brain (encephalitis) and/or the meninges (meningitis) can cause damage to nervous tissue and lead to weakness or impaired function of portions of the body. This can result in confusion and coma. Typically these features occur later in the disease course, years after the diagnosis.

Joint inflammation (arthritis) can lead to swelling, stiffness, warmth, pain, and tenderness of joints in patients with Behcet's syndrome. This occurs in about half of patients with Behcet's syndrome at some time during their lives. Knees, wrists, ankles, and elbows are the most common joints affected.

The skin of patients with Behcet's syndrome can develop areas of inflammation which spontaneously appear as raised, tender, reddish nodules (erythema nodosum), typically on the front of the legs. Some patients with Behcet's syndrome develop a peculiar red or blistery skin reaction in places where they have been pierced by blood-drawing needles (see pathergy test in diagnosis section below). Recent research has found that acne occurs more frequently in patients with Behcet's syndrome that also have arthritis as a manifestation.

Ulcerations can occur at any location in the stomach, large or small bowel in patients with Behcet's disease.

What are symptoms of Behcet's syndrome

The symptoms of Behcet's syndrome depend on the area of the body affected. Behcet's syndrome can involve inflammation of many areas of the body. These areas include the arteries that supply blood to the body's tissues. Behcet's syndrome can also affect the veins that take the blood back to the lungs to replenish the oxygen content. Other areas of body that can be affected by the inflammation of Behcet's syndrome include the back of the eyes (retina), brain, joints, skin, and bowels.

The mouth and genital ulcers are generally painful and recur in crops (many shallow ulcers at the same time). They range in size from a few millimeters to 20 millimeters in diameter. The mouth ulcers occur on the gums, tongue, and inner lining of the mouth. The genital ulcers occur on the scrotum and penis of males and vulva of women and can leave scars.

Inflammation of the eye, which can involve the front of the eye (uvea) causing uveitis, or the back of the eye (retina) causing retinitis, can lead to blindness. Symptoms of eye inflammation include pain, blurred vision, tearing, redness, and pain when looking at bright lights. It is very important for patients to have this sensitive area monitored by an eye specialist (ophthalmologist).

If the arteries become inflamed (arteritis) in patients with Behcet's syndrome, it can lead to death of the tissues whose oxygen supply depends on these vessels. This could cause a stroke if affecting the brain, belly pain if affecting the bowel, etc. When veins become inflamed (phlebitis), the inflammation can involve large veins that develop blood clots which can loosen to cause pulmonary embolism.

Symptoms of inflammation of the brain or tissue that covers the brain (meninges) include headaches, neck stiffness, and is often associated with fever. Inflammation of the brain (encephalitis) and/or the meninges (meningitis) can cause damage to nervous tissue and lead to weakness or impaired function of portions of the body. This can result in confusion and coma. Typically these features occur later in the disease course, years after the diagnosis.

Joint inflammation (arthritis) can lead to swelling, stiffness, warmth, pain, and tenderness of joints in patients with Behcet's syndrome. This occurs in about half of patients with Behcet's syndrome at some time during their lives. Knees, wrists, ankles, and elbows are the most common joints affected.

The skin of patients with Behcet's syndrome can develop areas of inflammation which spontaneously appear as raised, tender, reddish nodules (erythema nodosum), typically on the front of the legs. Some patients with Behcet's syndrome develop a peculiar red or blistery skin reaction in places where they have been pierced by blood-drawing needles (see pathergy test in diagnosis section below). Recent research has found that acne occurs more frequently in patients with Behcet's syndrome that also have arthritis as a manifestation.

How is Behcet's syndrome diagnosed

Behcet's syndrome is diagnosed based on the finding of recurrent mouth ulcerations combined with any two of the following: eye inflammation, genital ulcerations, or skin abnormalities mentioned above. A special skin test called a pathergy test can also suggest Behcet's syndrome. (The other criteria above are still required for ultimate diagnosis.) This test consists of pricking the skin of the forearm with a sterile needle. The test is called positive and suggests Behcet's syndrome when the puncture causes a sterile red nodule or pustule that is greater than two millimeters in diameter at 24 to 48 hours.

Tests, such as skin biopsy, lumbar puncture, MRI scan of the brain, and bowel tests are considered based upon symptoms that are present.

What is the treatment of Behcet's syndrome?

The treatment of Behcet's syndrome depends on the severity and the location of its manifestations in an individual patient.

Steroid (cortisone) gels, pastes (such as Kenolog in Orabase) and creams can be helpful for the mouth and genital ulcers. Colchicine can also minimize recurrent ulcerations. Mouth and genital ulcers healed and were reported at a national meeting of the American College of Rheumatology as less frequent in 9 or 12 patients who were treated with Trental (pentoxifylline). Trental also seemed to maintain the healed ulcers for up to the 29 months of the study. The effectiveness of Trental, the researchers said, seemed to be enhanced by the combination with colchicine in some patients.

Joint inflammation can require non-steroidal anti-inflammatory drugs (such as ibuprofen and others) or oral steroids. Colchicine and oral and injectable cortisone are used for inflammation involving the joints, eyes, skin, and brain. Sulfasalazine has been effective in some patients for arthritis.

Bowel disease is treated with oral steroids and sulfasalazine (Azulfidine).

Diligent treatment of eye inflammation is essential. Patients with eye symptoms or a history of eye inflammation should be monitored by an ophthalmologist. Recent research has reported successful management of resistant eye inflammation with new biologic medications that block a protein that plays a major role in initiating inflammation, called TNF. These TNF-blocking medications, including infliximab (Remicade) and etanercept (Enbrel), can also be helpful for severe mouth ulcerations.

Severe disease of the arteries, eyes, and brain can be difficult to treat and require powerful medications that suppress the immune system called immunosuppressive agents. Immunosuppressive agents used for severe Behcet's syndrome include chlorambucilazathioprine (Imuran), and cyclophosphamide (Cytoxan). Cyclosporine has been used for resistant disease. (Leukeran),

Recent studies suggest that thalidomide may be of benefit for certain patients with Behcet's syndrome in treating and preventing ulcerations of the mouth and genitals. Side effects of thalidomide include promoting abnormal development of fetal growth, nerve injury (neuropathy), and hypersedation.

Recent research further suggests that patients who have had heart valve replacement because of severe damage as a result of inflammation can benefit by immune suppression with azathioprine and prednisone after operation.

Trials are currently underway evaluating interferon alpha for the treatment of eye disease in patients with Behcet's syndrome.

What is the treatment of Behcet's syndrome

The treatment of Behcet's syndrome depends on the severity and the location of its manifestations in an individual patient.

Steroid (cortisone) gels, pastes (such as Kenolog in Orabase) and creams can be helpful for the mouth and genital ulcers. Colchicine can also minimize recurrent ulcerations. Mouth and genital ulcers healed and were reported at a national meeting of the American College of Rheumatology as less frequent in 9 or 12 patients who were treated with Trental (pentoxifylline). Trental also seemed to maintain the healed ulcers for up to the 29 months of the study. The effectiveness of Trental, the researchers said, seemed to be enhanced by the combination with colchicine in some patients.

Joint inflammation can require non-steroidal anti-inflammatory drugs (such as ibuprofen and others) or oral steroids. Colchicine and oral and injectable cortisone are used for inflammation involving the joints, eyes, skin, and brain. Sulfasalazine has been effective in some patients for arthritis.

Bowel disease is treated with oral steroids and sulfasalazine (Azulfidine).

Diligent treatment of eye inflammation is essential. Patients with eye symptoms or a history of eye inflammation should be monitored by an ophthalmologist. Recent research has reported successful management of resistant eye inflammation with new biologic medications that block a protein that plays a major role in initiating inflammation, called TNF. These TNF-blocking medications, including infliximab (Remicade) and etanercept (Enbrel), can also be helpful for severe mouth ulcerations.

Severe disease of the arteries, eyes, and brain can be difficult to treat and require powerful medications that suppress the immune system called immunosuppressive agents. Immunosuppressive agents used for severe Behcet's syndrome include chlorambucilazathioprine (Imuran), and cyclophosphamide (Cytoxan). Cyclosporine has been used for resistant disease. (Leukeran),

Recent studies suggest that thalidomide may be of benefit for certain patients with Behcet's syndrome in treating and preventing ulcerations of the mouth and genitals. Side effects of thalidomide include promoting abnormal development of fetal growth, nerve injury (neuropathy), and hypersedation.

Recent research further suggests that patients who have had heart valve replacement because of severe damage as a result of inflammation can benefit by immune suppression with azathioprine and prednisone after operation.

Trials are currently underway evaluating interferon alpha for the treatment of eye disease in patients with Behcet's syndrome.

Adult Onset Still's Disease

It's mysterious and it's rare. A form of rheumatoid arthritis, Still's Disease mainly affects children. But there's even a rarer form which strikes adults -- Adult Onset Still's Disease (AOSD).

AOSD is an inflammatory condition that attacks internal organs, joints and other parts of the body. It can appear and disappear suddenly. In very severe cases, AOSD becomes chronic and extremely debilitating, causing terrible pain and stiffness. After many years, the disease cripples vital organs such as the heart and lungs.

There are treatments, mainly anti-inflammatory drugs, that help with most AOSD symptoms. Until recently, we have known little about its causes but medical researchers are starting to learn more about AOSD. With this knowledge comes the promise of new and better treatments.

AOSD gets its name from Dr. Still, a renowned British pediatrician, who first identified the childhood form of the disease. Though rare, it is found worldwide and predominantly affects young adults between 16 and 35.

AOSD does not seem to run in families. The disease can be difficult to diagnose, as it is difficult to distinguish from a number of other conditions that cause unexplained fever as well as other forms of rheumatoid arthritis, as well as from a number of other diseases.

Symptoms of AOSD
Common symptoms of AOSD include those on the following list. It is important to remember that there is no definite pattern that AOSD symptoms follow. In some cases, only one or two symptoms occur immediately; others may follow later. Aside from fever and joint pain, which are almost always among the first signs of AOSD, some of the symptoms on this list may not appear for weeks, or even at all.

Fever
The first sign that someone may be coming down with AOSD is a high spiking fever of 103 degrees or above. The fever usually rises rapidly in the evening and then subsides to or near normal by the next morning. Occasionally, an unusual pattern of two fever spikes in a day is seen in one-fifth of AOSD sufferers.

Rash
The typical Still's rash is salmon pink in color and comes and goes unpredictably, although it sometimes occurs at the same time as high fever. It is most common on the chest and thigh, although it may also appear on the face, hands and feet. In some cases, the rash becomes itchy.

Joint and Muscle Pain
At some point, every AOSD sufferer experiences intense joint pain, often in the hand. This can be accompanied by severe muscle pain as well. Both may become worse during a fever spike.

Sore Throat
Most AOSD sufferers come down with a sore throat that is usually described as a severe, constant burning pain in the area around the pharynx.²

Heart and Lung Symptoms
These include pain, difficulty breathing and other problems that can be mistaken for an infection of tissue within the heart.

Abdominal Pain
This can be caused by swollen lymph nodes, as well as enlargement of the spleen or liver. These symptoms are also sometimes attributed to other causes.

Abnormal White Blood Cell Count and Other Blood Abnormalities
These can be easily detected using a variety of blood tests. Most patients with AOSD have greatly elevated white blood cell counts which may lead their doctors to suspect an underlying infection or even leukemia. However, the cultures of the blood and other sites are always negative and the blood and bone marrow do not show the abnormal cells found in leukemia. A group of tests referred to as "acute phase reactants" are almost always abnormally elevated in AOSD. The two most commonly associated with AOSD are an elevated sedimentation rate (ESR) and a high blood ferritin level.

Diagnosis of AOSD
While there is no simple test for AOSD, most doctors will make the diagnosis if a person has five or more of the criteria below, including two or more from the first (major criteria) list:⁷

Major AOSD Criteria

1. High fever lasting one week or longer
2. Joint pain lasting two weeks or longer
3. Rash
4. Abnormal white blood cell count and other blood problems

Minor AOSD Criteria

1. Sore throat
2. Swelling of the lymph nodes or spleen
3. Liver problems
4. Absence of rheumatoid arthritis

Joint and Muscle Change
Occasionally the diagnosis of AOSD may be supported by the finding of soft tissue swelling, bone loss and damage to the wrist, hand, hip, knee and spinal joints. These changes, however, are diagnostic.

Diseases that Mimic AOSD Symptoms
An important part of detecting AOSD is ruling out other diseases that can cause similar symptoms. Some of the prime suspects are:

• Infections such as hepatitis, rubella, parvovirus,coxsackie, EBV (Epstein-Barr virus) CMV (cytomegalo virus) and HIV (AIDS)
• Infective endocarditis (an infection of the heart tissue)
• Tuberculosis
• Lyme disease
• Ehrlichiosis
• Sarcoidosis
• Hepatitis
• Crohn's disease
• Cancer, including leukemia and lymphoma
• Connective tissue disease, such as SLE (Lupus)

Causes of AOSD
We do not know the exact cause AOSD but researchers are currently investigating a number of possibilities:

• Infection
  The abrupt appearance of high fever, sore throat, rash, lymph node swelling and abnormal white blood cell counts suggest some kind of infectious trigger.
  
  While no particular cause of infection has been found, the rubella (German Measles) virus has been detected in many people with AOSD cases. Researchers have also found some association between AOSD and EB, CMV, mumps, parainfluenza, and other viruses.
• Immune Disorder
• Genetics
• Hormonal Influences
  Pregnant women are slightly more likely to come down with AOSD or to have a relapse. On the other hand, if the female hormones associated with pregnancy played a role, we would expect AOSD to be more common in one sex or the other. Unlike lupus or rheumatoid arthritis, however, which are more common in women, AOSD seems to affect both sexes equally.

Treatment and Prognosis
The most widely used treatment for AOSD symptoms is non-steroidal anti-inflammatory drugs (NSAIDs). A good early indication of how well an AOSD sufferer will do in the long term is their initial response to these drugs. Statistically, 20-25% of AOSD sufferers improve with NSAIDs. Many of these find that their symptoms clear up quickly, sometimes for good. NSAIDs are normally taken until 1-3 months after the symptoms are gone.

In particularly acute or severe cases, doctors sometimes also prescribe corticosteroids to address heart, blood, and other life-threatening problems that AOSD can cause. Anti-TNF therapy, aimed at a component of the immune system, may be a promising treatment.¹⁰

Some AOSD sufferers do not respond well to NSAIDs and go on to develop the chronic (long term) form of the disease. Because corticosteroids have serious side effects, they cannot be used to treat AOSD over a period of years. Instead, depending on the individual case, doctors prescribe drugs such as methotrexate, IM gold, D-penicillamine, hydroxychloroquine and azathioprine. For safety reasons, cyclophosphamide is reserved only for the most difficult cases.

Summary
Though not common, AOSD is a serious and potentially debilitating disease that can cause serious damage and other problems to the joints, heart, lungs, liver and spleen. While some AOSD sufferers have only a mild form of the disease that responds well to safe NSAID drugs, others come down with a severe, chronic form that is more difficult to treat that can cause long term pain and disability or even death. While we have a lot to learn about how AOSD works and how to treat it, some progress is being made.

Cogan Syndrome

Cogan syndrome: Arteritis (also referred to as vasculitis) that involves the ear. This condition is called Cogan syndrome after the American ophthalmologist David Glendenning Cogan (1908-93) who first described it.

Cogan syndrome features not only problems of the hearing and balance portions of the ear, but also inflammation of the front of the eye (the cornea) and often fever, fatigue, and weight loss. Joint and muscle pains can also be present. Less frequently, the arteritis can involve blood vessels elsewhere in the body as in the skin, kidneys, nerves, and other tissues and organs.

Cogan syndrome can lead to deafness or blindness.

The treatment of Cogan syndrome is directed toward stopping the inflammation of the blood vessels. Cortisone-related medications, such as prednisone, are often used. Some patients with severe disease can require immune suppression medications, such as cyclophosphamide(CYTOXAN).

Cogan syndrome is extremely rare and its cause is not known.

Bicipital tendinitis

Bicipital tendinitis is an inflammation of one of the tendons that attach the muscle (biceps) on the front of the upper arm bone (humerus) to the shoulder joint. The inflammation usually occurs along the groove (bicipital groove) where the tendon passes over the humerus to attach just above the shoulder joint. See an illustration of the shoulderClick here to see an illustration..

Causes may include:

* Overuse, especially in athletes who use throwing motions.
* Inflammatory conditions, such as arthritis or bursitis.
* Infection.
* Injury.

Symptoms may include:

* Shoulder pain that may spread down the front of the arm.
* Tenderness where the biceps meets the shoulder (bicipital groove).
* Decreased shoulder movement and pain.
* A bulge in the biceps (if one of the biceps tendons ruptures).

Treatment includes rest, ice, compression, and elevation (RICE), gentle exercise, stopping smoking, and nonsteroidal anti-inflammatories (NSAIDs). Smoking can interfere with healing of tendinitis by decreasing blood supply and delaying tissue repair. A sling may be used temporarily for comfort. In rare cases, surgery is recommended if home treatment does not help.

Carpal Tunnel Syndrome

What is it The carpal tunnel is a space in the wrist where a nerve and nine tendons pass from the forearm into the hand. Carpal tunnel syndrome occurs when swelling in the tunnel compresses the median nerve.

What causes it The most common misconception is that carpal tunnel syndrome is limited to people who spent a great deal of time at computers. In reality, it affects anyone who grips something tightly or uses their wrists consistently, such as cashiers, cyclists, meat cutters and musicians. Occupations that involve prolonged use of vibrating equipment, such as a jackhammer, are also prone to carpal tunnel syndrome.

A second misconception is that carpal tunnel is always work-related. It is not; age, weight, smoker status, diabetes and pregnancy are also risk factors.

Symptoms: Tingling, numbness and pain in the thumb, index and middle fingers are the most common symptoms of carpal tunnel syndrome. These symptoms are usually experienced at night, but also accompany prolonged gripping (steering wheel, newspaper, grocery or tote bags). Patients may also experience clumsiness when handling objects or a weaker grip.

Initial Evaluation: The physician will examine your hand and arm and ask you about your medical history, any injuries you may have sustained to your hand or arm, the job that you perform, hobbies or sports you participate in, etc. An x-ray or other lab tests may be performed to rule out other causes of your symptoms. The Curtis National Hand Center has a test on-site that can determine if a person has carpal tunnel syndrome. Called the NeuroMetrix NC-stat system, the system measures neuromuscular signals that are useful in the diagnosis and evaluation of nerve entrapment affecting functions of the hand. The test is painless and results are available in about five minutes. Click here for a physician referral.

Treatment: There are many non-surgical courses of treatment for carpal tunnel syndrome, such as splints or braces to immobilize and rest the wrist, adjustments to how you perform daily activities, oral anti-inflammatory medications and steroid injections. If non-surgical treatment is not successful or treatment is sought too late, surgery may be required. This surgery involves enlarging the carpal tunnel, which in turn will relieve the swelling and pressure on the nerve. This is an outpatient procedure done under local anesthesia. In severe cases, even surgery may not reverse the effects of carpal tunnel syndrome. Carpal tunnel surgery is followed by hand therapy which varies by case, but usually lasts 1-3 months.

There are more than 100 types of arthritis and related conditions

More than 100 forms of arthritis and related diseases exist affecting approximately 46 million Americans today. A complete listing follows:

Achilles tendinitis Achondroplasia Acromegalic arthropathy Adhesive capsulitis Adult onset Still's disease Ankylosing spondylitis Anserine bursitis Avascular necrosis Behcet's syndrome Bicipital tendinitis Blount's disease Brucellar spondylitis Bursitis Calcaneal bursitis Calcium pyrophosphate dihydrate (CPPD) Crystal deposition disease Caplan's syndrome Carpal tunnel syndrome Chondrocalcinosis Chondromalacia patellae Chronic synovitis Chronic recurrent multifocal osteomyelitis Churg-Strauss syndrome Cogan's syndrome Corticosteroid-induced osteoporosis Costosternal syndrome CREST syndrome Cryoglobulinemia Degenerative joint disease Dermatomyositis Diabetic finger sclerosis Diffuse idiopathic skeletal hyperostosis (DISH) Discitis Discoid lupus erythematosus Drug-induced lupus Duchenne's muscular dystrophy Dupuytren's contracture Ehlers-Danlos syndrome Enteropathic arthritis Epicondylitis Erosive inflammatory osteoarthritis Exercise-induced compartment syndrome Fabry's disease Familial Mediterranean fever Farber's lipogranulomatosis Felty's syndrome Fibromyalgia Fifth's disease Flat feet Foreign body synovitis Freiberg's disease Fungal arthritis Gaucher's disease Giant cell arteritis Gonococcal arthritis Goodpasture's syndrome Gout Granulomatous arteritis Hemarthrosis hemochromatosis Henoch-Schonlein purpura Hepatitis B surface antigen disease Hip dysplasia Hurler syndrome Hypermobility syndrome Hypersensitivity vasculitis Hypertrophic osteoarthropathy Immune complex disease Impingement syndrome Jaccoud's arthropathy Juvenile ankylosing spondylitis Juvenile dermatomyositis Juvenile rheumatoid arthritis Kawasaki disease Kienbock's disease Legg-Calve-Perthes disease Lesch-Nyhan syndrome Linear scleroderma Lipoid dermatoarthritis Lofgren's syndrome Lyme disease Malignant synovioma Marfan's syndrome Medial plica syndrome Metastatic carcinomatous arthritis

What is Osteoarthritis

Osteoarthritis is a type of arthritis that is caused by the breakdown and eventual loss of the cartilage of one or more joints. Cartilage is a protein substance that serves as a "cushion" between the bones of the joints. Osteoarthritis is also known as degenerative arthritis. Among the over 100 different types of arthritis conditions, osteoarthritis is the most common, affecting over 20 million people in the United States. Osteoarthritis occurs more frequently as we age. Before age 45, osteoarthritis occurs more frequently in males. After age 55 years, it occurs more frequently in females. In the United States, all races appear equally affected. A higher incidence of osteoarthritis exists in the Japanese population, while South African blacks, East Indians and Southern Chinese have lower rates.

Osteoarthritis commonly affects the hands, feet, spine, and large weight-bearing joints, such as the hips and knees. Most cases of osteoarthritis have no known cause and are referred to as primary osteoarthritis. When the cause of the osteoarthritis is known, the condition is referred to as secondary osteoarthritis.

What causes osteoarthritis? Primary osteoarthritis is mostly related to aging. With aging, the water content of the cartilage increases and the protein makeup of cartilage degenerates. Repetitive use of the joints over the years irritates and inflames the cartilage, causing joint pain and swelling. Eventually, cartilage begins to degenerate by flaking or forming tiny crevasses. In advanced cases, there is a total loss of the cartilage cushion between the bones of the joints. Loss of cartilage cushion causes friction between the bones, leading to pain and limitation of joint mobility. Inflammation of the cartilage can also stimulate new bone outgrowths (spurs) to form around the joints. Osteoarthritis occasionally can be found in multiple members of the same family, implying an heredity (genetic) basis for this condition.

What are symptoms of osteoarthritis?

Osteoarthritis is a disease of the joints. Unlike many other forms of arthritis that are systemic illnesses, such as rheumatoid arthritis and systemic lupus, osteoarthritis does not affect other organs of the body. The most common symptom of osteoarthritis is pain in the affected joint(s) after repetitive use. Joint pain is usually worse later in the day. There can be swelling, warmth, and creaking of the affected joints. Pain and stiffness of the joints can also occur after long periods of inactivity, for example, sitting in a theater. In severe osteoarthritis, complete loss of cartilage cushion causes friction between bones, causing pain at rest or pain with limited motion.

Symptoms of osteoarthritis vary greatly from patient to patient. Some patients can be debilitated by their symptoms. On the other hand, others may have remarkably few symptoms in spite of dramatic degeneration of the joints apparent on x-rays. Symptoms also can be intermittent. It is not unusual for patients with osteoarthritis of the hands and knees to have years of pain-free intervals between symptoms.

Osteoarthritis of the knees is often associated with obesity or a history of repeated injury and/or joint surgery. Progressive cartilage degeneration of the knee joints can lead to deformity and outward curvature of the knees referred to as "bow legged." Patients with osteoarthritis of the weight bearing joints (like the knees) can develop a limp. The limping can worsen as more cartilage degenerates. In some patients, the pain, limping, and joint dysfunction may not respond to medications or other conservative measures. Therefore, severe osteoarthritis of the knees is one of the most common reasons for total knee replacement surgical procedures in the United States.

Osteoarthritis of the spine causes pain in the neck or low back. Bony spurs that form along the arthritic spine can irritate spinal nerves, causing severe pain, numbness, and tingling of the affected parts of the body.

Osteoarthritis causes the formation of hard bony enlargements of the small joints of the fingers. Classic bony enlargement of the small joint at the end of the fingers is called a Heberden's node, named after a very famous British doctor. The bony deformity is a result of the bone spurs from the osteoarthritis in that joint. Another common bony knob (node) occurs at the middle joint of the fingers in many patients with osteoarthritis and is called a Bouchard's node. Dr. Bouchard was a famous French doctor who also studied arthritis patients in the late 1800s. The Heberden's and Bouchard's nodes may not be painful, but they are often associated with limitation of motion of the joint. The characteristic appearances of these finger nodes can be helpful in diagnosing osteoarthritis. Osteoarthritis of the joint at the base of the big toes leads to the formation of a bunion. Osteoarthritis of the fingers and the toes may have a genetic basis, and can be found in numerous women members of some families.

How is osteoarthritis diagnosed?

There is no blood test for the diagnosis of osteoarthritis. Blood tests are performed to exclude diseases that can cause secondary osteoarthritis, as well as to exclude other arthritis conditions that can mimic osteoarthritis.

X-rays of the affected joints can suggest osteoarthritis. The common x-ray findings of osteoarthritis include loss of joint cartilage, narrowing of the joint space between adjacent bones, and bone spur formation. Simple x-ray testing can be very helpful to exclude other causes of pain in a particular joint as well as assist the decision-making as to when surgical intervention should be considered.

Arthrocentesis is often performed in the doctor's office. During arthrocentesis, a sterile needle is used to remove joint fluid for analysis. Joint fluid analysis is useful in excluding gout, infection, and other causes of arthritis. Removal of joint fluid and injection of corticosteroids into the joints during arthrocentesis can help relieve pain, swelling, and inflammation.

Arthroscopy is a surgical technique whereby a doctor inserts a viewing tube into the joint space. Abnormalities of and damage to the cartilage and ligaments can be detected and sometimes repaired through the arthroscope. If successful, patients can recover from the arthroscopic surgery much more quickly than from open joint surgery.

Finally, a careful analysis of the location, duration, and character of the joint symptoms and the appearance of the joints helps the doctor in diagnosing osteoarthritis. Bony enlargement of the joints from spur formations is characteristic of osteoarthritis. Therefore, Heberden's nodes, Bouchard's nodes, and bunions of the feet can help the doctor make a diagnosis of osteoarthritis.

What is the treatment for osteoarthritis

Aside from weight reduction and avoiding activities that exert excessive stress on the joint cartilage, there is no specific treatment to halt cartilage degeneration or to repair damaged cartilage in osteoarthritis. The goal of treatment in osteoarthritis is to reduce joint pain and inflammation while improving and maintaining joint function. Some patients with osteoarthritis have minimal or no pain, and may not need treatment. Others may benefit from conservative measures such as rest, exercise, weight reduction, physical and occupational therapy, and mechanical support devices. These measures are particularly important when large, weight-bearing joints are involved, such as the hips or knees. In fact, even modest weight reduction can help to decrease symptoms of osteoarthritis of the large joints, such as the knees and hips. Medications are used to complement the physical measures described above. Medication may be used topically, taken orally, or injected into the joints to decrease joint inflammation and pain. When conservative measures fail to control pain and improve joint function, surgery can be considered.

Resting sore joints decreases stress on the joints, and relieves pain and swelling. Patients are asked to simply decrease the intensity and/or frequency of the activities that consistently cause joint pain.

Exercise usually does not aggravate osteoarthritis when performed at levels that do not cause joint pain. Exercise is helpful in osteoarthritis in several ways. First, it strengthens the muscular support around the joints. It also prevents the joints from "freezing up" and improves and maintains joint mobility. Finally, it helps with weight reduction and promotes endurance. Applying local heat before and cold packs after exercise can help relieve pain and inflammation. Swimming is particularly suited for patients with osteoarthritis because it allows patients to exercise with minimal impact stress to the joints. Other popular exercises include walking, stationary cycling, and light weight training.

Physical therapists can provide support devices, such as splints, canes, walkers, and braces. These devices can be helpful in reducing stress on the joints. Occupational therapists can assess daily activities and determine additional devices that may help patients at work or home. Finger splints can support individual joints of the fingers. Paraffin wax dips, warm water soaks, and nighttime cotton gloves can help ease hand symptoms. Spine symptoms can improve with a neck collar, lumbar corset, or a firm mattress, depending on what areas are involved.

In many patients with osteoarthritis, mild pain relievers such as aspirin and acetaminophenprescription anti-inflammatory medications in relieving pain in osteoarthritis of the knees. Since acetaminophen has fewer gastrointestinal side effects than NSAIDS, especially among the elderly patients, acetaminophen is generally the preferred initial drug given to patients with osteoarthritis. Medicine to relax muscles in spasm skin over the joints can provide relief of minor arthritis pain. Examples include (Tylenol) may be sufficient treatment. Studies have shown that acetaminophen given in adequate doses can often be equally as effective as might also be given temporarily. Pain-relieving creams applied to the capsaicin (Arthricare, Zostrix), salycin (Aspercreme), methyl salicylate (Bengay, Icy Hot), and menthol (Flexall).

Nonsteroidal anti-inflammatory drugs (NSAIDs) are medications that are used to reduce pain and inflammation in the joints. Examples of NSAIDs include aspirin (Ecotrin), ibuprofennabumetone (Relafen), and naproxen (Naprosyn). It is sometimes possible to use NSAIDs for a while and then discontinue them for periods of time without recurrent symptoms, thereby decreasing side effect risks. (Motrin),

The most common side effects of NSAIDs involve gastrointestinal distress, such as stomach upset, cramping diarrhea, ulcer and even bleeding. The risk of these and other side effects increases in the elderly. Newer NSAIDs called Cox-2 Inhibitors have been designed that have less toxicity to the stomach and bowels. Because osteoarthritis symptoms vary and can be intermittent, these medicines might be given only when joint pains occur or prior to activities that have traditionally brought on symptoms.

Some studies, but not all, have suggested that the food supplements glucosamine and chondroitin can relieve symptoms of pain and stiffness for some persons with osteoarthritis. These supplements are available in pharmacies and health food stores without a prescription, although there is no certainty about the purity of the products or the dose of the active ingredients because they are not monitored by the FDA. The National Institutes of Health is studying glucosamine and chondroitin in the treatment of osteoarthritis. Their initial research demonstrated only a minor benefit in relieving pain for those with the most severe osteoarthritis. Further studies, it is hoped, will clarify many issues regarding dosing, safety, and effectiveness of these products for osteoarthritis. Patients taking blood-thinners should be careful taking chondroitin as it can increase the blood-thinning and cause excessive bleeding. Fish oil supplements have been shown to have some anti-inflammation properties and increasing the dietary fish intake and/or fish oil capsules (omega 3 capsules) can sometimes reduce inflammation of arthritis.

While oral cortisone is generally not used in treating osteoarthritis, when injected directly into the inflamed joints, it can rapidly decrease pain and restore function. Since repetitive cortisone injections can be harmful to the tissue and bones, they are reserved for patients with more pronounced symptoms.

For persisting pain of severe osteoarthritis of the knee that does not respond to weight reduction, exercise or medications, a series of injections of hyaluronic acid (Synvisc, Hyalgan) into the joint can sometimes be helpful, especially if surgery is not being considered. These products seem to work by temporarily restoring the thickness of the joint fluid, allowing better joint lubrication and impact capability, and perhaps by directly affecting pain receptors.

Surgery is generally reserved for those patients with osteoarthritis that is particularly severe and unresponsive to the conservative treatments. Arthroscopy, discussed above, can be helpful when cartilage tears are suspected. Osteotomy is a bone removal procedure that can help realign some of the deformity in selected patients, usually those with knee disease. In some cases, severely degenerated joints are best treated by fusion (arthrodesis) or replacement with an artificial joint (arthroplasty). Total hip and total knee replacements are now commonly performed in community hospitals throughout the United States. These can bring dramatic pain relief and improved function. For further information on joint surgeries, please read the Arthroscopy, Total Knee Replacement, and Total Hip Replacement articles.

Bursitis

How Bursitis Occurs

The bursa is what cushions the tendon and thereby helps prevent friction between the tendon and the bone. Unfortunately, constant rubbing of the tendon over the bone with high amounts of repetitive arm, shoulder, hip, knee and ankle motion can lead to enough friction of the bursa itself to cause the inflammation and irritation of the bursa called bursitis. For example, a person who throws a ball too many times at one interval may begin to cause this friction process in the shoulder or elbow. Another way that bursitis occurs is when compression of the bursa happens on a regular basis, such as a side sleeper who places a lot of shoulder or hip pressure when they lay down for long periods. In this case it would not take too much movement of this already compressed area to cause friction of the bursa.

Common Areas of Bursa inflammation

The most common tendon areas that become inflamed are the elbow, shoulder, hip, knee, ankle, and heel. Of course, bursitis can will vary with each person, as it strikes the areas you use and irritate the most.

Bursitis Symptoms

Symptoms can vary from an achy pain and stiffness to the local area of the joint, to a burning that surrounds the whole joint around the inflamed bursa. With this condition, the pain is usually worse during and after activity, and the bursa and surrounding joint area can become stiffer the following day.

Bursitis Treatment

With proper care for the area, the pain in the bursa should lessen over three weeks, but it should be noted that the healing of the area continues and doesn't even peak until at least six weeks following the initial injury. This is due to scar tissue formation, which initially acts like the glue to bond the tissue back together. Scar tissue will continue to form past six weeks in some cases and as long as a year in severe cases. After 6 months this condition is considered chronic and much more difficult to treat. The initial approach to treating a bursitis is to support and protect the bursa by bracing any areas of the tendon that are being pulled on during use, as this will help stop bursa friction from occurring. It is important to loosen up the tendons, lessen the pain, minimize any bursa inflammation, and reduce the compression that can occur with lying down or sitting.

The pressure can be reduced while sleeping by using a softer bed topper like a memory foam mattress pad or even getting a new mattress that is composed with memory foam and/or latex foam. Memory foam and latex foam reduce compression because they are the only substances that conform with the bumps and curves of the body and can thereby reduce the pressure spot by more evenly disbursing the weight of the body. See memoryfoammattress.org for information on this subject. Reducing bursa inflammation and soothing the pain of bursitis can be done topically if a pain reliever has the ability to penetrate the skin barrier and contains anti-inflammatory agents. A topical formula that contains natural menthol will not only relieve pain, but dilate the blood vessels. This allows for relief of the bursitis, without causing any stiffening of the tissue. MSM, also known as Methyl Sulfonyl Methane is a natural supplement that is getting a lot of attention due to its role in tissue healing at a cellular level. It is a natural organic sulfur that comes from rain fall and is found naturally in the human body. It has been shown to have anti-inflammatory effects on the tissues. See all about Glucosamine and MSM for more information this supplement. Ice can relieve inflammation, but will constrict the blood vessels and further stiffen the joint area. Cortisone injections can reduce inflammation, but unfortunately are very caustic and can cause a weakening of the tissue structure and a create more scar tissue. Dr. Swartzburg, our site editor, worked in conjunction with our sponsor, Relief-Mart, to develop a spray for Bursitis called Therapain Plus. It has all natural pain relievers plus 14,000mg of MSM and Glucosamine.

After the scar tissue has begun to accumulate, it will be important to perform procedures which help break down the scar tissue in the tendon tissue, so as to let the tendon and muscle regain it's normal flexibility and lessen the chance of further injury. While exercise is appropriate for breaking down scar tissue once the area has healed, it may further irritate the area during the initial stages. Therefore, other methods that can be performed by your healthcare provider, such as ultrasound and massage, may be safely used to accomplish this early on in the injury. Ultrasound uses sound waves that vibrate a such a fast level, that it cannot be felt with normal use. Ultrasound will cause an increase in circulation to the tissue and soften the scar tissue to allow it to further break down. Ultrasound can also be used as phonophoresis to help topical pain and nutrient solutions reach further down into the tissues by transporting them with the sound waves. Light stretches may also be performed if they do not cause any further irritation to the area.

Bursitis Prevention

Prevention of this condition requires stretching the muscle on a regular basis and thereby lengthening the tendon connections around the bursa. This will allow less friction to the tendon/bursa/bone connection. As mentioned previously, reducing the compression with sitting or lying down is crucial for helping to keep the bursa from losing its natural lubrication and allowing the bursa friction to occur more readily. When bursitis does occur, it is important to treat it immediately, and thereby prevent it from reaching a stage that is more severe.