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Different Types of arthritis and related conditions - list

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Types of juvenile arthritis

Meaning of arthritis

Rheumatoid arthritis, known as Still's disease of when it hits a person, a situation that causes inflammation of the joints of the body and associated distress, inflammation and stiffness. It causes the defense mechanisms of the body to attack the combined tissues, destruction of collagen fibers, cartilage and bone and sometimes other organs. This serious disease varies among individuals and changes over time, often marked by signs that improve only to reappear later. In some cases, RA is still lightweight and only a few months (such as rheumatoid arthritis is known as type 1), while in others, the disease becomes progressively complicated by disability and other health problems, for a period of many years (which is known as such rheumatoid arthritis 2).

This most often affects the wrist and fingers public areas closest to the hand, but can also affect the joints in the body. Disease Anyone can suffer from this, but women are more likely to develop signs, which usually begin between the ages of twenty and forty. The causes of joint stiffness are not yet known, but many effective strategies are now available to manage the symptoms.

Symptoms:

The main symptom of rheumatoid arthritis is morning stiffness, often in the arms or legs. Symptoms include stiffness that continues for an hour or more, or inflammation and discomfort which takes more than six weeks. Rheumatoid arthritis is usually shaped, ie the two arms hurt or feel stiff, not just one. Early crisis patients may suffer from fever and excessive exhaustion, or little known as "nodules" feel under the skin pieces. Other symptoms consist of anemia, loss of appetite, and accumulated in the ankles or behind the knee fluid. In children, the signs may consist of shaking chills and a pink rash may follow inflamed and distressing joints.

Why rheumatoid arthritis is offensive:

It is not identified if there is a relationship between the fibrous joint pain and destruction. Cartilage itself does not cause irritation because there are no nerve fiber structures for discomfort alerts. Most likely, the pain of rheumatoid arthritis and associated discomfort is due to the distress of other tissues in and around the common areas affected. This discomfort is because chemicals messengers, such as E2. Any nonsteroidal anti-inflammatory drugs (NSAIDS) reduce discomfort, since they inhibit the production of prostaglandins.

Other scenarios that can cause pain:

Pain and stiffness can occur due to many other facts. Any hammer toes to severe exhaustion syndrome can cause pain only a medical professional can understand the true cause of the pain, because similar symptoms may developed other problems such as cancer, or many other types of joint pain.

Possible base of rheumatoid arthritis:

The causes of the disease are not fully identified, but those essential factors play a vital role are to some extent known and identified and helped to understand. The distribution of its own reactions of the defense mechanism of the body due to hereditary predisposition and environmental influence is a good cause for rheumatoid arthritis. Changing androgenic hormone or testosterone may also play an important role in the development of this disease. More than one gene is responsible for the risk for the disease. Specific genes can increase the chances of developing arthritis of a person, it may as well take advantage of the gravity of his situation. However, given that all persons having an inherited temperament rheumatoid arthritis have disease, other aspects that may be essential to analyze it.

A specific scientific training has not yet been found or established, but some studies suggest that contamination by a virus or bacteria leads to the disease in genetically predisposed patients. This does not mean that the disease is transmissible. Those who have rheumatoid arthritis appear to have more antibody in the synovial fluid in common parts thereof, which suggests the existence of an infection.

Low levels of the hormone testosterone or androgens from the adrenal gland are common in patients with rheumatoid arthritis, but how testosterone interact with the environment and genetic data is not identified. Hormonal changes also cause the rheumatoid arthritis.

7 Major Differences Between Osteoarthritis and Rheumatoid Arthritis

Arthritis is a very painful That requirement affects millions and millions of Americans every year. There are Many different kinds of arthritis psoriatic arthritis Including, gout, septic arthritis, scleroderma, osteoarthritis, gonococcal arthritis, ankylosing spondylitis and rheumatoid arthritis.

Arthritis of all kinds is a requirement That affects the body's joints. A seal is defined as the location Where two bones in the body come together. People suffering from arthritis experience inflammation seal That May Occur in one bodily Many gold seal joints.

Two kinds of arthritis That Are Commonly discussed include osteoarthritis and rheumatoid arthritis. You May be wondering what Reviews some of the major differences Between thesis are two conditions. Here are seven major differences Between osteoarthritis (OA) and rheumatoid arthritis (RA).

Osteoarthritis is more common than Rheumatoid Arthritis. According To the National Institute of Health (NIH), OA affects around 27 million American adults 25 years and older. The Arthritis Foundation reports That RA affects about 1.5 million people in the United States.

Osteoarthritis is a degenerative conditions Caused by the wearing of bodily seals over time. RA is an autoimmune disease That OCCURS When a person's immune system attacks the body's joints.

Typically people experience OA When They get older. RA can strike a person at Any Point in life. When it OCCURS in children, it is sometimes called Expired juvenile rheumatoid arthritis.

RA can Occur Quickly quite Whereas OA tend to-have a more gradual progression over the course of Many Years.

RA tend to strike in a more symmetrical Manner Where a person might experience inflammation and pain in Both Hands or Both Feet. In contrast, OA can affect only one Easily attached in the body.

Both kinds of arthritis because a sense of stiffness in the morning. While the morning stiffness May lessen as the day goes on For Those with OA, people with RA are more Likely to experience this stiffness for a along period of time falling on and Throughout the day.

Rheumatoid arthritis is Often Accompanied with other symptoms include All which overall tiredness and malaise, Whereas the discomfort Associated with osteoarthritis is Specific to the seal That is affected.

ANY type of arthritis is painful and challenging. Treatment MOST Typically AIMS to help for reduce discomfort, aid physical Functioning and if possible, to Prevent additional damage to bodily seals.

Severe arthritis in the lower back - Arthritis Treatment Back

It's amazing the number of women especially in the West who go through the rigors of arthritis in the back at such a young age. where the rate at which the disease spreads, it could expect to spend at least beyond 70 years.

Course men also experience the same symptoms, but young Western women in particular have the quality of life stripped them from their late 30s, early 40s.

Just when you start a family and this new chapter in your life, variant forms of arthritis such as osteoarthritis (OA spine) or bursitis of the spine, women inflict fairly quickly, whereas before it They may also have lived with fibromyalgia, costochronditis or degenerative disc disease.

Obviously, the spinal arthritis is somewhat different knee or arthritis of the hand, but they all have their degrees of pain, but when the disease begins in the back, then down to the lower back - the way that the disease often takes is one that leads to the female genitalia make your almost useless control.

This is more likely to happen, unfortunately, if you damage the pudendal nerve, the nerve passes through the tail bone, rear and ends in the genitals, where it will potentially arthritis interfere with everything here.

Obviously, this is the worst, but it is very likely, especially if you are alone in your 40's, if this treatment can be taken to slow down the disease and in some way help to enter remission if possible.

Treatment of arthritis in the lower back

NSAIDs and injections

You can take them but beware the long-term use is not recommended due to the violent nature that they can inflict on your internal organs such as the liver, kidneys and heart.

Three commonly used NSAIDs for back pain are Rituxan, Bextra and methotrexate.

Injections also provide a quick solution to pain, where the steroid cortisone is often used to reduce swelling in an instant.

Surgery

Now, if you are in the United States, you know that if you do not have insurance, you or you will not be able to afford it.

The surgery is very expensive, but it obviously differs from state to state.

The first step of the procedure is to see a neurosurgeon that will cost $ 200 - $ 400, then the surgery will cost $ 10,000 - $ 25,000 and hospital expenses can range from $ 50 USD 30'00 ' 000.

Thus costs are detrimental to Canadians and Europeans and other American countries may or may not be able to undergo without surgery, depending on their health care system.

Surgery will fix this damage must remove or fusion of the spine, but it will not stop any evidence of disease, maybe just slow down and do it again the pain bearable.

Natural supplements and homeopathic treatments

FDA registered supplements in the United States and in pills against Europe and beyond work a little differently than NSAIDs.

They help reduce inflammation and relieve pain, but they also try and restore some bone density and slowing the disease by restricting this autoimmune disease attacking the bone.

This is something that NSAIDs can not do.

Homeopathic ingredients include magnesium and calcium for bone structure re-building, Reishi and Glucosamine Complex for the slowdown that the disease spreads and chondroitin sulfate, MSM and capsaicin to reduce swelling and flare.

FDA registered Glucosamine is an extremely effective way to reduce inflammation and joint pain - quickly, safely and naturally.

Arthritis and how the right diet can help you

Approximately 10 million people in the UK and 50 million in the United States suffer from arthritis

Arthritis is a painful condition that causes swelling of the joints, such as fingers, knees, wrists and ankles. Most people tend to associate the age requirement, but arthritis does not discriminate and can affect anyone of any age, even children.

Arthritis and Food

While it has always been anecdotal evidence suggests that certain foods can trigger arthritis, there have been studies that now look arthritis and diet and suggests that for some people, diet can play a role in the symptoms of arthritis.

Foods to Avoid

People with arthritis, including rheumatoid arthritis, say they notice a link between their food and they often have extensive experience. The most common foods associated with these thrusts are:

- Acid fruits. Citrus such as lemons, oranges and grapefruits.

- Dairy.

- Nightshade vegetables such as potatoes, peppers, tomatoes and eggplant.

Nightshade vegetables are rich in alkaloids that has been known to affect the nervous joint and muscle function in humans and animals. People who are sensitive to these alkaloids may experience a recurrence of their arthritis symptoms by eating these foods.

Calcium can also be problematic, because large amounts can not be broken down properly and may accumulate around the painful joints have all citrus is thought to worsen painful symptoms.

Dietary therapy arthritis

Omega-3 is known for its anti-inflammatory properties and so eat a diet rich in omega-3 may be beneficial for people with arthritis. Foods rich in omega-3 include:

- Fatty fish. Sardines, mackerel and salmon.

- Nuts and seeds. Flaxseed and flaxseed are good sources.

- Bio-living products. Some margarines and yogurts were enriched in omega-3.

- Cereals. Not only whole grains added omega-3 but also include nuts and seeds.

Omega-6 fatty acids may also help reduce inflammation and these fatty acids can be found in their natural form in sunflower oil and corn that can be used for frying and baking.

Taking supplements

Change their diet is not always possible for some people, so for convenience, you can take omega-3 supplements that also contain vitamin E, an essential antioxidant for free radicals that can be produced by Omega-3 fatty acids. Most cereals are also fortified with vitamin E in its natural state, is produced by foods like almonds, sunflower seeds, avocado and spinach.

Maintaining a healthy lifestyle and eating a healthy balanced diet are all factors that can help improve the symptoms of arthritis.

Ways to Support Healthy Digestion

Healthy digestion requires support for all the different components of digestion:

Chew thoroughly. Chewing is the physical process of breaking the food down into smaller fragments. Thorough chewing mixes food well with saliva, which moistens the food particles and provides a means for enzymes, like amylase and lipase, to get to the pieces of food and begin the process of starch and fat digestion. Chewing also signals the body to begin the digestion process, alerting the stomach to prepare to make stomach acid, and signaling the pancreas to prepare to secrete its contents into the lumen of the small intestinal tract.

When a meal is not well chewed, the food fragments are too big. Since the digestive enzymes can only work on the surface of the food fragments, inadequate chewing results in incomplete digestion. This means not only nutrients being left in the food and unabsorbed, but also extra food for bacteria in the colon. This extra bacterial food results in bacterial overgrowth, gas and symptoms of indigestion.

Eating should always begin with thorough chewing of food to allow for complete digestion to occur.

Ensure adequate amounts of digestive factors. After chewing, the food's next stop is the stomach, where an adequate amount of stomach acid (hydrochloric acid) is the next necessity. Stomach acid is required for adequate breakdown of proteins. Without adequate stomach acid, not only is protein digestion ineffective, but also digestion of vitamin B12 is seriously affected. Vitamin B12 digestion and absorption requires that it be liberated from protein. In addition, intrinsic factor, the protein that is necessary for vitamin B12 absorption, is low when stomach acid is low.

Low stomach acid (hypochlorhydria) is common, especially in older people since as we age, we make less stomach acid. Research suggests that as many as half of the people over 60 years old have hypochlorhydria. A variety of factors can inhibit sufficient stomach acid production including the pathogenic bacteria, Helicobacter pylori, and frequent use of antacids. Hypochlorhydria is also associated with many diseases, such as asthma, celiac sprue, hepatitis, rheumatoid arthritis, osteoporosis, and diabetes mellitus. Signs of hypochlorhydria include a sense of fullness after eating, bloating, excessive belching, indigestion, multiple food allergies, undigested food in the stool, and peeling and cracked fingernails.

In addition to hydrochloric acid, the production of pancreatic enzymes and bicarbonate is also compromised in some people. If necessary, these digestive factors can be replaced with appropriate supplementation. Digestive enzyme support can also be obtained from fresh pineapple or papaya, which contain the enzyme bromelain, and other fresh vegetables and herbs. Processed foods, like canned pineapple, contain little enzyme activity since digestive enzymes are proteins, which are destroyed by heating, such as in the sterilization process. So beginning a meal with fresh fruits or salad can provide support for healthy digestion.

Identify and eliminate food allergens. The intestinal brush border (the absorptive surface of the small intestine) can be negatively affected by food allergies, which cause inflammation along the intestinal tract wall. When a food allergic reaction occurs, the immune system perceives specific food molecules as hostile invaders, and forms antibodies, which latch on to these allergens to assist in their removal. As part of the immune system's defensive action against food allergens, inflammation can occur along the intestinal tract lining, interrupting the absorption process and causing damage to the lining. Gastrointestinal inflammatory diseases—such as diverticulosis or inflammatory bowel disease—and celiac sprue (intolerance of gluten found in wheat products) also result in damage to the intestinal wall. Most common food allergens include milk proteins, wheat, soy, some shellfish, and peanuts.

Support the gastrointestinal barrier. The gastrointestinal cell wall is the barrier between what you ingest and the inside of your body; therefore, the integrity of this barrier is vital to your health. Support for the mucus that covers the cells in the gastrointestinal tract is very important, especially in the stomach. The mucus layer is one way the stomach and upper small intestine protect themselves against the damaging effects of stomach acid. Alcohol, over-the-counter anti-inflammatory drugs, called NSAIDS (e.g. aspirin), and the pathogenic bacteria, Helicobacter pylori can reduce the mucous layer, leading to lesions in the stomach and small intestinal tract walls.

Choline provides nutritional support for a healthy mucous layer and is found in vegetables such as cauliflower and lettuce. Choline can be obtained from lecithin (phosphatidylcholine) as well, which is high in eggs and soybeans. Some foods also help combat or protect against the damage of Helicobacter pylori, and these include catechins found in green tea, some spices such as cinnamon, carotenoids found in vegetables, and vitamin C, found in citrus foods.

Provide a healing environment for the small intestine. Research studies have shown that the small intestinal tract barrier can become leaky under some conditions. That is, the cells loose their attachments to each other, resulting in a wall with holes between the cells instead of the cells forming a strong, connected and continuous surface. When this "leaky gut" happens, molecules can get inside the body that normally wouldn't be transported through the intestinal cell wall. Furthermore, studies have shown that this leaky gut can also cause problems in the normal transport of nutrients. This is probably because most nutrients are taken into the body through the cells in the intestinal wall by the selective process of active transport, and they may need to go through the cells and not around them to get to the right transport systems in your body. Therefore, with leaky gut, the things that shouldn't get in do, and those that should can't get where they need to be for adequate transport through the body. The result is the body doesn't get the nutrition it needs.

Anything that irritates the lining of the gastrointestinal tract can cause leaky gut, but a major contributor is inflammation (e.g., food allergies). Leaky gut occurs under stress (see below), and is found after radiation treatments for cancer, after some chemotherapy, with diseases such as inflammatory bowel disease, and with bacterial infections, which can result in bacterial overgrowth in the small intestine.

Eliminating foods to which you are intolerant or allergic can help provide a healing environment in the small intestine. Carotenoids, (a precursor to vitamin A), may be particularly important since vitamin A supports the maturation of epithelial cells, which are the type of cell that line the intestinal tract, and it is the mature epithelial cells that form the strongest barrier in the intestinal tract. Carotenoids are found at high levels in vegetables, especially the orange- and red-colored vegetables.

Glutathione, a small peptide found in the highest concentrations in fresh vegetables, fruits, and lean meats is also beneficial to the small intestine, since it can directly act as an antioxidant in the intestinal tract and help decrease damaging molecules that may be produced during inflammation. Vitamin C, from citrus fruits, and vitamin E, found in whole grain cereals and nut oils, are important antioxidants for the small intestine and work with glutathione to support intestinal healing.

The cells that line the intestinal tract need fuel to continue their process of nutrient uptake. The preferred fuel for these cells is the amino acid glutamine, which can be obtained from proteins. Some studies have shown that short-chain fatty acids may also support the small intestinal tract barrier because they can serve as an alternate fuel for the cells that make up the intestinal lining. The small intestinal tract cells also require energy to maintain integrity of the cell wall, and production of energy requires healthy levels of vitamin B5. Mushrooms, cauliflower, sweet potatoes, corn, broccoli, and beet greens are concentrated sources of pantothenic acid. The intestinal tract cells also require a number of vitamins, so adequate overall nutrition is necessary.

Support the growth of probiotic bacteria. When a good balance of probiotic bacteria have colonized the colon, they crowd out pathogenic bacteria and other microorganisms that compromise your health, preventing them from growing. By fermenting the fiber your body couldn't directly digest, these healthy colonic bacteria also produce short-chain fatty acids that the cells of the colon use for their own nourishment. In addition, these short-chain fatty acids are absorbed into the body and have beneficial effects on the small intestine and the system in general. For example, they may help maintain healthy blood sugar and lipid (fat) levels, and may also increase the amount of calcium taken in by the small intestine, and promote the movement of food through the intestinal tract. Foods that will supply probiotic bacteria include some yogurts, kefir, and other foods that have been fermented with Lactobacillus or contain Bifidobacteria, the beneficial types of bacteria. Foods that will nourish probiotic bacteria include foods that contain soy fiber, inulin (from chicory or Jerusalem artichoke), and rice fiber.

Provide for healthy intestinal transit. The movement of the food, or chyme, through the digestive tract is very important. Healthy intestinal transit is supported, in part, by the short-chain fatty acids produced by fermentation of prebiotic fibers in the colon. Fiber, in general, supports overall transit of the chyme and healthy elimination. Some fibers, like those found in rye, wheat and flax, also can bind to environmental toxins, such as pesticides, and carry them through the digestive tract for direct elimination, decreasing the amount that is absorbed into your body.

Learn how to deal with stress effectively. Research has shown that the intestine responds negatively to stress, during which the intestinal lining becomes leaky, absorption is less effective, and your body is unable to selectively take up the nutrients it needs. The reasons for these effects of stress on the intestinal tract are not entirely known, however many neurotransmitters (brain-produced signaling molecules) are found surrounding the intestinal tract. Furthermore, neurotransmitter receptors, which can bind and respond to these signaling molecules, are located along the intestinal tract. Therefore, it is known that brain signaling molecules can affect the intestinal tract. Foods with a calming effect include herb teas, like chamomile. Alcohol, caffeine, and refined carbohydrates, like table sugar, should be avoided. Eating meals at regular times and in a relaxed environment can also help decrease stress.

Plica syndrome

Plica Syndrome (also known as Synovial Plica Syndrome) is a condition which occurs when a plica (an extension of the protective synovial capsule of the knee) becomes irritated, enlarged, or inflamed.This inflammation is typically caused by the plica being caught on the femur, or pinched between the femur and the patella. The most common location of plica tissue is along the medial (inside) side of the knee. The plica can tether the patella to the femur, be located between the femur and patella, or be located along the femoral condyle. If the plica tethers the patella to the femoral condyle, the symptoms may cause it to be mistaken for Patello-femoral Syndrome or ligamental plague. Plica are very well visable on MRI.

The plica themselves are remnants of the fetal stage of development where the knee is divided into three compartments. The plica normally diminish in size during the second trimester of fetal development, as the three compartments develop into the synovial capsule. In adults, they normally exist as sleeves of tissue called synovial folds. The plica are usually harmless and unobtrusive; Plica Syndrome only occurs when the synovial capsule becomes irritated, which thickens the plica themselves (making them prone to irritation/inflammation, or being caught on the femur).

Detecting a plica is nearly impossible externally. They may be confirmed via MRI or during surgery.

Plica Syndrome treatment focuses on decreasing inflammation of the synovial capsule. A non-steroidal anti-inflammatory medication NSAID is often used in conjunction with therapeutic exercise and modalities. Iontophoresis and phonophoresis have been utilized successfully against inflammation of the plica and synovial capsule. Failing these, surgical removal of the plica of the affected knee may be necessary.

Treatment of arthritis of the knee with electrotherapy

Arthritis in the United States affects nearly 46 million Americans. The biggest challenge most people have to treat pain and inflammation associated with the disease. Arthritis sufferers who experience significant pain find it difficult to be productive and the operation of a normal life. In addition, the effective treatment options are wide and in most cases, ineffective. The good news is that new advancements in technology and changes to old technologies continue to show promising results for the treatment of disease. Electrotherapy is one of these technologies. Electrotherapy for use for the treatment of knee pain associated with a wide variety of ailments knee has received a lot of bad press in recent years, but our research has shown that small adjustments in the delivery of electrical stimulation and new methods processing can be very effective.

Electrotherapy is the use of electrical energy to stimulate the muscles and nerves within the body to generate natural mechanisms to cure a wide variety of medical conditions, in which case the knee pain and inflammation. It is believed that this stimulation inhibits interleukin-1 (IL-1), which is the cytokine responsible for the regulation of immune and inflammatory responses in the brain. It is also believed that releases endorphins, stimulates peri-Aquaductal gray area of ??the brain and acts on pain receptors to reduce and even eliminate knee pain for people with arthritis / osteoarthritis.

The patients in our study group showed a 82% reduction of pain on the basis of the results of the scoring of the test results KOOS. Our research has shown that adjustments to the frequency and sequence of traditional electrical stimulation have a dramatic effect on the treatment of knee pain and inflammation. In addition, traditional treatment methods involve icing the affected areas after treatment. We found that this is not necessary and, in fact, has a negative effect of the cure. It is our belief that more is not necessarily better and consistent stable therapy with electrical stimulation is a practical approach to treatment.

We continue to make small changes in our methods, monitor our study group and so far it is very promising to help patients deal with their pain and inflammation and ultimately get back on their feet. Our philosophy is that patients should be aware of what works for them, watch their diets and exercise regularly. We believe that these treatment methods provide effective excellent alternative for people with arthritis / osteoarthritis of the knee and prudent strategy can live a normal and active life.

Osteoarthritis

Osteoarthritis (OA) also known as degenerative arthritis or degenerative joint disease or osteoarthrosis, is a group of mechanical abnormalities involving degradation of joints,including articular cartilage and subchondral bone. Symptoms may include joint pain, tenderness, stiffness, locking, and sometimes an effusion. A variety of causes—hereditary, developmental, metabolic, and mechanical deficits—may initiate processes leading to loss of cartilage. When bone surfaces become less well protected by cartilage, bone may be exposed and damaged. As a result of decreased movement secondary to pain, regional muscles may atrophy, and ligaments may become more lax.

Treatment generally involves a combination of exercise, lifestyle modification, and analgesics. If pain becomes debilitating, joint replacement surgery may be used to improve the quality of life. OA is the most common form of arthritis, and the leading cause of chronic disability in the United States. It affects about 1.9 million people in Australia, 8 million people in the United Kingdom and nearly 27 million people in the United States.

MRI of osteoarthritis in the knee, with characteristic narrowing of the joint space.

ICD-10 M15-M19, M47

ICD-9 715

OMIM 165720

DiseasesDB 9313

MedlinePlus 000423

eMedicine med/1682 orthoped/427 pmr/93 radio/492

MeSH D010003

Signs and symptoms

Bouchard's nodes and Heberden's nodes may form in osteoarthritis

The main symptom is pain, causing loss of ability and often stiffness. "Pain" is generally described as a sharp ache or a burning sensation in the associated muscles and tendons. OA can cause a crackling noise (called "crepitus") when the affected joint is moved or touched and people may experience muscle spasms and contractions in the tendons. Occasionally, the joints may also be filled with fluid.[6] Some people report increased pain associated with cold temperature, high humidity, and/or a drop in barometric pressure, but studies have had mixed results.

OA commonly affects the hands, feet, spine, and the large weight bearing joints, such as the hips and knees, although in theory, any joint in the body can be affected. As OA progresses, the affected joints appear larger, are stiff and painful, and usually feel better with gentle use but worse with excessive or prolonged use, thus distinguishing it from rheumatoid arthritis.

In smaller joints, such as at the fingers, hard bony enlargements, called Heberden's nodes (on the distal interphalangeal joints) and/or Bouchard's nodes (on the proximal interphalangeal joints), may form, and though they are not necessarily painful, they do limit the movement of the fingers significantly. OA at the toes leads to the formation of bunions, rendering them red or swollen. Some people notice these physical changes before they experience any pain.

OA is the most common cause of a joint effusion of the knee.

Causes

Damage from mechanical stress with insufficient self repair by joints is believed to be the primary cause of osteoarthritis. Sources of this stress may include: misalignments of bones caused by congenital or pathogenic causes; mechanical injury; excess body weight; loss of strength in the muscles supporting a joint; and impairment of peripheral nerves, leading to sudden or uncoordinated movements.However exercise, including running in the absence of injury, has not been found to increase the risk.Nor has cracking one's knuckles been found to play a role.

Primary

Primary osteoarthritis of the left knee. Note the osteophytes, narrowing of the joint space (arrow), and increased subchondral bone density (arrow).

A number of studies have shown that there is a greater prevalence of the disease among siblings and especially identical twins, indicating a hereditary basis. Although a single factor is not generally sufficient to cause the disease, about half of the variation in susceptibility has been assigned to genetic factors.

As early human ancestors evolved into bipeds, changes occurred in the pelvis, hip joint and spine which increased the risk of osteoarthritis.Additionally genetic variations that increase the risk were likely not selected against because usually problems only occur after reproductive success.

The development of OA is correlated with a history of previous joint injury and with obesity, especially with respect to knees.Since the correlation with obesity has been observed not only for knees but also for non-weight bearing joints and the loss of body fat is more closely related to symptom relief than the loss of body weight, it has been suggested that there may be a metabolic link to body fat as opposed to just mechanical loading.

Changes in sex hormone levels may play a role in the development of OA as it is more prevalent among post-menopausal women than among men of the same age.A study of mice found natural female hormones to be protective while injections of the male hormone dihydrotestosterone reduced protection.

Secondary

This type of OA is caused by other factors but the resulting pathology is the same as for primary OA:

Alkaptonuria

Congenital disorders of joints

Diabetes

Ehlers-Danlos Syndrome

Hemochromatosis and Wilson's disease

Inflammatory diseases (such as Perthes' disease), (Lyme disease), and all chronic forms of arthritis (e.g. costochondritis, gout, and rheumatoid arthritis). In gout, uric acid crystals cause the cartilage to degenerate at a faster pace.

Injury to joints or ligaments (such as the ACL), as a result of an accident or orthopedic operations.

Ligamentous deterioration or instability may be a factor.

Marfan syndrome

Obesity

Septic arthritis (infection of a joint)

Pathophysiology

Primary OA is a chronic degenerative disorder related to but not caused by aging, as there are people well into their nineties who have no clinical or functional signs of the disease. As a person ages, the water content of the cartilage decreases better source needed] as a result of a reduced proteoglycan content, thus causing the cartilage to be less resilient. The water content of healthy cartilage is finely balanced by compressive force driving water out & swelling pressure drawing water in. Collagen fibres exert the compressive force, whereas the Gibbs-Donnan effect & cartilage proteoglycans create osmotic pressure which tends to draw water in. However during onset of OA there is an increase in cartilage water content.

This increase occurs because whilst there is an overall loss of proteoglycans, it is outweighed by a loss of collagen.Without the protective effects of the proteoglycans, the collagen fibers of the cartilage can become susceptible to degradation and thus exacerbate the degeneration. Inflammation of the surrounding joint capsule can also occur, though often mild (compared to what occurs in rheumatoid arthritis). This can happen as breakdown products from the cartilage are released into the synovial space, and the cells lining the joint attempt to remove them. New bone outgrowths, called "spurs" or osteophytes, can form on the margins of the joints, possibly in an attempt to improve the congruence of the articular cartilage surfaces. These bone changes, together with the inflammation, can be both painful and debilitating.

Diagnosis

Diagnosis is made with reasonable certainty based on history and clinical examination. X-rays may confirm the diagnosis. The typical changes seen on X-ray include: joint space narrowing, subchondral sclerosis (increased bone formation around the joint), subchondral cyst formation, and osteophytes.Plain films may not correlate with the findings on physical examination or with the degree of pain. Usually other imaging techniques are not necessary to clinically diagnose OA.

In 1990, the American College of Rheumatology, using data from a multi-center study, developed a set of criteria for the diagnosis of hand OA based on hard tissue enlargement and swelling of certain joints.[33] These criteria were found to be 92% sensitive and 98% specific for hand OA versus other entities such as rheumatoid arthritis and spondyloarthropathies.

Related pathologies whose names may be confused with OA include pseudo-arthrosis. This is derived from the Greek words pseudo, meaning "false", and arthrosis, meaning "joint." Radiographic diagnosis results in diagnosis of a fracture within a joint, which is not to be confused with OA which is a degenerative pathology affecting a high incidence of distal phalangeal joints of female patients. A polished ivory-like appearance may also develop on the bones of the affected joints, reflecting a change called eburnation.

Classification

OA can be classified into either primary or secondary depending on whether or not there is an identifiable underlying cause.

Both primary generalized nodal OA and erosive OA (EOA, also called inflammatory OA) are sub-sets of primary OA. EOA is a much less common, and more aggressive inflammatory form of OA which often affects the distal interphalangeal joints of the hand and has characteristic articular erosive changes on x-ray.

Management

Lifestyle modification (such as weight loss and exercise) and analgesics are the mainstay of treatment. Acetaminophen ( also known as paracetamol) is recommended first line with NSAIDs being used as add on therapy only if pain relief is not sufficient.This is due to the relative greater safety of acetaminophen.

Lifestyle modification

For overweight people, weight loss may be an important factor. Patient education has been shown to be helpful in the self-management of arthritis. It decreases pain, improves function, reduces stiffness and fatigue, and reduces medical usage.[38] Patient education can provide on average 20% more pain relief when compared to NSAIDs alone in patients with hip OA.

Physical measures

Moderate exercise is beneficial with respect to pain and function in those with osteoathritis of the knee and possibly hip.While some evidence supports certain physical therapies evidence for a combined program is limited.There is not enough evidence to determine the effectiveness of massage therapy.

The use of orthoses (which include splints, braces or insoles) have been studied. Lateral wedge insoles do not appear to be useful in osteoarthritis of the knee. Knee braces may be useful.

The evidence for manual therapy is inconclusive. Functional, gait, and balance training has been recommended to address impairments of position sense, balance, and strength in individuals with lower extremity arthritis as these can contribute to higher falls in older individuals.

Medication

The analgesic acetaminophen is the first line treatment for OA.For mild to moderate symptoms effectiveness is similar to non-steroidal anti-inflammatory drugs (NSAIDs), though for more severe symptoms NSAIDs may be more effective. NSAIDs such as naproxen while more effective in severe cases are associated with greater side effects such as gastrointestinal bleeding.Another class of NSAIDs, COX-2 selective inhibitors (such as celecoxib) are equally effective to NSAIDs with lower rates of adverse gastrointestinal effects but higher rates of cardiovascular disease such as myocardial infarction.[48] They are also much more expensive. Oral steroids are not recommended in the treatment of OA because of their modest benefit and high rate of adverse effects.

There are several NSAIDs available for topical use including diclofenac. They have fewer systemic side-effects and at least some therapeutic effect.A Cochrane review concluded that opioid analgesics such as morphine and fentanyl reduce pain, but this benefit is outweighed by frequent adverse events and thus they should not routinely be used.[50] Topical capsaicin is controversial with some reviews finding benefit and others not.

Injection of glucocorticoids (such as hydrocortisone) leads to short term pain relief that may last between a few weeks and a few months. Joint injections of hyaluronic acid have not been found to lead to significant improvement. Hyaluronic acid injects have been associated with significant harm. Nevertheless another study about hyaluronic acid injections says efficacy on pain and function, and no adverse effect when compared to saline injections.

Surgery

If disability is significant and more conservative management is ineffective, joint replacement surgery or resurfacing may be recommended. Evidence supports joint replacement for both knees and hips.[56] For the knee it improves both pain and functioning.[57] Arthroscopic surgical intervention for OA of the knee however has been found to be no better than placebo at relieving symptoms.

Alternative medicine

Dietary supplements

Many dietary supplements are sold as treatments for OA and some of them have been found to be effective. Phytodolor, SAMe, and SKI 306X (a Chinese herbal mixture) may be effective in improving pain, and there is some evidence to support the use of cat's claw as an anti-inflammatory.There is tentative evidence to support avocado/soybean unsaponifiables, Boswellia serrata extracts (frankincense),MSM and rose hip.

The effectiveness of glucosamine is controversial. Most recent reviews found it to be equal to or only slight better than placebo. A difference may exist between glucosamine sulfate and glucosamine hydrochloride, with glucosamine sulfate showing a benefit and glucosamine hydrochloride not.The Osteoarthritis Research Society International recommends that glucosamine be discontinued if no effect is observed after six months] and the National Institute of Clinical Excellence no longer recommends its use.Despite the difficulty in determining the efficacy of glucosamine, it remains a viable treatment option.

There is little evidence supporting benefits for some supplements, including: the Ayurvedic herbal preparations with brand names Articulin F and Eazmov, collagen, devil’s claw, Duhuo Jisheng Wan (a Chinese herbal preparation), fish liver oil, ginger, the herbal preparation Gitadyl, glucosamine, hyaluronic acid, omega-3 fatty acids, the brand-name product Reumalax, stinging nettle, turmeric, vitamins A, C, and E in combination, vitamin E alone, vitamin K and willow bark. There is insufficient evidence to make a recommendation about the safety and efficacy of these treatments.Chondroitin is not recommended as a treatment for OA.

Manual therapies

While acupuncture leads to a statistically significant improvement in pain relief, this improvement is small and may be of questionable clinical significance. Waiting list-controlled trials for peripheral joint osteoarthritis do show clinically relevant benefits, but these may be due to placebo effects.Acupuncture does not seem to produce long-term benefits.While electrostimulation techniques such as TENS have been used for twenty years to treat osteoarthritis in the knee, there is no conclusive evidence to show that it reduces pain or disability.

Epidemiology

Disability-adjusted life year for OA per 100,000 inhabitants in 2004.

no data

= 200

200–220

220–240

240–260

260–280

280–300

300–320

320–340

340–360

360–380

380–400

= 400

Globally approximately 250 million people have osteoarthritis of the knee (3.6% of the population). OA affects nearly 27 million people in the United States, accounting for 25% of visits to primary care physicians, and half of all NSAID prescriptions. It is estimated that 80% of the population have radiographic evidence of OA by age 65, although only 60% of those will have symptoms. In the United States, hospitalizations for OA increased from 322,000 in 1993 to 735,000 in 2006.

Globally OA causes moderate to severe disability in 43.4 million people as of 2004.

In the United States, there were approximately 964,000 hospitalizations for osteoarthritis in 2011, a rate of 31 stays per 10,000 population. With an aggregate cost of $14.8 billion ($15,400 per stay), it was the second-most expensive condition seen in U.S. hospital stays in 2011. By payer, it was the second-most costly condition billed to Medicare and private insurance.

Etymology

OA is derived from the Greek word part osteo-, meaning "of the bone", combined with arthritis: arthr-, meaning "joint", and -itis, the meaning of which has come to be associated with inflammation. The -itis of OA could be considered misleading as inflammation is not a conspicuous feature. Some clinicians refer to this condition as osteoarthosis to signify the lack of inflammatory response.

History

Evidence for OA found in the fossil record is studied by paleopathologists, specialists in ancient disease and injury. OA has been reported in fossils of the large carnivorous dinosaur Allosaurus fragilis.

How Does Digestion Work and How Can I Improve Mine? (Animated graphics)

The food you eat contains the nutrients that serve as building blocks, and provide energy and nourishment throughout your body. In food, nutrients are contained in large molecules that are chemically and physically bound together. Digestion is the process of breaking down these tightly bound molecules into individual nutrients that can be taken into your body and used to support its functions. Simply defined, digestion is cutting things down to a size in which they can be absorbed into your body.

Digestion occurs in the gastrointestinal tract—the 20 to 30 foot long tube extending from your mouth to your anus. Whatever you eat flows through this system, but until it is absorbed through the intestinal tract, the nutrients in food are physically outside of your body. This is because the gastrointestinal tract functions like an internal skin and provides a barrier between whatever you ingest from the outside (external) world and your internal bloodstream and cells. Part of the digestion process, then, is the selective transport of nutrients through the cell wall that lines your intestinal tract. Once transported across the intestinal barrier to the inside of your body, these nutrients can enter your bloodstream and circulate to all of your tissues to maintain organ function, support your need for energy, and provide for growth and repair of new cells and tissues.

While digestion can be simply defined, its mechanics are quite complex. This is because your food contains so many different sizes, shapes, and types of individual molecules, all tightly entwined, and because each of these types of molecules is chemically distinct. Digestion uses both mechanical processes, such as chewing and grinding, which help separate the different types of molecules, as well as chemical processes, in the form of enzymes that can cut the bonds within the molecules, to release small nutrients into your system. An analogy is two or more necklace chains of different types twisted, knotted, and interlocked together. Digestion would be the process of untwisting and separating the chains, usually requiring cutting them in a couple of places, and then pulling them apart and further cutting each of them into many smaller pieces, so they can become building blocks for other necklace chains.

Do you suffer from menopause and arthritis?

Climb a life free from arthritis menopause

Recent studies have shown that women in their late forties and early fifties show signs of menopause arthritis - a form of arthritis triggered by menopause. Was it not enough that menopause put on hot flashes, night sweats and a variety of aches and pains that kept a woman the night, menopausal arthritis was added to the list? The thought of a staircase that makes you want to escape and makes you want to move to a more expensive but comfortable apartment on the ground floor.

But before you start looking to adapt your lifestyle to adapt to this new phenomenon, to understand what is happening with your body first.

Understand what is arthritis

Osteoarthritis or Arthritis is a common complaint of women in the age group between thirty to fifty years. Arthritis is due to wear of the cartilage around joints. As this wear is progressive arthritis is usually a complaint of people belonging to any age group.

Menopause Arthritis - What is the link between the two?

Arthritis has always been a complaint with women than men. The logic linking hormone menopause with arthritis seems to be the hormone estrogen. When a woman's ovaries stop producing eggs during menopause her body undergoes hormonal imbalances. In particular, the levels of the hormone in the body of a woman starts reducing. Researchers have established the responsibility of arthritis on estrogen for the following reasons:

? The onset of arthritis to double the number of women than the number of men suggests that trigger arthritis must have some exclusive hormone in the female body

? pregnant women experienced symptoms of arthritis stronger than the average woman. A pregnant woman is also known to have higher estrogen levels

There are many causes that trigger arthritis. While estrogen leads the race in this case, there are other changes in the female body that affect arthritis. During menopause, due to hormonal imbalances, a woman is prone to gain more weight. The weight gained adds more pressure on the knees, causing further cartilage wear.

Estrogen addition, there are other hormones in the body of a woman, who know the imbalance caused by menopause. The secretion of these hormones causes tissue and cartilages around joints deteriorate faster.

Menopausal arthritis can it be avoided?

There is no foolproof plan that will keep you free from the clutches of menopause arthritis. However, the onset of arthritis can be prevented by taking small but of simple steps:

- Application hormones topical creams on the pains that start early may delay the onset of arthritis. These creams are designed to balance estrogen levels in the body and thus help relieve the pain caused by inflammation

-Regulating your diet and switching to a gluten free diet will ensure that you do not gain more weight and add more pressure on your knees, facilitating wear tissue around the knee joints. Weight gain also affect other joints of the knee and more like the back, ankles and wrists

- Use an anti-inflammatory cream for moderate peri-menopause delays the onset of menopause arthritis

-Use of supplements to strengthen bones at an early age, prevents the early onset of arthritis

Herbs that can help arthritis menopause

There are also home remedies you can use when you first encounter pain in the joints. Indian researchers have placed great confidence in the practice of Ayurveda and the use of medicinal herbs to relieve the aches and pains that lead to arthritis caused by menopause.

- Boswellia - An Indian plant without side effects stops the inflammation in the joints and release of biochemical substances that cause pain. Many women who have used this herb during perimenopause menopause had a free joint pain and back

- Turmeric - Turmeric is the wonder herb of India. Uses of turmeric are vast and varied, mainly used as an antiseptic to treat wounds, turmeric is known to have curcumin reduces inflammation and relieves pain. Application of turmeric paste on painful joints reduces pain

- Cayenne - More popularly known as a spice, Cayenne contains capsaicin works as a soothing analgesic on joint pain. Capsaicin actually encourages the body to release its own hormones responsible for pain

Although menopause arthritis is a painful truth most women have to deal with, it should not become a way of life. There are natural and medical means to prolong the onset of arthritis and to cope with an early onset. The transition to a more healthy and take care of your body at an age earlier diet will help you have a more comfortable menopause and painlessly.

In conclusion, the best practices for arthritis or one of the other 34 menopause symptom handling is a proactive approach to staying healthy, eating a clean, adding more fiber per day each meal, low in fat and sugar intake, and exercise at least 30 minutes every day.

Patellofemoral pain syndrome

Patellofemoral pain syndrome (PFPS) is a syndrome characterized by pain or discomfort seemingly originating from the contact of the posterior surface of the patella (back of the kneecap) with the femur (thigh bone). It is a frequently encountered diagnosis in sports medicine clinics.

Mechanism

The cause of pain and dysfunction often results from either abnormal forces (e.g. increased pull of the lateral quadriceps retinaculum with acute or chronic lateral PF subluxation/dislocation) or prolonged repetitive compressive or shearing forces (running or jumping) on the PF joint. The result is thinning and softening (chondromalacia) of the articular cartilage under the patella and/or on the medial or lateral femoral condyles, synovial irritation and inflammation and subchondral bony changes in the distal femur or patella known as "bone bruises". Secondary causes of PF Syndrome are fractures, internal knee derangement, OA of the knee and bony tumors in or around the knee.[1]

Specific populations at high risk of primary Patellofemoral Syndrome include runners, bicyclists, basketball players, young athletes and females. Typically patients will complain of localized anterior knee pain which is exacerbated by sports, walking, stair climbing, or sitting for a long time, often called the "Theater Sign" or "Movie-Goers Sign."[2] The pain from prolonged sitting is thought to occur because of the constant pull of the quadriceps muscle on the knee cap while sitting, which causes its impaction against the hard and unyielding surfaces of the bones of knee joint. Descending stairs may be worse than ascending. Unless there is an underlying pathology in the knee, swelling is usually mild to nil. Palpation, as well, is usually unremarkable.[citation needed]

Differential diagnosis

The diagnosis of patellofemoral pain syndrome is made by ruling out patellar tendinitis, prepatellar bursitis, plica syndrome, Sinding–Larsen–Johansson syndrome, and Osgood–Schlatter disease.

Treatment

Clinicians have traditionally used a variety of treatments for patellofemoral pain syndrome, many of which have little supporting evidence. Most patients with patellofemoral pain syndrome respond well to conservative therapy.

Exercises

A 2011 systematic review stated that evidence supports the use of quadriceps exercise for managing patellofemoral pain syndrome and that quadriceps strengthening is considered to be the "gold" standard treatment for patellofemoral pain syndrome. Quadriceps strengthening is commonly suggested because the quadriceps muscles help to stabilize the patella. Quadriceps weakness and quadriceps muscle imbalance may contribute to abnormal patellar tracking.[4] If the strength of the vastus medialis muscle is inadequate, the usually larger and stronger vastus lateralis muscle will pull sideways (laterally) on the kneecap. Strengthening the vastus medialis to prevent or counter the lateral force of the vastus lateralis is one way of relieving PFPS. Moderate evidence supports the addition of hip abductor and external rotator strengthening, as well as exercises targeting hip flexion and hip extension.[4] When executing these exercises, proper form is very important in order to ensure that the musculature is activated in such a way that will not lead to further injury. Inflexibility has often been cited as a source of patellofemoral pain syndrome. Stretching of the hip, hamstring, calf, and iliotibial band may help restore proper biomechanics.Furthermore, the use of a foam roller may help to add flexibility and relieve pain from sore or stiff muscles in the leg.[citation needed]

Rest

Patellofemoral pain syndrome may also result from overuse or overload of the PF joint. For this reason, knee activity should be reduced until the pain is resolved.[5][6] Those with pain originating from sitting too long should straighten the leg or walk periodically. Those who engage in high impact activity such as running should consider a nonimpact activity such as swimming or aerobics on an elliptical machine.[citation needed]

Ice and medication

To reduce inflammation, ice can be applied to the PF joint after an activity. The ice should be kept in place for 10 to 15 minutes. Additionally anti-inflammatory drugs such as NSAIDs can also be taken immediately after an activity or judicious use during daily activities and for those people whose symptoms aren't controlled with ice.[citation needed]

Orthosis and taping

In addition to physical therapy, external devices such as patellofemoral knee orthosis and tape could be used to stabilize the knee. These orthoses will not correct the underlying source but may prevent further injury. For this reason, they should be used in conjunction with and not in lieu of physical therapy. The technique of McConnell taping involves pulling the patella medially with tape (medial glide). The underlying goal of taping is multifaceted and intended to correct the position of the patella, increase vastus medialis oblique activation, and stretch the tight lateral structures of the patella leading to pain reduction and facilitating strengthening exercises of the quadriceps. Studies have shown that patella taping may reduce pain and potentially increase the activity of the VMO, however the underlying mechanisms of taping are not clearly understood.[20][21] Findings from some studies suggest that there is limited benefit with patella taping or bracing when compared to quadriceps exercises alone.

Arch support

Low arches can cause overpronation or the feet to roll inward too much increasing the Q angle and genu valgus. Poor lower extremity biomechanics may cause stress on the knees and ultimately patellofemoral pain syndrome. Stability or motion control shoes are designed for people with pronation issues. Arch supports and custom orthotics may also help to improve lower extremity biomechanics.

How to improve sleep in arthritis

Have a good sleep and adequate is important to keep you healthy and pain is still a major obstacle for a good sleep. Health conditions such as arthritis pain can disrupt sleep and reduce its quality. How arthritis affects your sleep and what can be done to reduce painful symptoms?

Sleep is supposed to refresh your energy and revitalize your body. Although suffering from diseases such as arthritis instead of waking up to enjoy the fresh new day in advance you wake up tired and feel like you can not move. If you feel that your sleep pattern is disturbed on a regular basis, you probably suffer from these health problems.

Waking up tired usually affects your whole day making you tired and unable to concentrate and of course affects your overall mood. In addition, lack of sleep can significantly aggravate the symptoms of arthritis and pain and muscle tension appear. How can you get a good sleep, you can enjoy even while suffering from arthritis?

There are several proven things you can do to make your sleep back to normal. Try to track your sleep patterns and learn from them. Always avoid sleeping during the day if possible. It will help you establish a rhythm of proper sleep. If you are prone to coffee side effects, avoid drinking before sleep. Also try not to eat and drink a lot before going to bed. Stay away from smoking and drinking alcohol before bedtime and during the night.

Many times, pillows or mattresses poor quality are the culprit behind all your sleep problems and get new can easily solve your problems. If they are not comfortable enough, to change for new high quality. Light exercise before sleep can also greatly improve and keep your body well distributed.

Such an exercise should be the end of a single fire if you like hard training session, do it during the day and not before sleep. Warm and relaxing bath is another way to improve sleep.

There are also several medications available that will reduce the symptoms of arthritis and to the quality of sleep you deserve. Anti-inflammatory pills and painkillers like paracetamol drugs should reduce the pain to a minimum. Sedatives such as Temazepan Zipiclone or can be used for a temporary quick sleep.

Although these drugs work very well, they usually carry unwanted side effects can not be used long term. You have to rely on them for quick relief.

Herbal supplements are another great way how to deal with arthritis and have a good sleep. Products herbal or all natural are increasingly popular because they are not only effective but also carry fewer side effects, they are safe to use. With proper medication every painful symptoms of arthritis will be deleted and you will be able to enjoy your sleep once more.

Find a Vitamin or Supplement

FLAXSEED OIL

Flaxseed is the seed from the plant Linum usitatissimum. Oil from the seed is used to make medicine.

People try flaxseed oil for many different conditions, including rheumatoid arthritis and high cholesterol. It is also tried for treating osteoarthritis, anxiety, benign prostatic hyperplasia (BPH), vaginal infections, dry eyes, “hardening of the arteries” (atherosclerosis), high blood pressure, heart disease, diabetes, and attention deficit-hyperactivity disorder (ADHD).

Some people use flaxseed oil as a laxative for constipation, for weight loss, and to prevent breast cancer and prostate cancer.

Flaxseed oil is also applied to the skin to sooth irritations or soften roughness.

In foods, flaxseed oil is used as cooking oil and in margarines.

In manufacturing, flaxseed oil is used as an ingredient in paints, varnishes, linoleum, and soap; and as a waterproofing agent.

How does it work?

Flaxseed oil is a source of polyunsaturated fatty acids such as alpha-linolenic acid. The alpha-linolenic acid and related chemicals in flaxseed oil seem to decrease inflammation. That is why flaxseed oil is thought to be useful for rheumatoid arthritis and other inflammatory (swelling) diseases.

Possibly Ineffective for:

High blood fats (hyperlipidemia). Some research shows that taking flaxseed oil does not significantly reduce cholesterol and triglyceride levels in people with high cholesterol and high triglycerides.

Rheumatoid arthritis (RA). Taking flaxseed oil daily for 3 months does not seem to improve symptoms of pain and stiffness, and has no effect on laboratory tests that measure severity of RA.

Insufficient Evidence for:

Attention deficit-hyperactivity disorder (ADHD). There is some evidence that taking flaxseed oil might improve attention, impulsiveness, restlessness, and self-control in children with ADHD.

"Hardening of the arteries" (atherosclerosis). There is some evidence that increasing the amount of linolenic acid in the diet can help to prevent hardening of the arteries. Flaxseed oil contains linolenic acid, so some people suggest that flaxseed oil ought to prevent atherosclerosis. Though this assumption seems reasonable, there has been no research yet to prove it is correct.

Breast cancer. Research has shown that women who have higher levels of alpha-linolenic acid in their breast tissue are less likely to get breast cancer. Scientists think that high intake of linolenic acid might protect against breast cancer. Flaxseed oil is one source of linolenic acid, but it’s not known whether increasing flaxseed oil intake will actually help to prevent breast cancer.

Heart disease. There is evidence that people with existing heart disease, who get more alpha-linolenic acid from their diet, have a lower risk of dying from heart disease. Flaxseed oil is one source of alpha-linolenic acid, but research has not directly measured the effect of flaxseed oil intake on heart disease outcomes. It is also not known if flaxseed oil supplements have the same effects as flaxseed oil from food.

Diabetes. Research to date suggests that flaxseed oil doesn’t lower blood sugar in people with Type 2 diabetes.

Dry eyes. Some preliminary clinical research suggests that taking flaxseed oil might reduce irritation and symptoms of dry eyes. A specific product containing fish oil plus flaxseed oil (TheraTears Nutrition) might also reduce symptoms of dry eye and increase tear production.

High blood pressure. Early studies suggest that flaxseed oil supplements help to lower blood pressure in men with normal blood pressure, but high cholesterol. We’ll have to wait to see if flaxseed oil lowers blood pressure in people with high blood pressure.

Prostate cancer. Research studies don’t agree about the role of the flaxseed oil ingredient, alpha-linolenic acid, in prostate cancer. Some epidemiologic research suggests that high dietary intake of alpha-linolenic acid is linked with an increased risk for prostate cancer. Other research suggests high intake or high blood levels of alpha-linolenic acid is not linked with the overall risk of prostate cancer; however, extra alpha-linolenic acid might make existing prostate cancer worse. The source of alpha-linolenic acid appears to be important. Alpha-linolenic acid from dairy and meat sources has been positively linked with prostate cancer. Alpha-linolenic acid from plant sources, such as flaxseed or flaxseed oil, does not affect prostate cancer risk.

Anxiety.

Constipation.

Cancer.

Vaginal problems.

Weight loss.

Other conditions.

More evidence is needed to rate flaxseed oil for these uses.

Flaxseed oil is LIKELY SAFE for most adults when used appropriately short-term.

Large doses of 30 grams per day and higher can cause loose stools and diarrhea. Allergic reactions have occurred while taking flaxseed oil.

Some men worry that taking flaxseed oil might increase their chance of getting prostate cancer because of the alpha-linolenic acid that flaxseed oil contains. Researchers are still trying to figure out the role of alpha-linolenic acid in prostate cancer. Some studies suggest that alpha-linolenic acid may increase risk or make existing prostate cancer worse, but other studies find no connection. Nevertheless, the alpha-linolenic acid in flaxseed oil doesn’t seem to be a problem. Alpha-linolenic acid from plant sources, such as flaxseed, does not seem to affect prostate cancer risk, although alpha-linolenic acid from dairy and meat sources has been linked in some studies with prostate cancer.

Not enough is known about the safety of flaxseed oil when it is applied to the skin.

Special Precautions & Warnings:

Pregnancy: Flaxseed oil is POSSIBLY UNSAFE in pregnancy. Some research suggests that flaxseed oil might increase the change of premature birth when taken during the second or third trimesters of pregnancy. Pregnant women should avoid taking flaxseed oil.

Breast-feeding: There isn’t enough reliable information available about the safety of flaxseed oil during breast-feeding. Stay on the safe side and avoid using flaxseed oil while breast-feeding until more is known.

Bleeding disorders: Flaxseed oil might increase the risk of severe bleeding in patients with bleeding disorders. Talk to your healthcare provider before using flaxseed oil if you have a bleeding disorder.

Surgery: Flaxseed oil might increase the risk of bleeding during and after surgery. Stop using it at least 2 weeks before a scheduled surgery.

Medications that slow blood clotting (Anticoagulant / Antiplatelet drugs) interacts with FLAXSEED OIL

Flaxseed oil might slow blood clotting. Taking flaxseed oil along with medications that also slow clotting might increase the chances of bruising and bleeding.

Some medications that slow blood clotting include aspirin, clopidogrel (Plavix), diclofenac (Voltaren, Cataflam, others), ibuprofen (Advil, Motrin, others), naproxen (Anaprox, Naprosyn, others), dalteparin (Fragmin), enoxaparin (Lovenox), heparin, warfarin (Coumadin), and others.

The appropriate dose of flaxseed oil depends on several factors such as the user’s age, health, and several other conditions. At this time there is not enough scientific information to determine an appropriate range of doses for flaxseed oil. Keep in mind that natural products are not always necessarily safe and dosages can be important. Be sure to follow relevant directions on product labels and consult your pharmacist or physician or other healthcare professional before using.

Note that flaxseed oil can easily break down chemically if exposed to light, heat, or air. Flaxseed oil should be stored in a frosted bottle and protected from heat. It can be stored in the refrigerator.

Daily dose of fish oil eases the pain from osteoarthritis

Millions take a fish oil supplement every day to ease aching joints, but until now scientists could not find hard evidence to prove it had any real benefits.

A two-year study has shown that even taking a low dose can reduce the pain and inflammation caused by osteoarthritis.

An estimated eight million people in Britain have some degree of osteoarthritis, caused by wear and tear on joints, such as the hips, knees and wrists, where the cartilage that cushions bone movement has broken down.

Bones then come into contact, and the friction makes joints swollen and extremely painful.

There is no cure and many sufferers rely on anti-inflammatory painkillers, although these can damage the stomach when used long-term.

Researchers, from several universities and hospitals in Australia and Tasmania, have now shown that not only does fish oil ease the symptoms of osteoarthritis, but low doses may actually be more effective than large ones.

They studied 200 patients with an average age of 60 and discovered that those on a low dose had double the reduction in knee pain of patients on higher doses. They also saw significantly greater improvements in their mobility.

In a report on their findings the researchers said that ‘high doses were not superior to low doses’ but they were still unsure why.

Is there an allergy arthritis connection?

Arthritis is one of the most debilitating diseases in the United States and a major cause of missed work. Unfortunately, conventional treatments are limited and almost exclusively focused on anti- inflammatory drugs , not the elimination of the original trigger of this inflammation .

What is " arthritis " means ?

The word "arthritis " simply means " joint inflammation ." There are basically two types: osteoarthritis and rheumatoid arthritis.

Osteoarthritis is an inflammation caused by the degeneration of the joint and is due to chronic wear and tear. Osteoarthritis is most commonly found in the knees.

Rheumatoid arthritis ( RA) is a more common term for inflammation , pain and swelling of joints. Rheumatoid arthritis is often seen in the hands , although it can affect any part of the body .

The traditional approach of arthritis

Rheumatoid arthritis is considered by an unknown cause autoimmune disease . This belief ignores a large body of scientific evidence showing food allergies as a major cause of arthritis. The correlation between arthritis and allergies proves quite significant .

Dr. Theron G. Randolph Illinois was the founder of environmental medicine . During his research, he has tested more than 1,000 patients with rheumatoid commonly eaten foods and chemicals . He tested substances from natural gas, automobile exhaust , paint , perfume, hair spray , insecticides , tobacco smoke which of these substances caused their symptoms.

Several other studies have shown that many foods , food additives , as well as foreign invaders such as protozoa, bacteria , yeasts, fungi and can trigger or worsen arthritic symptoms . In the case of food allergies , eating too much of certain foods too often is another problem. " Most people eat the same few foods over and over again , sometimes literally " ad nauseam , "wrote Dr. Randolph .

In addition , Dr. Marshall Mandell, author , book Allergy- Mr. Mandell recipes , tested over 6000 patients. He found that foods, chemicals, grass , pollen , mold and other airborne substances caused allergic reactions in joints nearly 85 % of arthritic it tested .

The medical community has focused almost exclusively on the treatment of arthritis with anti -inflammatory medications , either prescription or nonprescription . These medications provide only temporary relief of pain and swelling, but they never cure arthritis . In the long term , this type of treatment also comes with a host of side effects.

Is it possible to eliminate inflammation without drugs?

Very often it is possible to eliminate the cause of the inflammation without the use of drugs to suppress . Inflammation is caused by the immune system . The important question is : "Why the immune system creates inflammation " ?

What triggers the immune system to create inflammation? Â ? ¨

Anything that triggers an immune response also triggers inflammation. These include allergies , foods that are incorrectly identified by the immune system as not belonging to the body . Thus , an allergic reaction to a food can result in inflammation of the joints and pain .

What foods cause arthritis ?

The body may be allergic to food , therefore, any food allergy is able to cause inflammation and arthritis. This includes RA , juvenile arthritis , and joint pain defined.

That is why it can be so hard for one to recognize the relationship between their diet and their symptoms. Many times there is a delay between eating the suspect food and the associated pain.

What to do?

If we can remove the defective programming and replace it with a program that does not create inflammation, reduce pain and in many cases disappear completely.

Programs like NAET were very effective in the treatment of joint pain and allergies. And if you do not have the time or money to investigate this very successful removal treatment of allergy.

Plica Syndrome Treatment & Management

Medical Therapy

Medical treatment of plica syndrome has been driven largely by empirical evidence. A structured program of stretching and strengthening exercises often leads to some improvement. This may include short-arc quadriceps extension exercises (terminal approximately 20° of extension). These exercises are aimed at optimizing patellofemoral biodynamic relationships in an effort to control symptoms. A patellar knee sleeve worn during sporting activities (usually a neoprene-type brace) may also be a useful adjunct for many athletes. In addition, nonsteroidal anti-inflammatory medications are a time-tested and confirmed aid for many athletes with plica syndrome.

Surgical Therapy

Surgical therapy for plica syndrome is virtually always arthroscopic. The arthroscopic surgeon needs to exclude other potential intra-articular causes of knee pain and then address any pathologic plicae. Plica resection may be performed with arthroscopic hand instruments, a motorized soft-tissue resector, or certain commercially available electrothermal devices.

Preoperative Details

The preoperative phase of treatment involves optimizing the patient's knee strength and flexibility in an effort to streamline postoperative rehabilitation. Preoperative preparation of the patient also involves education and appropriate goal setting. For instance, the patient should understand that therapeutic exercises typically begin shortly after surgery (hours to days) and that a full return to sports can be realized soon thereafter (days to weeks). Patients who know this in advance tend to achieve these goals quite readily.

Intraoperative Details

After arthroscopic evaluation establishes that no other intra-articular abnormalities need to be addressed, the plica can be resected. Using whatever tools work best in the surgeon's hands, the plica should be resected back to a point where it no longer impinges on articular structures. With beefy synovitic plicae that extend into the patellofemoral joint space (typically 50% or more), as in the first image below, this may require extensive debridement, as in the second image below. With tough, fibrotic plicae that drape over the medial femoral condyle, this may involve little more than disruption of the tight band.

Plica syndrome. Preoperative appearance of medial

Plica syndrome. Preoperative appearance of medial parapatellar plica (a 4+ plica by the Jee classification, extending across more than two thirds of the medial facet of the patella).

Plica syndrome. Postoperative appearance of the sa

Plica syndrome. Postoperative appearance of the same patient as in Image 5 after plical resection.

At times, even a suprapatellar plica may lead to symptoms. Strover et al reported on an arthroscopic technique demonstrating the pathomechanics of such suprapatellar plicae.[31] They recommended that the arthroscope should be inserted through a lateral suprapatellar portal. Proximal visualization is then optimized. In those patients in whom the suprapatellar plica is symptomatic, progressive flexion of the knee results in the plical tissue becoming taut. It also makes contact with the medial femoral condyle and even becomes entrapped between the quadriceps tendon and medial femoral condyle.

Postoperative Details

Postoperatively, the patient is started on a structured course of therapeutic exercise that initially emphasizes reestablishment of active quadriceps control and firing. This progresses to regaining full range of motion and then full strength. The patient concludes therapeutic recovery by gradually performing more and more sport-specific exercises until a controlled reentry to the sport is achieved.

Follow-up

Follow-up care focuses on confirmation that symptoms have abated. True recurrence of the original plical pathology is quite rare and is more likely to represent either an incomplete resection or entirely new knee pathology. Continued use of a patellar stabilizing-type brace is preferred by many patients.

Complications

Complications of surgical treatment of plica syndrome are really complications associated with arthroscopic surgery of the knee. These include septic arthritis, neurapraxias or neuromas, and synovial fistulae. Reflex sympathetic dystrophy may also occur following such surgery. The rate of each of these complications is extremely small (< 1% in most cases). Only patients with particular risk factors (eg, diabetes, steroid dependence, history of RSD) may be at a significantly higher risk.

Outcome and Prognosis

The outcome of surgical treatment for well-selected patients with plica syndrome is very good.[32, 33, 34] A clinical trial conducted by Johnson et al in England demonstrated a success rate of more than 80%. In this same study, nearly 50% of patients in the control group experienced continued symptoms severe enough that they later returned for definitive arthroscopic resection of their plicae.

In a predominantly adult population (average age 25 y, age range 11-56 y), Kasim and Fulkerson reported 88% moderate-to-substantial improvement at an average of more than 4 years following resection of localized segments of painful retinacula (ie, plicae) about the knee.

Future and Controversies

Synovial plicae within the knee are clearly normal anatomic structures that can become potent pain generators.[36] Therefore, little debate exists as to whether they may become pathologically involved. Future treatment of plica syndrome may be supplemented further by improved brace designs and pharmacological treatments. Earlier recognition of patients with the syndrome might facilitate syndrome resolution by such means, in contrast to patients who experience years of symptoms.

Hallux Rigidus, Stiff Big Toe

Hallux rigidus or osteoarthritis of the first MP joint (great toe joint) is a very common condition affecting adults. The symptoms are pain and stiffness in the toe. Patients also have difficulty getting up on their toe, running and wearing a high-heeled shoe. Most patients notice a bump on the top of the foot at the big toe joint and a stiff and painful toe. The non-operative treatment for hallux rigidus involves shoe modification, which includes a rocker bottom to their shoe, custom orthotics or sometimes injections. Most patients with a hallux rigidus benefit from surgical intervention.

There are three types of procedures we do for hallux rigidus. The first procedure is called Moberg cheilectomy. In this procedure, we do a cheilectomy (a shaving on the bone off the top of the foot). This helps take the spurs off the joint. The second part of procedure is to wedge the toe a little bit up so that it bends more. This involves taking a small wedge out of the toe bone itself and inserting a small screw. This procedure is very effective for mild to moderate hallux rigidus and most patients can return to full activity afterwards.

Hallux Rigidus Treatment | Stiff Big Toe Treatment | Manhattan | New York City Hallux Rigidus Treatment | Stiff Big Toe Treatment | Manhattan | New York City

The next procedure we do for hallux rigidus, reserved for more severe cases, is called capsular interpositional arthroplasty. In this procedure, we try to make a new joint in the arthritic joint. This is reserved for patients with very severe hallux rigidus or very severe arthritis. This procedure leads to some shortening in the toe but leads to markedly increased range of motion and very good pain relief. It is usually reserved for patients who are not high level athletes but who want to be able to walk comfortably, wear high heels, and participate in some recreational sports.

The final procedure we do for hallux rigidus is fusion of the first MP joint. This procedure is for patients with severe arthritis in the joint and often patients who have had previous surgery that has failed. This is a very effective treatment for relieving pain in the first MP joint. Patients are able to wear normal shoes but not able to wear more than a two-inch heel. They are able to walk because the joint in front of the big toe joint is not fused and the foot bends as well.

The first signs and symptoms of arthritis - osteoarthritis, rheumatoid arthritis and gout

Arthritis is an inflammatory joint disease that can affect all joints in any part of the body and cause symptoms ranging from mild pain to swelling of the affected joints. Discover the signs and symptoms of arthritis, common types of arthritis, and treatment options for arthritis in this article.

Arthritis literally translates to "joint inflammation" and its implied meaning, it is an inflammatory joint disease that can affect all joints in any part of the body. A joint is where two or more bones connect together such as the knee, shoulder or wrist. Healthy joints are protected by a dense connective tissue called cartilage. Furthermore, the joint is locked in the synovial membrane which forms a solid sheath and secretes synovial fluid which helps in protecting cartilage bones to rub against each other.

Symptoms of arthritis

Joint inflammation caused by arthritis lead to symptoms ranging from mild pain to swelling of the affected joints. Other common symptoms associated with arthritis include redness in the joints that feel warm to the touch, increased stiffness in the joints especially after waking up from the bed, a crack in the joints when changing position and pain severe joint that can cause this is hard to move.

The first signs of arthritis

Arthritis can take four to ten years to appear after the early signs are. Here is a list of signs and symptoms of arthritis you need to watch. These symptoms of arthritis are varied from person to person, from the nutritional intake of each person is different.

Dry scalp with dandruff

Dry skin with a whitish in different parts of the body

Ear has no earwax

Nail fragility

Premature graying hair

Wrinkles around the neck

Ringing in the ears

pale skin

Itching of the nose and rectum

Accumulation of dry spots in the corners of the eyes

Stiffness on waking in the morning

Cold and clammy in hands and legs

Bleeding gums

Varicose veins in the legs

Being sterile.

Types of arthritis

There are more than 100 different diseases associated with rheumatoid term, and the three most common types of arthritis are osteoarthritis, rheumatoid arthritis and gout.

Osteoarthritis

Osteoarthritis is a very common type of arthritis. It generally affects cartilage, a resilient and resistant fabric that prevents friction of the bones in the joint. After some time, or due to illness, the cartilage may begin to wear out or rot, and in extreme cases, all the cartilage can be worn by producing nothing to protect the bones in the joint to rub together against the other. This friction often causes pain and swelling of the affected area, and even disability. While osteoarthritis can affect any joint, strike often large weight-bearing joints such as knees, hips and feet, but also my hands, the facet joints of the spine and neck.

Rheumatoid arthritis

Rheumatoid arthritis is another common type of arthritis that affects patients. It attacks the joints and classified as a systemic disease that can damage other organs. After some time, the symptoms of rheumatoid arthritis may disappear, but the problem is still present. The exact cause of rheumatoid arthritis is unknown for now, but experts suggest that things like infections, fungi, bacteria or authors. In addition, some people believe that rheumatoid arthritis is genetic. The first signs of rheumatoid arthritis are pain and swelling in the affected joints. Other common symptoms include muscle torment, extreme tiredness, redness and warmth in the joints, a slight fever and loss of appetite.

Drop

Gout is a painful rheumatic disease and usually initiated by the sudden onset of acute pain, followed by swelling and stiffness in the joints that is often hot to the touch and red air. Gout is caused by the accumulation of excess uric acid in the blood and connective tissue of the joint respectively. Overtime, this deposit will ignite causing common acute gouty arthritis. Moreover, this accumulation of uric acid may also damage the kidneys, where kidney stones formed. Stressful events, alcohol or drugs, or the presence of other diseases can all trigger gout. It often affects the end joints such as knees, heels, ankles or toes.

Look at the list of the first signs of arthritis and decide if you experience one or more symptoms of arthritis. If you do, you should begin to improve your nutritional intake, such as the use of good oils for the prevention of arthritis and eliminating foods that affect your joints and health, lose weight to reduce the stress and strain on joints, reducing both physical and emotional stress, incorporating mild stress exercises into your daily routine and try both hot and cold treatments. However, if your arthritis symptoms are severe, you should consult your doctor as soon as possible. Several medical treatment options for more advanced arthritis include use of splints and orthotics to protect your joints, medical and surgical treatments.

Remember, it may take several years for arthritis to develop after the first signs of arthritis do. So the sooner you start living healthier, better.

Plica of the knee - the great mimic

"A young soccer player finds himself frustrated, unable to find out what is wrong with his knee. After submitting to extensive physiotherapy and two lots of surgery he finds out that his symptoms are due to a thickened plica." - case presentation by Dr Angus Strover.

footballer

J.L. is a 16 year old schoolboy. He is a talented sportsman, playing soccer, tennis, squash and running to keep fit.

About 18 months ago he tried to get fit enough to compete in middle distance athletics but had to give it up because he developed pain in his right knee which developed after running. The pain was quite severe and was situated above the knee cap and on the inner side of the knee. The pain was aggravated by going downstairs but not by going up. He was unaware of any swelling, but said that the knee felt hot on occasion. The pain was associated with a regular click under the kneecap. He noticed the clicking more in the morning on first getting up and going downstairs to the bathroom. Besides the pain and clicking, J.L. noticed that his knee became stiff and ached when he sat in one position for any length of time.

Struggling for a diagnosis

J.L. sought treatment from the club physiotherapist (PT) who taped the kneecap and gave him V.M.O exercises (vastus medialis obliquus - ie the inner quads muscle). Although this seemed to help in the first instance, as time went on the exercises made the pain worse and his physio suggested that he sought advice from a podiatrist as J.L. had pronated (flat) feet which is known to often aggravate knee pain. The physio felt that the problem might be corrected by appropriate inserts into his footware.

J.L. spent £300 (about $500) on inserts for his shoes and trainers but his knee pain got worse until he noticed that he could only run about a mile or play soccer for about 20 minutes before the pain stopped him from continuing the exercise. Pain on stairs was becoming an everyday occurrence and J.L. stopped playing soccer and stopped jogging.

He sought advice from his G.P. (primary care practitioner) who did some blood tests and prescribed anti-inflammatory tablets, rest and ice. The pain and clicking settled down during this period, but immediately returned when he went back to sporting activities. He asked for a referral to an orthopaedic surgeon with an interest in sports medicine.

Surgery fails to reveal diagnosis

This orthopaedic surgeon examined J.L.'s knee and suspected chondromalacia and maltracking of the patella, or else some damage to his joint surface or his meniscal cartilages. He ordered an X-ray, which was normal, and an M.R.I. scan which was also reported as normal. He decided to do an arthroscopy as a day case.

The arthroscopy showed normal appearances to the meniscal cartilages, ligaments and joint surfaces, but the surgeon took photographs and kept a video of the procedure. He also did a biopsy of the synovial membrane.

The biopsy showed 'non-specific synovitis' (inflammation without obvious cause) and the surgeon advised that a steroid injection into the joint might help.

The injection into the knee did help for about 6 weeks, but then the symptoms came back.

More rehab but still no diagnosis

The surgeon sent J.L. to another physiotherapist, who decided to do an isokinetic test. This tests the muscles working the joint at maximum strength at a pre-determined speed through a full range of movements. The test was painful and the physio asked J.L. to score the pain on a scale of 1 to 10. J.L. said that at its worst the pain was about 5 out of 10.

Again he was given quadriceps exercises, but J.L.'s pain returned when he went back to playing squash and running.

Ah-haa!

Finally J.L. was referred to another surgeon who felt that the story was typical of 'the plica syndrome'. He explained that a synovial plica is a fold of the synovial membrane - the inner lining of the knee joint. These folds are normal structures which develop in the first eight weeks of a pregnancy when the embryo's joints are developing in its limbs. In most people synovial plicae (plural of plica) do not give problems. But in some people, often following a minor injury such as a direct blow on the knee, a synovial plica becomes inflamed and loses its normal elastic compliant nature. It then forms scar tissue which clicks as it slides across the surfaces of the joint and with exercise the plica becomes painful and inflamed. The process is on-going and progressively becomes worse with time especially after sporting activities.

The surgeon explained that a plica can be missed during arthroscopy if the knee was not examined from above. He also explained that it is frequently unreported on MRI scan as a plica is generally considered a normal finding. But in his own clinical experience it is a frequent cause of problems.

J.L. was persuaded to have another arthroscopy during which this surgeon inspected the joint from an entry portal (small surgical cut) above the kneecap. A thickened plica was found and a video showed the entrapment of the plica between the patella and the femur whilst the knee was being bent to 90 degrees.

The plica was completely removed during the surgery.

After the operation J.L.'s knee was swollen for four weeks and he was given gentle mobilisation, anti-inflammatory tablets and ice on the knee. During the next three months the knee became stronger, the swelling went completely, the clicking diminished and was not painful and, finally, at six months after the operation J.L. returned to soccer, running and squash. Stairs are now no problem and J.L is delighted with the complete absence of any pain in his knee.