The Itis Family

• Osteo • Rheum • Psoriatic • Reactive • Juvenile rheumatoid • Gouty

Osteoarthritis

• OA, the most common arthritis,

affects more than Americans and is a leading cause of disability.

21 million

• At present, there is

no available therapy that can reverse the damage of OA in the joint, but many studies are underway.

Rheumatoid arthritis

• a chronic disease that causes pain,

stiffness, swelling, and limitation in the motion and function of multiple joints.

• rheumatoid nodules beneath the skin in

areas such as the elbow and hands

• low-grade fevers, loss of energy, loss of

appetite

• RA is the most common form of

inflammatory arthritis usually female and 4 th -5 th decade

Psoriatic arthritis

• body's immune system goes into

overdrive and causes excessive inflammation

• between ages 30 to 50, but can begin

in childhood

• Only about 15 percent of people with

psoriasis develop the disease

Reactive arthritis

• Swollen, painful and stiff joints, often

involving the knees and/or ankles

• Reaction to an infectious agent are typically

male, between the ages of 20-50

• Self limiting • Although many infections, including viruses,

can result in a reactive arthritis, the term usually applies to symptoms occurring after an infection of the bowel or genitals

jra

• Joint inflammation and begin before

the age of 16

• Systemic onset, Pauciarticular and

Polyarticular

• Not regarded as hereditary • Research points to exposure to an

infectious trigger

• JRA targets the lining of the joint

gout

• Gout occurs when excess uric acid

accumulates in the body, and crystals deposit in the joints.

• about 1 in 100 people and as many as

6 – 7 percent of older men

• Gout is strongly associated with

obesity hypertension, hyperlipidemia and diabetes

PMR

• Aching and stiffness affecting the

upper arms, neck, buttocks, and thighs.

• Rarely in people younger than 50 • Rarely causes swollen joints • Respond promptly and completely to

low doses of corticosteroids

Early ra

Early ra

Moderate ra

Severe Ra

•

PAIN

• Biggest symptom • Chronic (greater than 6 weeks) • Escalating (after, with, before, at

rest)

• Occasionally migrating • Growing unresponsive to remedies • Effecting ADL

’ s

Associated symptoms

• Stiffness • Joint noise • Heat • Weakness • Sleep disorder • Emotional change • Trigger points

Testing testing……..

• Xrays • Mri’s • Joint fluid • Biopsy • Blood = rheumatoid factor, sed rate, cbc,

uric acid, ana, c-reactive protein, hlab27, anti-cyclic citrullinated peptide

Time for a treat

• Electrical, needle • Antiinflammatories- NSAID, Steroid • Muscle relaxers • Pain control agents • Mood altering • Injections- Steroids, HA • DMARD’s • Topicals, herbals

antiinflammatories

• Motrin, advil, ibuprofen, aleve,

naprosyn, nuprin, aspirin

• Feldene, orudis, dolobid, voltaren,

cataflam, indocin, clinoril, daypro

• Toradol • Lodine, Relafen, mobic • Celebrex, vioxx, bextra • Prednisone, medrol

Muscle relaxers

• Skelaxin • Flexeril • Soma

• Vicodin • T 3 • Darvocet • Percocet • Dilaudid • Opiates

Narc’s

Mood altering

• SSRI’s • Tricyclics • Antidepressants

DMARD’s

• Disease Modifying Agents of

Rheumatology

• Cytoxan, imuran, cyclosporine,

methotrexate, leukoran, plaquenil

• Humira, remicade, orencia,

Herbal supplements

• Capsicum • White willow bark • Turmeric • Ginger • Devils claw • Burdock • Boswelia

Alternative supplements

• Omega 3 fish oil(

eicosapentanoic acid, docosahexaenoic acid)

• Glucosamine sulfate • Shark cartilage • Plant based bioflavinoids (limbrel)

Diet no

• No dairy • No refined sugar • No intoxicants • No Sweets • No excess meat or protein from any

source

Diet yes

• Fruits veggies and their juices • Seaweeds • Sprouts of seed, grains, legumes • O-3 foods and oils • Cooked grains, lightly cooked veg and

sprouts

• Raw veg sprout salad

The consultants

• Rheumatology • Physical medicine and rehabilitation • Orthopedic surgeons • Sportsmedicine specialists • Primary care • Chiropractor • Naturopath

Hands on

• Physical therapist • Chiropractor • Massage therapist • Acupuncturist • Tai chi intructor • Yogi • Reiki therapist • Reflexologist • Iridologist, craniosacral therapist, ayurveda

therapist

Counseling

• Nutrition / dietary • Spiritual / prayer • Herbalist • Aromatherapy blender • Naturopath • Homeopath • Human resources / disability

Dr Saguil’s approach

• Cool down the worse joints (meds/herbs) • Rule out big disease • Get the patient to function daily • Get the patient to rehab or flexibility

school

• Antiinflammatory diet • Wean off meds • Wean on herbs

Dr saguil’s shortcut

• Cool down • Get moving • Build up • Get off meds (or shorter term goals) • Maintain • “Cut it out”

Be patient