In AS, the joints and ligaments that normally let the back move and flex become inflamed. The inflammation produces pain and stiffness, usually beginning in the lower back. With time, the disease may progress into the upper spine, chest and neck. As a result, the joints and bones (vertebrae) may grow together (fuse), causing the spine to become rigid and inflexible. Other joints, such as the hips, shoulders, knees or ankles, also may become inflamed.

Ankylosing spondylitis may be a chronic (long-lasting) disease. The severity of symptoms and disability vary from person to person. Early diagnosis and proper treatment can help control the pain and stiffness associated with AS, and reduce or prevent major deformity.

Causes of AS
The cause of ankylosing spondylitis is unknown, but genes and heredity do play a role. Scientists have discovered a gene called HLA-B27 that is found in more than 90 percent of people with AS. It is one of a family of genes that play an important role in the body’s immune system, which defends against infection.

Symptoms of AS
The inflammation of AS usually starts around the sacroiliac joints, where the lower spine joins the pelvis.

The most common early symptoms of AS are chronic pain and stiffness in the lower back and hips. This discomfort usually develops slowly over several weeks or even months. Unlike lower back pain from other causes, the pain associated with AS is worse during periods of rest or inactivity. People with AS often awaken in the middle of the night with back pain and feel very stiff in the morning. Typically, symptoms lessen with movement and exercise.

Diagnosis
Doctors base their diagnosis of AS on symptoms, physical examination and X-rays showing that the sacroiliac joint at the back of the pelvis is affected.

AS Treatment
Treatment for AS focuses on reducing pain and stiffness, preventing deformities and helping you continue your normal activities. The major areas of ankylosing spondylitis treatment and management are medication, good posture and exercise.

Carpal tunnel syndrome may affect one or both hands and can occur at any age. Use associated CTS is most commonly observed in people between the ages of 20 and 50, while non-use associated CTS is generally seen in people over 50. Regardless of age, CTS occurs in women more often than in men. In cases of non-use associated CTS, arthritis of the wrist occurs frequently.

• pain, tingling and numbness in your thumb, index, middle and/or ring fingers;
• pain that shoots from your hand up your arm as far as your shoulder;
• a swollen feeling in your fingers, even though they may not be visibly swollen.

You also may notice that:

• your hands feel stiff in the morning;
• you have trouble grasping or pinching objects;
• you drop objects more than usual;
• you have trouble using your hands for certain tasks, such as writing, buttoning, a shirt or opening a jar lid;
• your symptoms worsen at night;
• the muscles at the base of your thumb are smaller and weaker than before.

Diagnosis
Your doctor will review your medical history and examine your hand and wrist.

Treatment
The goal of treatment is to relieve pain and prevent CTS from getting worse. The type of treatment you use depends on the severity of your CTS.

• increased levels of uric acid in the blood; and
• the formation of uric acid crystals in joints.

Gout usually occurs in three phases:

1. Sudden joint pain and swelling that usually goes away after five to 10 days.
2. A period of no symptoms at all, followed by new, sudden attacks of gout.
3. After a number of years, if left untreated, persistent swelling, stiffness and mild to moderate pain in one or more joints can occur. In addition, crystals of uric acid can form large deposits under the skin called tophi.

Gout can affect people differently. Some people have one episode and never have any other joint problems. Other people have frequent, painful episodes along with lasting joint stiffness and damage. Gout can be controlled and even prevented if it is diagnosed correctly and appropriate medication and lifestyle changes are followed. Proper treatment can help you avoid episodes and long-term joint damage. It is important to see a rheumatologist, a doctor who specializes in arthritis and related conditions, such as gout.

• The kidneys can’t get rid of uric acid fast enough.
• The body makes too much uric acid.

Diagnosis
To diagnose gout, your doctor will examine you and ask you to describe your symptoms. Your doctor will take a blood test to measure the level of uric acid in your blood. A high level of uric acid in your blood doesn’t necessarily mean you have gout, just as a normal level does not mean you do not have it. Your doctor may remove fluid from a joint suspected to be caused by gout and examine the fluid under the microscope for uric acid crystals. The finding of uric acid crystals in the joint fluid is the surest way to make the diagnosis of gout.

Treatment
Your treatment for gout will include taking medication(s) and watching your diet.

What Is Lupus?
Lupus refers to several forms of a disease of the immune system that affects joints, skin, kidneys and other parts of the body. The immune system is your body’s natural defense against infections, such as bacteria and viruses. In lupus, the immune system produces antibodies that react with the body’s own tissues. Because of this, lupus is referred to as an autoimmune (aw-toeim- MYOON) disease. In most cases the term “lupus” refers to the form known as systemic lupus erythematosus (sis-TEM-ick LOO-pus e-RIH-them-ah-TOE-sis), or SLE for short.

Systemic Lupus
About 70 percent of the people who have lupus have the systemic form, or SLE. A systemic disease is one in which several different body systems may be affected. In systemic lupus, the skin, joints, kidneys, nervous system, lungs, heart and/or blood-forming organs can be affected.

Discoid Lupus
About 15 percent of people with lupus have a form known as discoid (DIS-coyd) lupus or cutaneous (cue-TANE-ee-us) lupus. This form of lupus results in a chronic skin rash that can sometimes cause scars. Discoid lupus may affect the skin without affecting other organs.

Drug-Induced Lupus
The least common form of lupus develops as a result of drugs taken for other medical problems. This form is called drug-induced lupus. Signs and symptoms are similar to SLE, although people with this form of lupus rarely develop serious organ damage. Many different drugs can cause drug-induced lupus. Signs and symptoms usually improve and disappear once the drug is stopped.

What Causes Lupus?
The cause of lupus, with the exception of drug-induced lupus, is unknown. Doctors and scientists refer to lupus as an autoimmune disease. The immune system fights off bacteria and viruses in several ways. One way is by creating special types of blood proteins called antibodies that attack and destroy invading substances.

Main Symptoms and Signs
If you have four or more of the signs or symptoms listed below, talk to a doctor who can determine whether you have lupus or one of many other conditions that can cause similar symptoms. The 11 main symptoms and signs that may indicate lupus include:

• A rash across the cheeks and the bridge of the nose (called a “butterfly rash”)
• Scaly, disk-shaped rash on the face, neck, ears, scalp and/or chest
• Sensitivity to sunlight, such as severe rashes or fever from minimal sun exposure
• Painless sores on the tongue, inside the mouth and/or in the nose
• Arthritis (pain, stiffness and swelling in the joints)
• Pain in your chest and side when you breathe, indicating inflammation of the lining of the heart (pericarditis) or lungs (pleurisy)
• Kidney problems
• Neurologic (brain) problems, including seizures and mental problems
• Low white or red blood cell count
• Presence of specific autoantibodies measured in the blood
• The presence of antinuclear antibodies, the most commonly seen autoantibody in SLE

Diagnosis
Lupus can be hard to diagnose. It is important to see a rheumatologist (ROO-ma-tall-o-jist), a doctor who specializes in arthritis and related diseases, like lupus. The rheumatologist will begin by asking you questions and conducting a physical exam. You’ll also have laboratory tests, including ones to see if you have too few red blood cells, white blood cells or platelets (blood cells that help to control bleeding and clotting). Blood chemistry tests and urine studies can help determine whether your organs, such as the kidneys and liver, are functioning normally.

Treatments
The treatment plan for lupus includes taking medications to reduce the inflammation and reduce the activity of the immune system, balancing rest with exercise and eating a proper diet.

• polymyositis;
• dermatomyositis;
• inclusion body myositis;
• myositis in children (juvenile myositis); and
• myositis that occures in people with other autoimmune diseases, such as rheumatoid arthritis (RA), lupus and scleroderma.

The most common form of myositis is polymyositis (poly means many). muscle inflammation develops in both arms and legs. The form of myositis called dermatomyositis (dermato means skin) is associated with a skin rash. The rash usually is found over the knuckles in hands around the eyes. However, in some people, rashes occur on other parts of the body.

What causes Myositis?
Scientists don't know yet what causes myositis. Because myositis has many forms, it probably has many different causes. Some scientists think that myositis develops after a person with a certain genetic background is exposed to particular drugs, chemicals, viruses or other infectious agents. Other enviromental exposures such as ultraviolet light or stressful life events may tigger the development of myositis.

Symptoms of Myositis
The many forms of myositis begin and progress in different ways. In most people, the illness develops slowly over a period of months oe even years. In some people, problems can occur suddenly. Typically, myositis develops so slowly that people aren't aware that their muscles are week for a long time. This makes it hard for doctors to diagnose at first.

• a rheumatologist (roo-ma-TALL-o-jist), a doctor who specializes in arthritis and related diseases, such as myositis;
• a pediatric rheumatologist (pee-dee-AAH-trik roo-ma-TALL-o-jist), a doctor who specializes in treating children with arthritis and related diseases; or
• a neurologist (nur-ALL-o-jist), a doctor who specializes in treating problems of the central nervous system.

Treatment
There are many types of treatment for myositis. These include medications, rest, exercise and physical therapy. Treatment will vary from person to person and will change over time for each person. The treatment recommended will depend upon the severity and type of problems, other medical conditions, and any bad reactions you may have to previous therapy.

Medication
The most effective and most commonly prescribed drugs in treating myositis are glucocorticoids (such as prednisone and cortisone). Glucocorticoids are powerful drugs that help reduce inflammation and relieve stiffness and pain.

Risk factors for OA include:

• being overweight;
• joint injury;
• muscle weakness;
• having other forms of arthritis; and
• heredity.

Osteoarthritis can affect any joint, but it occurs most often in knees, hips, spine, small joints of the fingers, and the base of the thumb and big toe. It rarely affects other joints, except as a result of previous injury to the joint or unusual stress on the joint.

What happens in Osteoarthritis?
In normal joints, a firm, rubbery material called cartilage covers the end of each bone. Cartilage provides a smooth, gliding surface for joint motion and acts as a cushion between the bones. In osteoarthritis, the cartilage between the joints breaks down leading to symptoms such as pain and swelling, as well as problems using the joint.

Symptoms
Usually joints affected by osteoarthritis hurt most after you’ve overused them or after periods of inactivity. You probably will find it difficult to move the joint after first getting up in the morning, or following more-than-usual use of the joint.

If you don’t move and exercise, the muscles surrounding the affected joint will become weaker and sometimes even smaller in size. In turn, the weak muscles may not be able to support the joint as well. This may contribute to increased joint pain. You also may notice that your coordination, walking and posture become affected.

Your doctor usually diagnoses osteoarthritis based on your medical history and a physical examination. However, your doctor also may recommend additional procedures, such as X-rays, to help confirm the diagnosis, rule out other causes of pain, and determine how much joint damage has occurred. Joint aspiration, a procedure in which fluid is drained from the affected joints and examined, also may be used to rule out other diseases.

How can it be managed?
Your treatment program will be based on how severe your disease is, which joints are affected, the nature of your symptoms and other medical problems. Your age, occupation and everyday activities also will be taken into consideration. You will work in partnership with your doctor and other health professionals, such as physical and occupational therapists, to make sure your program meets your needs.

Medication
Many people are able to treat their OA symptoms with exercise, physical therapy or the other techniques just discussed. Your doctor may recommend medications to help relieve pain. Some medications are taken on a daily basis; others are not. Your doctor will decide which medication and schedule is best for you. Many common OA medications are discussed here, and others are under study for possible use in the future.

Osteoporosis is a serious health problem in the United States. It affects about 28 million people and results in more than 1.5 millionfractures of the back, wrists and hips each year. Eighty percent of people with osteoporosis are women. It is the main cause of bone fractures in postmenopausal women and the elderly. You are more at risk for osteoporosis if you have a condition such as rheumatoid arthritis (ROOma-toyd ar-THRY-tis) or lupus, or if you take glucocorticoid medications.

Bone is a changing, living tissue. It is a structure filled with calcium and mineral deposits. During a lifetime, bone goes through a process called remodeling. This means that the bone is broken down and replaced with strong, new bone. Up until ages 20 to 25, the calcium you get from food helps bone rebuild faster than it breaks down. When your bones are the strongest and reach the highest density they’ll ever be, it is called peak bone mass. This usually happens by age 25.

By around age 40, bone mass begins to decline slowly. After menopause, women lose bone mass because of a drop in estrogen level. Over the next five to 10 years women can lose up to one-third of their bone mass. This is because bone breaks down faster than it can be replaced. An early sign of osteoporosis is called osteopenia (ah-stee-oh-PEE-nee-ah), which means low bone. Osteopenia is detected by the studies that measure bone mass with measurements that are lower than normal but not low enough to be diagnosed as osteoporosis. In many people, the first warning sign of osteoporosis may be a broken bone. This is why osteoporosis is called a silent disease.

• women, especially those past menopause;
• women who go through menopause early (before age 45) or who have very irregular menstrual periods;
• people with thin or small frames;
• people with a family history of osteoporosis;
• people with a history of bone fractures after minor trauma (fractures that occur without a serious accident, such as falling);
• people with an inflammatory form of arthritis,such as rheumatoid arthritis or lupus (see page 5);
• people who take drugs that reduce bone strength such as glucocorticoids, anticonvulsants (seizure medications) or heparin;
• people who eat few calcium-rich foods, such as dairy foods;
• smokers;
• people who drink more than two alcoholic beverages a day;
• people who don’t exercise regularly; and
• men with low levels of testosterone.

How to prevent Osteoporosis
The keys to preventing osteoporosis are building strong bone and preventing bone loss. If your bones are strong to start with Ð both through genetics and lifestyle choices Ð you’ll be less likely to have problems when bone loss does occur. Although you have no control over genetics, you can prevent or slow down osteoporosis by making smart lifestyle choices. Before age 35, you can take the following steps to build as much bone mass as possible and help slow the rate of bone loss later in life.

Osteoporosis Diagnosis
Since osteoporosis doesn’t cause any symptoms, you may not even be aware you have it until you:

• break a bone;
• notice a loss in height; or
• find that your upper back bends forward. However, your doctor can determine if you have osteoporosis or are at risk of developing it. He or she will ask you questions about your medical history, including:
• your overall health;
• medications;
• fractures;
• diet; and
• family history.

Bone-density tests may be recommended for some women after they have experienced menopause if they are not taking estrogen or if they are at very high risk for osteoporosis. The tests also are used to monitor osteoporosis prevention and treatment. Bone measurement is a quick, painless and inexpensive test. The most accurate of these tests is done with a tool called a bone densitometer, which uses dual-energy X-ray absorptiometry (DEXA). The DEXA scan can measure as little as 1 percent to 2 percent loss of bone. The DEXA scan also is used to note changes in bone density over time and with treatment.

What is Psoriatic Arthritis?
Psoriatic (sore-ee-AAH-tick) arthritis is a condition that causes pain and swelling in joints and scaly patches on the skin. Psoriatic arthritis occurs in people with psoriasis (so-RYE-ah-sis), a chronic (long-lasting) skin disease. Not everyone who has psoriasis develops psoriatic arthritis. Psoriasis is characterized by a scaly, itchy skin rash. This rash most commonly occurs on the elbows, knees and scalp. Psoriasis may cause changes in your fingernails and toenails including small, pinpoint depressions in the surface of the nails, called pitting. The joint pain caused by psoriatic arthritis is often associated with swelling and redness of joints, particularly in the knees, ankles, fingers and toes. Some people with psoriatic arthritis also have neck and/or back pain and stiffness. This can limit movement. People who develop psoriatic arthritis may have either the skin or joint symptoms first. Both symptoms may appear at the same time.

What causes Psoriatic Arthritis?
The cause of psoriatic arthritis is not yet known. It is believed that genetics (hereditary factors), abnormalities of the body’s immune system and the environment play a role in developing the disease. Some researchers believe that certain bacteria, such as streptococci, may play a role in psoriatic arthritis and cause chronic stimulation of the immune system. This stimulation of the immune system could result in arthritis in people with a genetic susceptibility to psoriatic arthritis.

• Pain and swelling in one or more joints, usually the wrists, knees, ankles and/or joints at the ends of the fingers or toes
• Swelling of fingers and/or toes that gives them a sausage-like appearance
• Low back or buttocks pain
• Silver or gray, scaly spots on the scalp, elbows, knees and/or the lower end of the backbone
• Pitting,which is characterized by small depressionsand/or detachment of fingernails and/or toenails.

What are the patterns of joint involvement?
Psoriatic arthritis can affect peripheral joints such as the knees, fingers and feet as well as joints in the spines. In most of these people, more than five joints (polyarthritis) are affected. When peripheral joints are affected, psoriatic arthritis may occur in the same joints on both sides of the body (symmetrical arthritis). At the beginning of the disease, however, it is more likely to occur in different joints on either side of the body (asymmetrical arthritis). Some people only have swelling involving the outermost joints of the fingers or toes. In addition, the entire finger or toe may become painful and swollen, called a sausage digit.

How is it diagnosed?
To find out if you have psoriatic arthritis, your doctor will ask about your symptoms and perform a physical examination. The examination can detect abnormalities of joints such as tenderness, swelling, pain on movement of joints, or limitations in joint movement. In addition, your doctor will look for evidence of psoriasis on the skin or changes in your fingernails and toenails.

The pain and stiffness of PMR are caused by inflammation of the joints and surrounding tissues. The shoulders and hips are most often affected, but inflammation may also occur in other parts of the body. The cause of PMR is not yet known, however both genetic and environmental factors are thought to play important roles in the disease.

Stiffness is a main symptom of PMR, and it is usually worse in the morning. When stiffness is severe, you may have difficulty getting out of bed. Pain may wake you at night, and turning over in bed may be difficult. The stiffness may be worse during periods of inactivity, such as after a long car ride.

• Pain and stiffness
• Fatigue
• Poor appetite
• Weight loss
• Fever
• Depression

PMR treatment focuses on reducing pain and inflammation, and easing stiffness, achiness, fatigue and fever. Regular exercise is important to maintain joint flexibility, muscle strength and function.

Giant cell arteritis usually affects arteries near the temples on the upper front sides of the head. It also involves other arteries in the head, neck, arms and occasionally affects other large arteries in the body. Inflammation causes the artery to narrow or become blocked, allowing little blood to pass through.

Giant cell arteritis may be difficult to diagnose in some people who never have headaches or scalp tenderness. Instead, these people may have more vague symptoms such as fever, fatigue, weight loss and anemia. Vision loss can be temporary or permanent. Early diagnosis and treatment with corticosteroids helps to reduce the risk of blindness from GCA.

GCA Diagnosis
To find out if you have GCA, your doctor will remove a piece of the temporal artery above and in front of your ear. The artery will be taken from the temple through a small incision. You will not need to be put to sleep for this, but you will receive medicine to numb the area. The piece of the artery will be examined under a microscope. If you have GCA, inflammation is seen in the wall of the artery. In rare cases, the disease cannot be detected in the biopsy. The doctor will make the final diagnosis based on your other signs and symptoms.

GCA Treatment
Glucocorticoid drugs are used to treat GCA. Higher doses are required to treat GCA than to treat PMR (usually 40 - 60 mg per day taken once or twice per day). The high dose will put you at greater risk for developing side effects. Taking calcium and vitamin D supplements is important for preventing osteoporosis that can result from glucocorticoids.

What is Rheumatoid Arthritis?
Rheumatoid arthritis, or RA, is a common form of arthritis (arth means joint, itis means inflammation). RA causes inflammation in the lining of joints, leading to warmth, decreased range of motion, swelling and pain in the joint. RA tends to persist for many years. Typically, it affects many different joints throughout the body and can cause damage to the cartilage, bone, tendons and ligaments of the joints.

What causes RA?
The cause of RA is not yet known, although we do know that the body’s immune system plays an important role in the inflammation and joint damage that occurs in RA. The immune system is the body’s defense against bacteria, viruses and other foreign cells. In RA, for reasons that aren’t yet well understood, the immune system attacks the body’s own joints and other organs.

If you have RA, you will likely experience inflamed joints that are warm, swollen, tender, often red and painful, and difficult to move. These physical signs of arthritis are due to inflammation of the lining, or synovium, of the joints. If this inflammation persists or does not respond well to treatment, damage of nearby cartilage, bone, tendons and ligaments can follow. This often leads to joint deformity and disability and can be permanent.

How is RA diagnosed?
To diagnose RA, your physician will take a medical history and perform a physical examination. The doctor will look for certain features of RA, including swelling, warmth and limited motion in joints throughout your body, as well as nodules or lumps under the skin. Your doctor may also ask if you have experienced fatigue and an overall feeling of stiffness, especially when you first get up, both of which are associated with RA. The pattern of joints affected by arthritis can help distinguish RA from other conditions.

How is RA treated?
Right now, there is no cure for RA. Until the cause of RA is known, it may not be possible to eliminate the disease entirely. However, highly effective drug treatments exist, and early treatment is critical to prevent the damage that RA can cause. Current treatment methods focus on relieving pain, reducing inflammation, stopping or slowing joint damage, and improving patient function and well-being. Modern treatments have substantially improved the quality of life for people with RA. Your treatment program will be tailored to meet your needs, taking into account the severity of your arthritis, other medical conditions you may have and your individual lifestyle. Your doctor and other members of your healthcare team will work with each other and with you to find the best treatment program.

There are two forms of Raynaud’s phenomenon. When it occurs in the absence of disease, it is known as primary Raynaud’s phenomenon. Raynaud’s phenomenon also may occur with certain forms of arthritis, such as rheumatoid arthritis (RA), scleroderma and lupus. This form is called secondary Raynaud’s phenomenon.

During an episode of Raynaud’s phenomenon, the blood vessels in the affected areas usually the fingers and/or toes become narrower for a short time. This narrowing prevents the blood from flowing freely to the affected area.

What causes Raynaud’s Phenomenon?
Doctors do not know what causes Raynaud’s phenomenon. They do know, however, that episodes are often triggered by cold temperatures and sometimes by emotional stress, such as nervousness or excitement. There are many causes of secondary Raynaud’s phenomenon. These include inflammation of blood vessels (called vasculitis) or blockage of blood vessels.

How is it Diagnosed?
In order to diagnose your condition, your doctor may:

• ask questions about your symptoms
• perform a physical examination
• take blood samples to test for other illnesses that may cause Raynaud’s phenomenon
• examine your fingers under a special microscope to look for abnormal blood vessels
• ask you to come back for several more visits

Sjögren’s syndrome can occur in two forms: primary and secondary. Primary Sjögren’s syndrome occurs by itself and is not associated with other diseases. Secondary Sjögren’s syndrome occurs in association with other forms of arthritis, such as rheumatoid arthritis, lupus, myositis or scleroderma.

Diagnosis
The cause of Sjögren’s syndrome is not known, but there is some evidence that heredity and viral infections may play a role. Your doctor’s diagnosis may be based on the sources of information listed. Getting the right diagnosis is important for making sure you get the proper treatment. Early diagnosis is important to lessen or prevent the effects of dryness of the eyes, mouth and involvement of other organs. First, your doctor will review your medical records and ask you to describe your symptoms. The doctor will also examine you for changes in your eyes, mouth and/or salivary glands; enlargement of lymph nodes in your neck; muscle weakness; and joint inflammation. Your doctor may recommend that you have an eye exam done by an ophthalmologist (eye specialist).

Symptoms and Treatments
Sjögren’s syndrome affects everyone somewhat differently, and its symptoms vary in severity. One of the main goals of overall treatment is to relieve discomfort and lessen or prevent the effects of the dryness. Your treatment plan needs to be based upon your specific needs.