Bosweilla relieves my painful arthritis without worry that it will cause stomach irritation like ibruprofen and other nsaids can.  Ordering and delivery has been excellent. 
Catherine, New York, USA

Boswellia has been a miracle for me. I have osteoarthritis in my back. The bone on bone doesn't bother me but the muscle pain that results has made life very difficult. The pain started about eight years ago. Just going to the supermarket would be enough to almost bring me to my knees as would simply standing still for a couple of minutes. A TENS unit helped a little as did Aleve and Ultram. Physical Therapy was a waste of money. Doctors were of no help. Several months ago I read that  Boswellia might help so I added them on a daily basis.  Seemed to help right away. I decided to take 2 capsules of Boswellia twice a day. That was the end of my back pain. One month now and not even the slightest twinge. I even sent a bottle to my 95 year old Mother who will start taking it. I'm writing this because of the years of horrendous back pain I endured, hoping it might help someone else.
Hardy, Brooklyn, NY, USA

This product boswellia is a very good herb for pain. One month or so that I was taking it. and it did work for me.
Diana West, NV, USA

I am not a big fan of supplements, because many companies like to make outrageous claims, but I decided to try  Boswellia for my knee pains (I had a  meniscus surgery on one knee, and a torn meniscus on the other knee, plus arthritis in both knees and a lumbar vertebrae). All I can say is that within two weeks the pains were gone. 
Debra. G, Los Angeles, CA, USA

This Boswellia extract has sincerely helped me. I am also on other medications for pain, but they are opiods and I have needed them less since using this extract. I take two capsules twice a day, and for the first time in a year, I feel up to walking longer distances. I'm not saying I'm hiking it, but walking to class has become an option for the first time in a long time. Try it. It's worth a shot
Jackson, Detroit, MI, USA

Boswellia Resin has proven to me to be a excellent supplement to my current treatment. With it I don't have to take as much of the prescribed medicine
Aubrey, Milford, PA, USA

I have a 5 year old Border collie who was diagnosed with severe hip dysplasia. He tried expensive Rx pain meds and a very expensive injectable medication all with little results. I got Boswellia on the advice of another dog owner with a dysplastic dog. Within 2 weeks, Luca was back to running and playing normally, no more crying, limping, morning joint stiffness, or trouble getting in the car. I have been able to stop all pain meds and he is just on glucosamine and the Boswellia twice daily. I highly recommend this to other owners of dogs with joint problems! 
Gayla P, Bolivar, MO, USA

My neighbour, in her 80's, has arthritis all down her spine and recommended this Boswellia extract as it did wonders for her as it did for her son who has it in his hands.My mother, in her 70's, began to have severe pain in her knees due to arthritis. Dreaded having to get up from a sitting position because it was agony. The severity of the pain would change depending on the weather conditions etc. I suggested she try this. Taking two caplets 3 times a day. After 6 weeks she began to notice a difference but we weren't 100% convinced whether it was the pills or the changes in the weather. After 8 weeks my mother was convinced that it was the pills as she had gone through various weather conditions. She called me to tell me that for the first time in years she went for a day where she didn't notice the pain. She has pain when she first gets up in the morning but a bit of exercise soon loosens everything up and the pain doesn't come back like it used to.
She is finally able to go for walks and work on the garden with no problems.
She uses it in conjuction with fish oil and glucosamine. In this case results appeared after about 6 weeks but it may be different for others or it might not work at all. All I can say is that, for my mother, this is a life saver.
Michael S, Prairieville, LA, USA




Boswellia Serrata is known as Shallaki in Sanskrit. It has been used in Ayurveda the traditional Indian medicine as a safe support for healthy joint & muscle functions. The herb Boswellia Serrata  is considered to possess analgesic properties. By regulating the mediators of inflammation, boswellia exerts a significant anti inflammatory activity that reduce inflammation due to exercise or normal overuse. It helps soothe the joints & helps treat levels of synovial fluid which in turn may make the entire structure lubricated and easy to rotate or to move. 

Common NSAID's used to manage arthritis are Aspirin (Bufferin, Bayer), Celecoxib (Celebrex), Diclofenac (Cataflam, Voltaren), Diflunisal (Dolobid), Etodolac (Lodine), Fenoprofen (Nalfon), Flurbiprofen (Ansaid), 
Ibuprofen (Advil, Motrin), Indomethacin (Indocin), Ketoprofen (Oruvail, Orudis), Ketorolac (Toradol), Meloxicam (Mobic), Nabumetone (Relafen), Naproxen (Aleve, Anaprox, Naprelan, Naprosyn), Oxaprozin (Daypro), Piroxicam (Feldene), Salsalate (Amigesic), Sulindac (Clinoril), Tolmetin (Tolectin), Arthrotec , Prevacid, Vimovo  etc. 

Osteoarthritis and rheumatoid arthritis are the most common form of arthritis, affecting millions of people around the world. Untreated, it is usually a progressive degenerative disease in which the joint cartilage gradually wears away. Cartilage is a tough, flexible tissue found throughout the body. Cartilage serves two main functions as a shock absorber and as a mould Cartilage covers the surface of joints, enabling bones to slide over one another while reducing friction and preventing damage. It helps to support your weight when you move, bend, stretch and run. Unlike other types of tissue, cartilage does not have its own blood supply. Blood cells help repair damaged tissue, so damaged cartilage does not heal as quickly as damaged skin or muscles. Glycosaminoglycan synthesis is essential for cartilage repair.

The major drawback with NSAIDs that are commonly used to manage arthritis is that they can disrupt Glycosaminoglycan synthesis which will accelerate further cartilage damage. Whereas Boswellic acid prevents the decrease in the levels of Glycosaminoglycan. 

Boswellia serrata is a promising safe alternative to NSAIDs for pain management. Boswellia extract has produced superior anti-inflammatory effects in acute and chronic cases of inflammation. Above all it is a natural herbal alternative devoid of any side effects like gastric erosion (that is very common with NSAID's). As a positive side effects Boswellia can improve conditions of Irritable Bowel Syndrome, Colitis, Irregular bowel movement and constipation.

Boswellia can help instantly if the joint pain is due to any of the following underlying causes (almost 99% of the joint pains are due to the following reasons)

Rheumatoid arthritis 
Osteoarthritis (OA)
Systemic lupus erythematosis 
Excessive intake of Vitamin A
Viral arthritis 
Reactive arthritis 
Rheumatic fever 
Lyme disease 
Gonococcal arthritis 
Drug-induced arthritis 
Gout attack 
Physical trauma 
Septic arthritis 

Opt for Boswellia and the results can be felt instantly. Boswellia is a safe natural herbal remedy. This is  unlike the myriad range of prescription medicines, NSAIDs and steroids that are used to treat joint pains but are fraught with many serious side effects. Unlike other herbal remedies the effects of Boswellia Serrata can be felt instantly. You can feel the benefits of Boswellia immediately. The effects of Boswellia are more long lasting and permanent unlike any other medicines or supplements. Boswellia is not like other herbal products or supplements which though beneficial are considered to have weak acting active ingredients. Our product with 65% Boswellic acid is very powerful.

  The wikipedia page on Boswellia Serrata

1 Bottle - 60 capsules of Boswellia Serrata Extract. Dosage : 2 per day. One Month's supply
We recommend taking a 4 months course of Boswellia Serrata Extract. 

         Price: $68
Offer Price: $45
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Various Research reports on Boswellia Serrata

NYU Langone Medical Center,  New York, NY 10016 
Hospital for Joint Diseases (one of only five hospitals in the USA dedicated to orthopaedics and rheumatology)

Growing evidence suggests that boswellia has anti-inflammatory effects. On this basis, the herb has been tried for a number of conditions in which inflammation is involved, including painful conditions such as bursitis, osteoarthritis, rheumatoid arthritis, and tendonitis. Double-blind trials have found boswellia to be effective in relieving the symptoms of rheumatoid arthritis. Two placebo-controlled studies, involving a total of 81 people with rheumatoid arthritis, reportedly found significant reductions in swelling and pain over the course of 3 months. In a double-blind study of 30 people with osteoarthritis of the knee, researchers compared boswellia against placebo. 13 Participants received either boswellia or placebo for 8 weeks and were then switched over to the opposite treatment for an additional 8 weeks. The results showed significantly greater improvement in knee pain, knee mobility, and walking distance with boswellia compared to placebo. 

Newy York Langone Medical Center page on Boswellia
Special extract of BOSWELLIA serrata (H 15) in the treatment of rheumatoid arthritis:
    R. Etzel - Pyhtomedicine Scientist,  Karl-Theodor-Str. 14, D-82343 Poecking, Germany

H15, a special extract of the gum resin of Boswellia serrata (BS) is effective in the treatment of rheumatoid arthritis (RA). These findings were obtained in more than 260 patients by using a range of different clinical approaches for evaluation. The criteria for assessment were mainly joint swelling, pain, erytrocyte sedimentation rate (ESR), stiffness, additional use of NSAID, side effects and tolerance. These findings were obtained in more than 260 patients by using a range of different clinical approaches for evaluation.

Sciencedirect Research on Boswellia
Efficacy and tolerability of Boswellia serrata extract in treatment of osteoarthritis of knee � A randomized double blind placebo controlled trial
 Indira Gandhi Medical College, Nagpur, India

Osteoarthritis is a common, chronic, progressive, skeletal, degenerative disorder, which commonly affects the knee joint. Boswellia serrata tree is commonly found in India. The therapeutic value of its gum (guggulu) has been known. It posses good anti-inflammatory, anti-arthritic and analgesic activity.

A randomized double blind placebo controlled crossover study was conducted to assess the efficacy, safety and tolerability of Boswellia serrata Extract (BSE) in 30 patients of osteoarthritis of knee, 15 each receiving active drug or placebo for eight weeks. After the first intervention, washout was given and then the groups were crossed over to receive the opposite intervention for eight weeks. All patients receiving drug treatment reported decrease in knee pain, increased knee flexion and increased walking distance. The frequency of swelling in the knee joint was decreased. Radiologically there was no change. The observed differences between drug treated and placebo being statistically significant, are clinically relevant. BSE was well tolerated by the subjects except for minor gastrointestinal ADRs. BSE is recommended in the patients of osteoarthritis of the knee with possible therapeutic use in other arthritis.

More on above research on Boswellia
Anti-arthritic activity of boswellic acids in bovine serum albumin (BSA)-induced arthritis
Discipline of Pharmacology, Regional Research Laboratory (CSIR), Canal Road, Jammu Tawi-180 001, India

The effect of boswellic acids on bovine serum albumin (BSA)-induced arthritis in rabbits was studied. Oral administration of boswellic acids (25, 50 and 100 mg/kg/day) significantly reduced the population of leucocytes in a BSA-injected knee and changed the electrophoretic pattern of the synovial fluid proteins. The local injection of boswellic acids (5, 10 and 20 mg) into the knee 15 min prior to BSA challenge also significantly reduced the infiltration of leucocytes into the knee joint, reduced the infiltration of leucocytes into the pleural cavity and inhibited the migration of PMN in vitro. The leucocyte-inhibitory activity of boswellic acids was not due to its cytotoxic effect. The boswellic acids did not show any detergent or surfactant properties.

More on above research on Boswellia

Boswellia resin: from religious ceremonies to medical uses; a review of in-vitro, in-vivo and clinical trials
Dr Arieh Moussaieff, and Raphael Mechoulam, Royal Pharmaceutical Society of Great Britain

Boswellia resin is marketed as an anti-arthritic herbal remedy, and several studies have examined the anti-arthritic effect of the resin and its constituents. These indicate that boswellic acids exert a beneficial effect in bovine serum albumin-induced arthritis in rabbits. Boswellic acids attenuated elevated levels of connective tissue metabolites (hydroxyproline, hexosamine and uronic acid) in the urine of adjuvant-induced arthritic rats, especially in the chronic phase of the disease.82 The degradation of glycosaminoglycans was found to be reduced markedly following treatment with boswellic acids or Boswellia resin extract. Studies done on extracts from B. carterii and B. serrata support the notion that components of these resins may ameliorate arthritic conditions.

Anti-inflammatory activities of the triterpene acids from the resin of Boswellia carteri
Norihiro Banno, Toshihiro Akihisa, Ken Yasukawa, Harukuni Tokuda, Keiichi Tabata, Yuji Nakamura, Reiko Nishimura, Yumiko Kimura, Takashi Suzuki
Nihon University School of Medicine, Tokyo, Japan

Boswellic acids are the main well-known active components of the resin of Boswellia carteri (Burseraceae) and these are still dealing with the ethnomedicinal use for the treatment of rheumatoid arthritis and other inflammatory diseases. Although several studies have already been reported on the pharmacological properties, especially on the anti-inflammatory activity, of Boswellia carteri resin and boswellic acids, the ethnomedicinal importance of Boswellia carteri and its components, boswellic acids, prompted us to undertake detailed investigation on the constituents of the resin and their anti-inflammatory activity. Fifteen triterpene acids, viz., seven of the ß-boswellic acids (ursane-type) (1–7), two of the a-boswellic acids (oleanane-type) (8, 9), two of the lupeolic acids (lupane-type) (10, 11), and four of the tirucallane-type (12–14, 16), along with two cembrane-type diterpenes (17, 18), were isolated and identified from the methanol extract of the resin of Boswellia carteri. Upon evaluation of 17 compounds, 1–14 and 16–18, and compound 15, semi-synthesized from 14 by acetylation, for their inhibitory activity against 12-O-tetradecanoylphorbol-13-acetate (TPA)-induced inflammation (1 µg/ear) in mice, all of the compounds, except for 18, exhibited marked anti-inflammatory activity with a 50% inhibitory dose (ID50) of 0.05–0.49 mg/ear.

What is Special about our Boswellia Serrata Extract?

  • Boswellic Acid is the active component that has anti inflammatory effect particularly being beneficial in colitis and arthritis. Even the best quality of Boswellia Serrata leaves contain only 25% Boswellic Acid. Most others may be offering only physically purified and powdered Boswellia Serrata leaves. What we offer is the Boswellia Serrata Extract containing as much as 65% Boswellic Acid. Large amount of Boswellia leaves are required to increase the concentration of Boswellic Acid beyond 30%. Each capsule of 400 milligrams (mg) contains 65% - 260 mg of Boswellic Acid (rest being Boswellia Serrata leaves). To get such a concentration 260 mg of Boswellic Acid we need around 10,000 mg (almost 20 times the amount of Boswellic Acid). 
  • Ours is an ISO 9002 Accredited set up and we are also GMP (Good Manufacturing Procedure) certified. We are registered with United States Food and Drug Administration (US-FDA) as a food facility. 
  • Boswellia and Boswellia Extract are our specialty. Unlike other internet based vendors  we do not have hundreds of products which are mostly outsourced from others and sold through the web sites. We deal only in Boswellia (and some 2 other related products)- we make it in our own processing set up. We understand Boswellia and we know how to get the best out of it. 
  • We are the actual manufacturers of the finished product (processing of Boswellia extract from the boswellia plant and resins). We are able to keep he cost to the end user at the lowest. 
  • Immediatly on of taking our Boswellia you will start feeling the difference. Your joints pains will subside and you can gradually stop any other medicines that you might be taking (in consultation with the doctor)


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What is arthritis?

The word arthritis, which literally means joint inflammation, is derived from the Greek words arthros (joint) and itis (inflammation), and the condition’s
major symptom is joint pain. The same group of ailments is sometimes called rheumatism. Arthritis is a term that actually describes more than 100 different diseases. No two cases of rheumatoid arthritis are exactly alike. No two people with osteoarthritis have the same experience. Arthritis is not a single disease but a number of different disorders that can affect the joints at any stage of life, from the early days of childhood until the closing stages of old age. Arthritis has two key characteristics—joint pain and inflammation. Some people with arthritis only have pain but most have a combination of the two. The hallmark of arthritis is joint inflammation, which leads to tenderness and swelling. People with arthritis usually complain of joint stiffness as well. The many types of arthritis can be divided into inflammatory and degenerative groups, although the distinction is not always clear-cut. In inflammatory arthritis, such as rheumatoid arthritis, there is more swelling of the soft tissues around a joint, and stiffness is most noticeable in the morning, when it may last an hour or more. Degenerative arthritis, such as osteoarthritis, is characterized by more bony swelling and less softtissue swelling; stiffness usually occurs at rest or after exercise. When only one joint is involved the condition is sometimes called a monoarthritis. When many joints are affected the condition may be described as a polyarthritis. Oligoarthritis is sometimes used to describe a condition involving a few joints. One feature of some forms of arthritis is that similar joints are involved on both sides of the body. This symmetrical joint involvement is very typical of rheumatoid arthritis. To make sense of arthritis it is important to understand some key general information, such as the types of joints and the causes and consequences of joint inflammation.

Understanding the bone joints

Any place in the body where two bones meet is called a joint. Sometimes those bones actually fuse. Skull is an example of an area with fused bones. But in the joints that can develop arthritis, the bones don’t actually touch. A small space exists between the two bone ends. The space between the ends of the bones keeps them from grinding against each other and wearing each other down. Other structures surrounding the joints, such as muscles, tendons, and bursae – small sacs that cushion thetendons – support the joints and provide the power that makes thebones move. The joint capsule wraps itself around the joint, and its special lining, the synovial membrane or synovium, makes a slick, slippery liquid called the synovial fluid. This liquid fills that little space between the bone ends. Finally, the bone ends are capped by cartilage – a slick, tough, rubbery material that is eight times more slippery than ice and a better shock absorber than the tyres and springs on the car. Together, these parts make up the joint, one of the most fascinating bits of machinery found in the body. Bones are living tissue – hard, porous structures with a blood supply and nerves – that constantly rebuild themselves. Bones protect your vital organs and provide the supporting framework for your body. Without bones, you would consist of nothing more than blobs of tissue – like a tent without any supporting poles! But bones are more than broomsticks that prop you up and, fortunately, they don’t leave you rigid and awkward. The 200-plus bones found in your body are connected together by some 150 joints, giving you a remarkable flexibility and range of motion.
Cushioning cartilage: The human shock absorber Cartilage is extremely important for the healthy functioning of a joint, especially if that joint bears weight, like your knee.

Types of joints

The skeletal system is made up of different shapes and sizes of bones, which connect to form different kinds of joints. The joints are categorised
according to how much motion they allow.

Synarthrodial joints allow no movement at all. These joints are found in the skull, where the bones meet to form tough, fibrous joints called sutures. Because synarthrodial joints don’t move, arthritis doesn’t affect them. 

Amphiarthrodial joints, such as those in the pelvis, allow limited movement. Generally, these joints aren’t attacked by arthritic conditions as often as others. (A slipped disc is not arthritis.) 

Synovial joints contain synovial fluid and allow a wide range of movement. Most joints fall into this class. Synovial joints come in all kinds of interesting variations including those that glide, hinge, pivot, look like saddles, or have a ball-and-socket type structure. Because of the synovial joints, you can bend over and pick a flower, kick up your heels while line dancing, reach for a glass on a high shelf, and turn around to see what’s going on behind you. Unfortunately, these joints are also the ones most likely to be hit with arthritis, precisely because they do move!

Types of synovial joints

Because of their tendency to become arthritic synovial joints have to be understood in detail. Synovial joints come in a wide variety of shapes and sizes to
accommodate a wide variety of movements.

Gliding joints joint contains two bones with somewhat flat surfaces that can slide over each other. The vertebrae in your spine are connected by gliding joints,
allowing you to bend forward to touch your toes and backward to do a backbend.

Hinge joints are present in your elbows, knees, and fingers. These joints open and close like a door. But just like a door, hinge joints only go one way – you
can’t bend your knee up toward your face, only back toward your rear.

Saddle joints are type of joints that looks like a horse’s back with a saddle resting on it. One bone is rounded outwards (convex) and fits neatly into the other bone, which is rounded inwards (concave). Examples of a saddle joints are elbow, wrist and at the base of your thumb. A saddle joint moves up and down and side to side, but it doesn’t rotate.

Various types of arthritis and arthritisrelated diseases

True arthritis isn’t a medical term; it’s just a convenient way of referring to the group of ailments in which arthritis is the primary disease process and is a major part of the syndrome. Osteoarthritis and rheumatoid arthritis are the best-known members of this group, which can cause problems ranging from mild joint pain to a permanently bowed spine. 

Ankylosing spondylitis: A chronic inflammation of the spine, this disease can cause the vertebrae to grow together, making the spine rigid. Its appearance on an X-ray is often referred to as bamboo spine. Although the cause is unknown, heredity is a factor. 

Gonococcal arthritis: The most widespread of the infectious forms of arthritis, originates from the gonococci bacterium (which also causes the venereal disease gonorrhoea). Symptoms include pain flitting from one joint to another, with small blisters appearing on the skin over all or parts of the body. 

Gout: Known as the ‘king of diseases’ and the ‘disease of kings’, this ‘regal’ form of arthritis is caused by the build-up of uric acid. The uric acid forms sharp crystals that are deposited in a joint causing inflammation and leading to severe pain. These needle-like crystals are most commonly found in the knees, wrists, and the ‘bunion’ joint of the big toe. Genetic factors, diet, and certain drugs can cause gout. 

Infectious arthritis: Bacteria, viruses, or fungi that enter the body can settle in the joints, causing fever, inflammation, and loss of joint function. 

Juvenile arthritis: This is a catch-all term for the different kinds of arthritis that strike children under the age of 16. The most common type is juvenile rheumatoid arthritis (JRA). Typical symptoms of JRA include pain or swelling in the shoulders, elbows, knees, ankles, or toes; chills; a reappearing fever; and sometimes a body rash. The cause remains unknown. 

Osteoarthritis (OA): In this, the most common type of arthritis, the cartilage breaks down, exposing bone ends and allowing them to rub together. The resulting pain, stiffness, loss of movement, and sometimes swelling can have a profound effect on quality of life. Osteoarthritis is most often found in weight-bearing joints, such as the hips, knees, ankles, and spine, but it can also affect the fingers. Osteoarthritis often results from trauma, metabolic conditions, obesity and may also have a hereditary basis.

Pseudogout: Like gout, pseudogout is caused by crystals being deposited in the joint. But, instead of uric acid crystals as in ‘real’ gout, these crystals are made from calcium. The results can include pain, swelling, and sometimes the destruction of cartilage. Note: These calcium crystals are not related to the dietary intake of calcium. 

Psoriatic arthropathy: This form of arthritis occurs in people who have a skin condition called psoriasis, which causes scaly, red, rough patches on the neck, elbows, and knees, as well as pitting of the nails. Often settling in the joints of the fingers and toes, psoriatic arthritis can cause the digits to swell up like little sausages. 

Reiter’s syndrome: Sufferers are usually young men, who commonly experience inflammation of the urogenital tract, conjunctivitis, plus swollen, stiff joints (usually the knees or ankles). The disease is an immune reaction to Chlamydia, but can follow a bout of Salmonella food poisoning. There is no cure, but painkillers and rest can help to relieve symptoms. 

Rheumatoid arthritis (RA): In this, the second-most common form of arthritis, the immune system turns against the body, causing inflammation and swelling that begins in the joint lining and spreads to the cartilage and the bone. It often affects the same joint on both sides of the body (for example, both wrists), when it is described as ‘symmetrical’.

In the following conditions, arthritis is present and is usually a major part of the syndrome, but is not the main, underlying, or primary disease process:

Lyme disease: Caused by a certain type of bacteria transmitted to humans via tick bites, Lyme disease causes a fever, distinctive red skin lesion in the shape of a bull’s eye, problems with the nerves and/or heart, and arthritis. Antibiotics are the main treatment for this disease. 

Reactive arthritis: An inflammation of the joints, reactive arthritis strikes along with, or shortly after, the onset of a sexually transmitted or intestinal infection. The three problems generally associated with reactive arthritis are arthritis, conjunctivitis (inflammation of the eye lining), and urethritis (inflammation of the urethra, which is the urinary tube). 

Scleroderma: The word scleroderma means hard skin and results when the body responds to inflammation of tiny blood vessels (capillaries) with the overproduction of collagen. This condition leads to stiffening of tissues in the skin, blood vessels, internal organs, and joints. The joint stiffness in scleroderma is actually due to hardening of the overlying skin. An autoimmune disease, scleroderma usually attacks adults rather than children.

Systemic lupus erythematosus (SLE): Yet another disease caused when your immune system goes wrong. In lupus (or SLE), the body attacks its own tissues, causing inflammation, joint pain, stiffness, permanent damage to the joints, and exhaustion. Although lupus most often affects women of child-bearing age, it does strike some men and can occur at nearly any age, including childhood and post-menopause. There is another, more limited form of the disease, discoid lupus, which generally confines itself to the skin and usually doesn’t venture into your body to attack other organs.

In the following conditions, arthritis may appear, but is a minor part of the syndrom

Bursitis and tendonitis: Caused by overusing or injuring a joint, bursitis is an inflammation of the fibrous sac that cushions your tendons. Tendonitis is an irritation of the tendons, which attach your muscles to your bones. The sheaths surrounding certain tendons can also get inflamed, producing a condition known as tenosynovitis. 

Paget’s disease: With Paget’s disease, the breakdown and rebuilding of your bones is speeded-up. The resulting bone is larger but also softer and weaker, making it more likely to fracture. These weakened and deformed bones cause arthritis to develop in their respective joints, which typically include those of the hip, skull, spine, knee, and ankle. The cause is unknown. 

Polymyalgia rheumatica: Often known simply as PMR, this condition can strike seemingly overnight, causing severe pain and stiffness in the lower back, hips, shoulders, and neck that can make it difficult even to get out of bed. The pain is similar to that of RA, but there’s no evidence of any active arthritis. PMR can occur by itself or together with a lifethreatening inflammation of the blood vessels called giant cell arteritis (GCA). Symptoms of GCA can occur before, after, or at the same time as PMR, and include headaches, scalp tenderness, hearing problems, jaw pain, difficulty swallowing, and coughing. Anyone experiencing these symptoms should be evaluated by a medical professional immediately as, if left untreated, GCA can lead to serious problems such as sudden blindness. 

Raynaud’s disease: A disease, in its primary form, that affects the small blood vessels in the fingers and toes, causing discolouration, pain, tingling, burning, and sometimes numbness, which are brought on by cold or stress. The secondary form, Raynaud’s phenomenon, is less common and more serious, and usually accompanies scleroderma or lupus. 

Sjögren’s syndrome: Another autoimmune disease, Sjögren’s syndrome brings about inflammation of the tear and saliva glands, causing dryness of your eyes and mouth, hazy vision, cracks at the corners of your mouth, and problems with chewing and swallowing. Inflammation of the brain, nerves, thyroid, lungs, liver, kidneys, and, of course, the joints can also occur.

In the following conditions arthritis may be present, but it constitutes another separate disease process

Carpal tunnel syndrome: This syndrome results when pressure on a nerve in your wrist makes your fingers tingle and feel numb. This syndrome is usually caused by overuse of the wrist. Permanent muscle and nerve damage can occur if carpal tunnel isn’t treated. 

Fibromyalgia: Also known as fibromyalgia syndrome (FMS), this condition involves pain in your muscles and tendons that occurs without a specific injury or cause. Fibromyalgia can make you ‘hurt all over’, particularly in certain tender points in the neck, upper back, elbows, and knees. Those with fibromyalgia often develop sleep abnormalities, fatigue, stiffness, and depression. The cause is unknown. Physical or mental stress, fatigue, or infections may trigger this condition. 

Myositis: This disease causes inflammation of your muscles, which can take one of two forms: polymyositis – an inflammation of the muscles that causes weakening and breakdown, as well as pain, and dermatomyositis – polymyositis plus rashes that can lead to skin scarring and changes in pigmentation.

 Is it Arthritis or some temporary ache?

With all the different kinds of arthritis, how do you know whether or not you have one of them? Remember two things: Arthritis can strike anyone at any time, and you may find it difficult to tell whether the pain you’re experiencing is serious enough to warrant medical attention. Almost everyone has an ache or pain at some time or other, after overextending themselves physically, but you need to know what is minor and temporary, and what may be serious and long term. Knowing what symptoms to watch for can make a difference in your treatment and physical comfort. Typical warning signs of arthritis include:

Joint pain: This includes not only steady, ever-present pain, but also offagain- on-again pain or pain that occurs only when you move or only when you sit still. In fact, if your joints hurt in any way for more than two weeks, you should see your doctor. 

Stiffness or difficulty in moving a joint: If you have trouble getting out of bed, unscrewing a jar lid, climbing the stairs, or doing anything else that involves moving your joints, consider it a red flag. Although difficulty moving a joint is most often the result of a muscular condition, it is sometimes a sign of arthritis. 

Swelling: If the skin around a joint is red, puffed up, hot, throbbing, or painful to the touch, you’re experiencing joint inflammation. Don’t wait. See your doctor. The warning signs may come in triplicate (pain plus stiffness plus swelling), two together, or one all alone. 

You may also experience other early signs, such as malaise or muscle pain. But if you experience any of these or other symptoms in or around a joint for longer than two weeks, see your doctor.

Causes of Arthritis 

Just as many different kinds of arthritis exist, many different causes also exist – and some of them are still unknown. However, scientists have found that certain factors can contribute to the development of joint problems: 

Heredity: Your parents gave you your beautiful eyes, strong jawline, exceptional maths ability, and, possibly, a tendency to develop rheumatoid arthritis. Scientists have discovered that the genetic marker HLADR4 is linked to rheumatoid arthritis, so if you happen to have this gene, you’re more likely to develop the disease. Ankylosing spondylitis is linked to the genetic marker HLA-B27, and although having this gene doesn’t mean that you absolutely will get this form of arthritis, you can – if the conditions are right. 

Age: It’s a fact of life that the older you get, the more likely you are to develop arthritis, especially osteoarthritis. Like the tyres on your car, cartilage can wear down over time, becoming thin, cracked, or even wearing through. Bones may also break down with age, bringing on joint pain and dysfunction. However, osteoarthritis is not just a wear-and-tear disease. Research suggests it involves an active process in which the cartilage lining a joint becomes weakened, followed by an over-zealous healing response. Osteoarthritis usually starts after the late 40s and rises steeply with increasing age. Most people aged over 65 years have some evidence of osteoarthritis. As more people live longer, osteoarthritis will become more common, probably because they will experience increasing muscle weakness and they will be less able to repair worn or damaged tissues.

Obesity: If a person is more than 25 percent above target healthy weight then there is marked increase for  the risk of osteoarthritis. This is most likely because of pressure of the increased weight on the joints. The knee is at particular risk. At the same time, people who are overweight or obese increase their chances of osteoarthritis worsening once it has developed.

Overuse of a joint: What do ballet dancers, cricket bowlers, and tennis players have in common? A great chance that they may develop arthritis due to the tremendous repetitive strain they put on their joints. The dancers, who go from flat foot to pointe hundreds of times during a practise session, often end up with painful arthritic ankles. In cricket, fast bowlers, who propel balls at speeds of up to 100 mph, regularly develop arthritis of the shoulder and/or elbow. But you don’t need to be a tennis pro to develop tennis elbow, a form of tendonitis that has sidelined many a player. 

Injury: Sustaining injury to a joint (from a household mishap, a car accident, playing sports, or doing anything else) increases the odds that you may develop arthritis in that joint in the future. Rugby players are wellknown victims of arthritis of the knee, which is certainly not surprising: They often fall smack on their knees or other joints when they’re tackled – then have a ton of ‘rugby flesh’ crash down on top of them. 

Infection: Some forms of arthritis are the result of bacteria, viruses, or fungi that can either cause the disease or trigger it in susceptible people. Lyme disease comes from bacteria transmitted by the bite of a tick. Infectious arthritis can arise following surgery, trauma, a needle being inserted into the joint, bone infection, or an infection that’s travelled from another area of the body.

Tumour necrosis factor (TNF): TNF is a substance the body produces that causes inflammation and may play a part in initiating or maintaining rheumatoid arthritis. Although scientists are unsure exactly what triggers rheumatoid arthritis, they have found that drugs that counteract the effects of TNF, called TNF antagonists, are often helpful in managing the symptoms of this disease.

Who Gets Arthritis?

Arthritis isn’t all that picky and doesn’t worry too much about statistics: It strikes young and old, male and female, rich and poor, and doesn’t seem to care where you live. Arthritis, in one form or another, can affect just about anybody from any walk of life. However, arthritis does seem to hit women particularly hard. Nearly twothirds of those who get the disease are women, and the facts about females and arthritis make interesting reading:  In surveys, 34 per cent of the female population say they currently have arthritis or joint pains compared with 23 per cent of males. Women are almost 5 times more likely to have rheumatoid arthritis than men, and girls are 2.5 times more likely to develop RA than boys. For every male with moderate-to-severe X-ray evidence of osteoarthritis of the hands, 2 women are affected, and 4 times as many women as men have X-ray evidence of OA of the knees. The incidence of OA of the hips is similar in both sexes but, overall, women usually develop the disease at a younger age. Women are over 5 times more likely to develop ankylosing spondylitis than men. Ninety per cent of those who have either lupus or fibromyalgia are women. Women are more likely to develop back pain, which is often a symptom of arthritis, than men.


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Osteoarthritis is the most common form of arthritis. It is usually considered to be a degenerative “wear-and-tear” condition that is associated with aging, although younger people can also develop it following an injury. In osteoarthritis it may be only one joint or a small number of joints that are affected. The most likely are the top joints of your fingers, the base joint of your thumb, your hips, or your knees. Osteoarthritis is more common in the knee than in the hip; taken together, the hips and knees are affected in 10–20 percent of people aged over 65 and are a major cause of pain and disability in elderly people. About 21 million people in the US have osteoarthritis, but only half of those actively seek treatment. The others do not know they have it, or suffer any pain, although it may be seen when they are X–rayed for other reasons. 

Risk factors: Usually, several risk factors need to be present before osteoarthritis develops. The main factors include age, gender, obesity, occupation, genetics, trauma, or any previous inflammation of a joint. Age is the dominant risk factor. Osteoarthritis usually starts after the late 40s and rises steeply with increasing age. Most people aged over 65 years have some evidence of osteoarthritis. As more people live longer, osteoarthritis will become more common, probably because they will experience increasing muscle weakness and they will be less able to repair worn or damaged tissues. Gender is important, too. For most joints, particularly the knees and hands, osteoarthritis is more common and more severe in women than in men. Obesity which is defined as being more than 25 percent above a person's target healthy weight markedly increases the risk of osteoarthritis. This is most likely because of pressure of the increased weight on the joints. The knee is at particular risk. At the same time, people who are overweight or obese increase their chances of osteoarthritis worsening once it has developed. Trauma or a major injury or operation on a joint may lead to osteoarthritis at that site later in life. If you do a hard and repetitive activity you may injure a joint and make it prone to osteoarthritis. This condition may also develop in an injured joint if you exercise before the injury has had time to heal properly. Occupations such as farming make osteoarthritis of the hip more likely; soccer players are prone to osteoarthritis of the knee. Occupations involving knee bending, squatting, and heavy lifting are associated with osteoarthritis of the knee. Genetics plays a clear role in the development of the common form of nodal osteoarthritis which particularly affects the hands of middle-aged women. In osteoarthritis of the knee and hip, heredity plays a smaller, although still significant, role. General osteoarthritis probably has a genetic basis too. Genes that are likely to be involved in the common forms of osteoarthritis include the vitamin D receptor gene, the insulin-like growth factor genes, the cartilage oligomeric protein genes, and the HLA region. There are some very rare but dramatic forms of osteoarthritis that start at a young age and run in families. These are linked with single genes that affect the protein collagen, which is an essential component of healthy cartilage. 

Progression of Osteoarthritis: Osteoarthritis often develops slowly and varies from person to person: some people have only minor symptoms, but in others the condition can be very severe. The primary site is the cartilage that covers the ends of the bones in a joint. Healthy cartilage lets bones glide over one another and absorbs the energy from movement. In osteoarthritis, the surface of the cartilage breaks down and wears away so that the bones under the cartilage start to rub together. The results are pain, swelling, and reduced movement. The swelling is usually the result of lumps forming on the bone but sometimes it can be caused by increased fluid in the joint. In some cases, the joint makes an abnormal noise, or crepitus, when it moves. Affected joints often stiffen after exercise, sometimes known as “gelling.” Some people with osteoarthritis feel stiff in the morning, but this lasts only a few minutes. Osteoarthritis does not affect internal organs. Eventually, the affected joint loses its normal shape and becomes deformed. Small spurs called osteophytes often form at the end of the bones. Small pieces of cartilage or bone may break off and float inside the joint space, causing further pain and damage. In some ways osteoarthritis represents joint failure, which can be minimal or complete, depending on its severity. 

Osteoarthritis of the knee: When osteoarthritis affects the knee, particularly among people between their late 50s and early 70s, it can be very complicated. Osteoarthritis of the knee is more common in women than men and generally affects both knees. You may have more chance of developing osteoarthritis of the knee if you are overweight, have osteoarthritis in another joint, or have had a previous sports injury or knee surgery, in particular cartilage removal Often, however, there is no obvious cause. Pain is usually felt at the front and sides of the knee. In the later stages, the knees can become bent and deformed. more usually later in life. 
Osteoarthritis of the hip: Women and men are equally affected by osteoarthritis of the hip. It can start in their 40s but more usually later in life. One or both hips are equally likely to be involved. Certain hip problems that were present at birth or have developed in childhood may later lead to osteoarthritis. Some people have anatomical features that predispose them to osteoarthritis. For example, in certain cases, the acetabulum—the cup of the pelvic socket into which the head of the thigh bone sits—is not as well developed as it should be. Hip pain from osteoarthritis is usually at the front of the groin, but it can also occur in the buttock or in the knee, when it is considered to be “referred” pain. 

Osteoarthritis of the hands: This condition mainly involves women and commonly starts in the late 40s or early 50s, often around the time of menopause. It chiefly affects the joint at the base of the thumbs and the joints at the top of the fingers. Although the fingers become knobbly and sometimes slightly bent, they work well and rarely cause long-term problems. Nodal osteoarthritis affects the finger joints. These joints are swollen and tender, especially at the beginning, and then develop firm, bony, knobby swellings. When these affect the top joints of the fingers they are called Heberden’s nodes, after the 18th century British physician who first described them. In some cases, similar bony swellings—called Bouchard’s nodes after the 19th century French pathologist—appear on the joints in the middle of the fingers. Occasionally, by the time these two types of node have formed, the joints are relatively free from pain and tenderness. People with nodal osteoarthritis in middle age are more likely to develop osteoarthritis of the knee during old age.

Rheumatoid arthritis 

About 4.1 million adults in the US have rheumatoid arthritis, making it the most common form of inflammatory arthritis. Although its cause is unknown, it is usually thought to be an autoimmune disease in which the body starts to attack itself—but the evidence for this is incomplete. Rheumatoid arthritis can occur at any age, but it is more common in later life. Usually, many joints are involved. It is a long-term (chronic) disease that is characterized by persistent joint inflammation. This, over a prolonged period of time, results in irreversible joint damage. 

Risk Factors: Gender, genetics, and age are the most important risk factors. Others include heavy smoking, obesity, a history of blood transfusions, and, in women, a shorter fertile period associated with low levels of reproductive hormones. Drinking coffee and trauma may also be predisposing risk factors, although the evidence is inconclusive. Gender is a dominant risk factor —up to three-quarters of people with rheumatoid arthritis are women. Research suggests that in a population of 100,000 adults there will be about 36 new cases of rheumatoid arthritis in women and 14 in men per year. The incidence of rheumatoid arthritis rises steeply as people grow older, especially in men. Genetics play a significant role in rheumatoid disease. Up to 60 percent of the predisposition to rheumatoid arthritis is explained by genetic factors. The disease is strongly related to the presence of a protein on the surface of white blood cells (leucocytes) called HLA–DR4. Most evidence suggests that genetics contribute mainly to the severity of the disease rather than to disease susceptibility. Age has a complex effect on the risks of developing the disease, which can begin at any age. It was viewed traditionally as starting in young adulthood, with a peak age of onset between 20 and 45 years. For unknown reasons, this has changed and the average age of onset has increased to 60 years. 

Rheumatoid arthritis progression: The synovial membrane of one or more joints becomes inflamed, causing pain, swelling, and stiffness. In the early stages, the swelling involves only soft tissue and there may be an an increase of fluid in the joint (an effusion). Stiffness is characteristic of any type of inflammatory arthritis and is usually present in the morning— it can last for an hour or two, but in severe cases can persist all day. The inflammation spreads to the synovial sheaths that protect and lubricate the tendons linking the bones of the joints to the muscles that move them. As the disease progresses, the inflammation persists for some unknown reason and results in progressive and usually irreversible damage to joints. The more the inflammation, the greater the risks of damage. Bony swellings appear and deformity develops as the joints become damaged and begin to fail. The muscles weaken, partly though lack of use and partly from the effects of a generalized inflammatory condition. Rheumatoid arthritis starts in different ways. Usually, it starts slowly, with intermittent pain and swelling in some joints, especially in the fingers, wrists, and feet. The symptoms gradually worsen until it is self-evident to the individual that there is something wrong with the joints. In perhaps 20 percent of cases, the disease starts very suddenly: one day the individual is normal and the next, many joints are painful, swollen, and stiff. In some people the disease starts in less usual ways. For example, it may involve a single joint. In others, the disease comes and goes repeatedly, often over several years, before becoming persistent. Occasionally, it starts with pain and stiffness around the shoulders and mimics a condition called polymyalgia rheumatica. The way the disease progresses is variable. Some people have a mild disease with few problems and can live normal lives. For others, the disease may enter a period of sustained remission without returning, or else follows an intermittent course, when flareups are followed by remissions that do not last long. Many people have chronic persistent arthritis, in which continuing disease activity has added flare-ups from time to time. A few people have a persisting severe disease that remains active despite the best efforts of most therapies.

Disability risk in Rheumatoid arthritis:  Taken together, inflammation and damage to joints cause marked disability. This varies with time and is unique to an individual, depending on the exact ways their joints are involved. Some people with rheumatoid arthritis are simply unable to do normal things. The disability is also psychological and social. For example, many, though by no means all, people with rheumatoid arthritis find it difficult to work and some will need to leave their job as a result.

Medical care for Arthritis

Doctors are experts who are well trained in diagnosis and treatment of arthritic conditions  Although many people think of medicine as a science, it’s often just as much an art. Doctors frequently follow hunches during their diagnostic work-ups. And although standard approaches, or guidelines, for treating most diseases exist, doctors know that everybody responds a little differently. Thus, most treatment programmes are individualised and change as time goes on – anywhere from slightly tweaked to radically altered.

Most important questions that your doctor should be answering are

• How did you determine that I have this particular kind of arthritis?
• What’s causing my arthritis?
• Do I have any joint deformity?
• What kinds of treatment do you recommend?
• What outcome can I expect?
• Which non-medication treatments do you recommend?
• Does physiotherapy help?
• Do I need surgery? If so, how long can I wait before I have it?
• What happens if I do nothing?
• What’s the cost of my treatment?

Choosing between a General medical practitioner or rheumatologist: Whether you need a specialist depends upon the kind of arthritis you have. If you have osteoarthritis you may do well under the care of a GP or orthopaedic surgeon when the time comes to consider joint replacement. But if you have a more complicated kind of arthritis, one that involves entire body systems (such as rheumatoid arthritis), you probably need to see a rheumatologist. Rheumatologists specialise in diseases of the joints, muscles, and bones. They treat arthritis, musculoskeletal pain disorders, osteoporosis, and various autoimmune diseases. An important part of the rheumatologist’s job is the proper diagnosis of the disease, because symptoms can point to many different conditions. After the rheumatologist pinpoints the disease, proper treatment can begin, so early and accurate diagnosis is crucial. If you don’t have a clear-cut case of osteoarthritis, or if your GP seems baffled by your symptoms, ask to see a rheumatologist.


Diagnosing arthritis 

Diagnosing arthritis is sometimes very easy and can be determined instantly merely looking the at the joints. Sometimes it may take months or even years of following up on clues and running endless tests. With osteoarthritis (OA), the diagnosis is usually pretty clear: Those affected typically are over 40, have pain in a single joint but no swelling, and X-rays show narrowing of the joint space. But with other forms of arthritis, such as infectious arthritis, the symptoms are often more vague: Fatigue, chills, fever, rash, inflammation of the heart, meningitis, and joint aches that may come and go for years. However, doctors have access to many methods that can help narrow down the long list of possibilities and pinpoint a diagnosis. 

No single test can determine for sure whether you have arthritis. Instead, your doctor goes through several procedures, such as taking a thorough medical history, examining you carefully, and requesting a series of tests. Together, these clues provide a pretty accurate picture of what’s going on in your body.
Your doctor will ask you a series of questions regarding your overall health and medical history. Following are the typical questions 

  • Any accidents or injuries you’ve sustained
  • Diseases that run in your family
  • Illnesses you’ve had (especially recently)
  • Other problems, including recent weight loss, depression, sleep disturbances, aches and pain, skin changes, and fatigue
The doctor also reviews your activities at work and at home. Knowing that you type eight hours a day may help the doctor connect your hand pain and tingling to carpal tunnel syndrome or discovering that you drink a lot of alcohol may point to the possibility of gout. You may guide your doctor to the diagnosis of Lyme disease by revealing that you went camping in the woods and discovered a rash on your back shortly before your joints began hurting. And of course, you should tell the doctor about any and all of your symptoms, including embarrassing ones like a discharge or pain when urinating. Don’t hold back information because you think it’s not important. You may not mention that you have some difficulty in swallowing, because you don’t think it’s related to your joint and muscle pain. But if you have scleroderma or polymyositis this symptom is an important piece of the information.

Why General Physician play the most important role in diagnosis of arthritis? 

You should always consult a general physician first before consulting a specialist like rheumatologist. Even if you have pain in just a single joint, your doctor examines you from head to toe. Your GP is the doctor most likely to perform this initial examination. If you see a rheumatologis or other specialist, he or she probably won't look you over from stem to stern, but still carefully examines all affected and related areas. How important is the head-to-toe examination? Well, urinary difficulties in men can result from reactive arthritis (Reiter’s syndrome), gonococcal arthritis, or something totally different, such as an enlarged prostate gland. Without a thorough examination, the proper diagnosis is easily missed.




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