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),
(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.
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).
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)
Systemic lupus erythematosis
Excessive intake of Vitamin
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.
wikipedia page on Boswellia Serrata en.wikipedia.org/wiki/Boswellia_serrata
Note: The theraputic effects of BOSWELLIA
has not been evaluated by US FDA. BOSWELLIA is not intended to diagnose,
treat or cure any ailment. Individual results may vary.
1 Bottle - 60 capsules of Boswellia
Serrata Extract. Dosage : 2 per day. One Month's supply
ONE - U.S.$12/-
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reports on Boswellia Serrata
NYU Langone Medical
Center, New York, NY 10016
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.
results showed significantly greater improvement in knee pain, knee mobility,
and walking distance with boswellia compared to placebo.
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.
Research on Boswellia
Efficacy and tolerability of Boswellia
serrata extract in treatment of osteoarthritis of knee ï¿½ 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.
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,
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.
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
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
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.
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)
Interact with us on facebook facebook.com/Arthritis.Boswellia
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
The human shock absorber Cartilage is extremely important for the healthy
functioning of a joint, especially if that joint bears weight, like your
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
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.
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
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
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.
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.
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.
Bacteria, viruses, or fungi that enter the body can settle in the joints,
causing fever, inflammation, and loss of joint function.
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.
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.
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.
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.
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.
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.
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.
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
Carpal tunnel syndrome:
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
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
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.
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
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
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 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
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.
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:
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.
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.
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
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 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
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.
Any accidents or injuries you’ve
Diseases that run in your family
Illnesses you’ve had (especially
Other problems, including recent
weight loss, depression, sleep disturbances, aches and pain, skin changes,
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.