The Itis Family

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

Osteoarthritis

•OA, the most common arthritis, affects more than 21 million Americans and is a leading cause of disability.

•At present, there is no available therapy that can reverse the damage of OA in the joint, but many studies are underway.

Rheumatoid arthritis• a chronic disease that causes pain,

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

• rheumatoid nodules beneath the skin in areas such as the elbow and hands

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

• RA is the most common form of inflammatory arthritis usually female and 4th-5th decade

Psoriatic arthritis

• body's immune system goes into overdrive and causes excessive inflammation

• between ages 30 to 50, but can begin in childhood

• Only about 15 percent of people with psoriasis develop the disease

Reactive arthritis

• Swollen, painful and stiff joints, often involving the knees and/or ankles

• Reaction to an infectious agent are typically male, between the ages of 20-50

• Self limiting • Although many infections, including

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

jra

• Joint inflammation and begin before the age of 16

• Systemic onset, Pauciarticular and Polyarticular

• Not regarded as hereditary • Research points to exposure to

an infectious trigger • JRA targets the lining of the joint

gout

• Gout occurs when excess uric acid accumulates in the body, and crystals deposit in the joints.

• about 1 in 100 people and as many as 6 – 7 percent of older men

• Gout is strongly associated with obesity hypertension, hyperlipidemia and diabetes

PMR

• Aching and stiffness affecting the upper arms, neck, buttocks, and thighs.

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

completely to low doses of corticosteroids

Early ra

Early ra

Moderate ra

Severe Ra

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

rest)• Occasionally migrating• Growing unresponsive to remedies• Effecting ADL’s

•

Associated symptoms

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

Testing testing……..

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

cbc, uric acid, ana, c-reactive protein, hlab27,

anti-cyclic citrullinated peptide

Time for a treat

• Electrical, needle• Antiinflammatories- NSAID,

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

antiinflammatories

• Motrin, advil, ibuprofen, aleve, naprosyn, nuprin, aspirin

• Feldene, orudis, dolobid, voltaren, cataflam, indocin, clinoril, daypro

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

Muscle relaxers

•Skelaxin•Flexeril•Soma

Narc’s

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

Mood altering

• SSRI’s• Tricyclics• Antidepressants

DMARD’s

• Disease Modifying Agents of Rheumatology

• Cytoxan, imuran, cyclosporine, methotrexate, leukoran, plaquenil

• Humira, remicade, orencia,

Herbal supplements

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

Alternative supplements

• Omega 3 fish oil(eicosapentanoic acid, docosahexaenoic acid)

• Glucosamine sulfate• Shark cartilage• Plant based bioflavinoids

(limbrel)

Diet no

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

any source

Diet yes

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

veg and sprouts• Raw veg sprout salad

The consultants

• Rheumatology • Physical medicine and

rehabilitation• Orthopedic surgeons• Sportsmedicine specialists• Primary care• Chiropractor• Naturopath

Hands on

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

therapist

Counseling

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

Dr Saguil’s approach

• Cool down the worse joints (meds/herbs)

• Rule out big disease• Get the patient to function daily• Get the patient to rehab or flexibility

school• Antiinflammatory diet• Wean off meds• Wean on herbs

Dr saguil’s shortcut

• Cool down• Get moving• Build up • Get off meds (or shorter term

goals)• Maintain

• “Cut it out”

Be patient