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http://www.cancerbackup.org.uk/Treatments/Chemotherapy/Individualdrugs/Methotrexate This is my new drug I am taken called Methotrexate Chemo Theraphy. This is my medication I am taken but it can also treat RA not cure but remission and it can make your hair fall out I think he had to wait until my blood test where some what normal before he could do aggressive treatment like this. So, it can help my Lymphatic system which I think is where it all started there and my lungs and even other stuff. What is lupus? Lupus is a condition of chronic inflammation caused by an autoimmune disease. Autoimmune diseases are illnesses that occur when the body's tissues are attacked by its own immune system. The immune system is a complex system within the body that is designed to fight infectious agents, for example, bacteria, and other foreign invaders. One of the mechanisms that the immune system uses to fight infections is the production of antibodies. Patients with lupus produce abnormal antibodies in their blood that target tissues within their own body rather than foreign infectious agents. Because the antibodies and accompanying cells of inflammation can involve tissues anywhere in the body, lupus has the potential to affect a variety of areas of the body. Sometimes lupus can cause disease of the skin, heart, lungs, kidneys, joints, and/or nervous system. When only the skin is involved, the condition is called discoid lupus. When internal organs are involved, the condition is called systemic lupus erythematosus (SLE). Both discoid and systemic lupus are more common in women than men (about eight times more common). The disease can affect all ages but most commonly begins from age 20 to 45 years. It is more frequent in African-Americans and people of Chinese and Japanese descent. What causes lupus? The precise reason for the abnormal autoimmunity that causes lupus is not known. Inherited genes, viruses, ultraviolet light, and drugs may all play some role. Genetic factors increase the tendency of developing autoimmune diseases, and autoimmune diseases such as lupus, rheumatoid arthritis , and immune thyroid disorders are more common among relatives of patients with lupus than the general population. Some scientists believe that the immune system in lupus is more easily stimulated by external factors like viruses or ultraviolet light. Sometimes, symptoms of lupus can be precipitated or aggravated by only a brief period of sun exposure. Dozens of medications have been reported to trigger SLE; however, more than 90% of this "drug-induced lupus" occurs as a side effect of one of the following six drugs: hydralazine (used for high blood pressure), quinidine and procainamide (used for abnormal heart rhythm), phenytoin (used forepilepsy), isoniazide (used fortuberculosis), d- penicillamine (used for rheumatoid arthritis). These drugs are known to stimulate the immune system and cause SLE. Fortunately, drug-induced SLE is infrequent (accounting for less than 5% of SLE among all patients with SLE) and usually resolves when the medications are discontinued. It also is known that some women with SLE can experience worsening of their symptoms prior to their menstrual periods. This phenomenon, together with the female predominance of SLE, suggest that female hormones play an important role in the expression of SLE. This hormonal relationship is an active area of ongoing study by scientists. Recent research provides direct evidence that a key enzyme's failure to dispose of dying cells contributes to SLE. The enzyme, DNase1, normally eliminates what is called "garbage DNA" and other cellular debris by chopping them into tiny fragments for easier disposal. The researchers turned off the DNase1 gene in mice. The mice appeared healthy at birth but after 6-8 months, the majority of mice without DNase1 showed signs of SLE. Thus, a genetic mutation that disrupts the body's cellular waste disposal may be involved in the beginning of SLE What is scleroderma? Scleroderma is an autoimmune disease of the connective tissue. Autoimmune diseases are illnesses which occur when the body's tissues are attacked by its own immune system. Scleroderma is characterized by the formation of scar tissue (fibrosis) in the skin and organs of the body. This leads to thickness and firmness of involved areas. Scleroderma is also referred to as systemic sclerosis. The cause of scleroderma is not known. Researchers have found some evidence that genes are important factors, but the environment seems to also play a role. The result is activation of the immune system causing injury to tissues that result in injury similar to scar tissue formation. The fact that genes seem to cause a predisposition to developing scleroderma means that inheritance at least play a partial role. It is not unusual to find other autoimmune diseases in families of scleroderma patients. Some evidence for the role genes may play in leading to the development of scleroderma comes from the study of Choctaw Native Americans who are the group with the highest reported prevalence of the disease. The disease is more frequent in females than in males. How is scleroderma classified? Scleroderma can be classified in terms of the degree and location of the skin involvement. Accordingly, scleroderma has been categorized into two major groups, diffuse and limited. The diffuse form of scleroderma is involves symmetric thickening of skin of the extremities, face, trunk (chest, back, abdomen, or flanks) which can rapidly progress to hardening after an early inflammatory phase. Organ disease can occur early on and be serious. Organs affected include the esophagus, bowels, lungs with scarring (fibrosis), heart, and kidneys. High blood pressure can be a troublesome side effect. The limited form of scleroderma tends to be confined to the skin of the fingers and face. The skin changes and other features of disease tend to occur more slowly than in the diffuse form. Because a characteristic clinical pattern can occur in patients with the limited form of scleroderma, this form has taken another name which is composed of the first initials of the common components. Thus, this form is also called the CREST variant of scleroderma. This name represents the following features: C.....Calcinosis, refers to the formation of tiny deposits of calcium in the skin. This is seen as hard whitish areas in the superficial skin, commonly overlying the elbows, knees, or fingers. These firm deposits can be tender, can become infected, and can fall off spontaneously or require surgical removal. This is the least common of the CREST scleroderma variant features. R.....Raynaud's phenomenon refers to the spasm of the tiny artery vessels supplying blood to the fingers, toes, nose, tongue, or ears. These areas turns blue, white, then red after exposure to extremes of cold, or even sometimes with extremes of heat or emotional upset. For more information, please read the Raynaud's Phenomenon article. E.....Esophagus disease in scleroderma is characterized by poorly functioning muscle of the lower 2/3 of the esophagus. This can lead to an abnormally wide esophagus which allows stomach acid to backflow into the esophagus to cause heartburn, inflammation, and potentially scarring. This can eventually lead to difficulty in passing food from the mouth through the esophagus into the stomach. Symptoms of heartburn are treated aggressively in patients with scleroderma in order to prevent injury to the esophagus. S.....Sclerodactyly refers to the localized thickening and tightness of the skin of the fingers or toes. This can give them a "shiny" and slightly puffy appearance. The tightness can cause severe limitation of motion of the fingers and toes. These skin changes generally progress much slower that those of patients with the diffuse form of scleroderma. T.....Telangiectasias are tiny red areas, frequently on the face, hands and in the mouth behind the lips. These areas blanch when they are pressed upon and represent dilated capillaries. Patients can have variations of CREST, for example, CRST, REST, ST, etc. Patients can also have "overlap" illness with features of both CREST and the diffuse form of scleroderma. Some patients have overlaps of scleroderma and other connective tissue diseases, such as rheumatoid arthritis, systemic lupus erythematosus, and polymyositis. When features of scleroderma are present along with features of polymyositis and systemic lupus erythematosus, the condition is referred to as mixed connective tissue disease (MCTD). Finally, scleroderma skin changes can be very localized. Morphea is scleroderma skin that is localized to a patchy area of the skin that becomes hardened and slightly pigmented. Sometimes morphea can cause multiple lesions in the skin. Linear scleroderma is scleroderma that is localized usually to a lower extremity, frequently presenting as a strip of hardening skin down the leg of a child. Linear scleroderma in children can stunt bone growth of the affected limb. Sometimes linear scleroderma is associated with a "satellite" area of a patch of localized scleroderma skin, such as on the abdomen. Rheumatoid Arthritis Medical Author: William C. Shiel Jr., MD, FACP, FACR What is rheumatoid arthritis? What causes rheumatoid arthritis? What are the symptoms of rheumatoid arthritis? How is rheumatoid arthritis diagnosed? How is rheumatoid arthritis treated? "First-line" drugs "Second-line" or "slow-acting" drugs Newer treatments Other treatments Future treatments Rheumatoid Arthritis At A Glance Related Rheumatoid Arthritis articles: Rheumatoid Arthritis - on WebMD Rheumatoid Arthritis - on eMedicine Health Living With Rheumatoid Arthritis Mrs. K. D. is a 43 year old wife and mother of two children and suffers from severe rheumatoid arthritis. This is her story... This article is not about my disease itself or its treatment, but about the way it affects what I do throughout my day. My disease has caused deformity of my hands and feet. My fingers are recognizably gnarled and have bumps, called nodules. My wrists have nearly fused so that I can move them very little. My toes have cocked up and I have calluses under the pads at the bottoms of my feet. My knees are chronically slightly swollen as are many of the small joints of my knuckles. Things that most people take for granted for example sleeping, bathing, brushing your teeth, getting dressed, making meals, and even driving a car; for me, are extremely challenging. Read More about Living with Arthritis What is rheumatoid arthritis? Rheumatoid arthritis is an autoimmune disease that causes chronic inflammation of the joints. Rheumatoid arthritis can also cause inflammation of the tissue around the joints, as well as other organs in the body. Autoimmune diseases are illnesses that occur when the body tissues are mistakenly attacked by its own immune system. The immune system is a complex organization of cells and antibodies designed normally to "seek and destroy" invaders of the body, particularly infections. Patients with autoimmune diseases have antibodies in their blood that target their own body tissues, where they can be associated with inflammation. Because it can affect multiple other organs of the body, rheumatoid arthritis is referred to as a systemic illness and is sometimes called rheumatoid disease. While rheumatoid arthritis is a chronic illness, meaning it can last for years, patients may experience long periods without symptoms. Typically, however, rheumatoid arthritis is a progressive illness that has the potential to cause joint destruction and functional disability. A joint is where two bones meet to allow movement of body parts. Arthritis means joint inflammation. The joint inflammation of rheumatoid arthritis causes swelling, pain, stiffness, and redness in the joints. The inflammation of rheumatoid disease can also occur in tissues around the joints, such as the tendons, ligaments, and muscles. In some patients with rheumatoid arthritis, chronic inflammation leads to the destruction of the cartilage, bone and ligaments causing deformity of the joints. Damage to the joints can occur early in the disease and be progressive. Moreover, studies have shown that the progressive damage to the joints does not necessarily correlate with the degree of pain, stiffness, or swelling present in the joints. Rheumatoid arthritis is a common rheumatic disease, affecting more than two million people in the United States. The disease is three times more common in women as in men. It afflicts people of all races equally. The disease can begin at any age, but most often starts after age forty and before sixty. In some families, multiple members can be affected, suggesting a genetic basis for the disorder. How can cancer be detected early? In many cases, the sooner cancer is diagnosed and treated, the better a person's chance for a full recovery. If you develop cancer, you can improve the chance that it will be detected early if you have regular medical checkups and do certain self-exams. Often a doctor can find early cancer during a physical exam or with routine tests, even if a person has no symptoms. Some important medical exams, tests, and self- exams are discussed on the next pages. The doctor may suggest other exams for people who are at increased risk for cancer. Ask your doctor about your cancer risk, problems to watch for, and a schedule of regular checkups. The doctor's advice will be based on your age, medical history, and other risk factors. The doctor also can help you learn about self-exams. (More information and free booklets about self-exams are available from the Cancer Information Service). Many local health departments have information about cancer screening or early detection programs. The Cancer Information Service also can tell you about such programs. Exams For Both Men And Women Skin - The doctor should examine your skin during regular checkups for signs of skin cancer. You should also check regularly for new growths, sores that do not heal, changes in the size, shape, or color of any moles, or any other changes on the skin. Warning signs like these should be reported to the doctor right away. Colon and Rectum - Beginning at age 50, you should have a yearly fecal occult blood test. This test is a check for hidden (occult) blood in the stool. A small amount of stool is placed on a plastic slide or on special paper. It may be tested in the doctor's office or sent to a lab. This test is done because cancer of the colon and rectum can cause bleeding. However, noncancerous conditions can also cause bleeding, so having blood in the stool does not necessarily mean a person has cancer. If blood is found, the doctor orders more tests to help make a diagnosis. To check for cancer of the rectum, the doctor inserts a gloved finger into the rectum and feels for any bumps or abnormal areas. A digital rectal exam should be done during regular checkups. Every 3 to 5 years after age 50, an individual should have sigmoidoscopy. In this exam, the doctor uses a thin, flexible tube with a light to look inside the rectum and colon for abnormal areas. Mouth - Your doctor and dentist should examine your mouth at regular visits. Also, by looking in a mirror, you can check inside your mouth for changes in the color of the lips, gums, tongue, or inner cheeks, and for scabs, cracks, sores, white patches, swelling, or bleeding. It is often possible to see or feel changes in the mouth that might be cancer or a condition that might lead to cancer. Any symptoms in your mouth should be checked by a doctor or dentist. Oral exams are especially important for people who use alcohol or tobacco products and for anyone over age 50. Exams For Men Prostate - Men over age 40 should have a yearly digital rectal exam to check the prostate gland for hard or lumpy areas. The doctor feels the prostate through the wall of the rectum. Testicles - Testicular cancer occurs most often between ages 15 and 34. Most of these cancers are found by men themselves, often by doing a testicular self-exam. If you find a lump or notice another change, such as heaviness, swelling, unusual tenderness, or pain, you should see your doctor. Also, the doctor should examine the testicles as part of regular medical checkups. Exams For Women Breast - When breast cancer is found early, a woman has more treatment choices and a good chance of complete recovery. It is, therefore, important that breast cancer be detected as early as possible. The National Cancer Institute encourages women to take an active part in early detection. They should talk to their doctor about this disease, the symptoms to watch for, and an appropriate schedule of checkups. Women should ask their doctor about: Mammograms (x-rays of the breast); Breast exams by a doctor or nurse; and Breast self-examination (BSE) A mammogram can often show tumors or changes in the breast before they can be felt or cause symptoms. However, we know mammograms cannot find every abnormal area in the breast. This is especially true in the breasts of young women. Another important step in early detection is for women to have their breasts examined regularly by a doctor or a nurse. Between visits to the doctor, women should examine their breasts every month. By doing BSE, women learn what looks and feels normal for their breasts, and they are more likely to find a change. Any changes should be reported to the doctor. Most breast lumps are not cancer, but only a doctor can make a diagnosis. Cervix - Regular pelvic exams and Pap tests are important to detect early cancer of the cervix. In a pelvic exam, the doctor feels the uterus, vagina, ovaries, fallopian tubes, bladder, and rectum for any change in size or shape. For the Pap test, a sample of cells is collected from the upper vagina and cervix with a small brush or a flat wooden stick. The sample is placed in a glass slide and checked under a microscope for cancer or other abnormal cells. Women should start having a Pap test every year after they turn 18 or become sexually active. If the results are normal for 3 or more years in a row, a woman may have this test less often, based on her doctor's advice. What is psoriasis? Psoriasis is a chronic (long-lasting) skin disease characterized by scaling and inflammation. Scaling occurs when cells in the outer layer of skin reproduce faster than normal and pile up on the skin's surface. Psoriasis affects 2 to 2.6 percent of the United States population, or almost 5.8 to 7 million people. It occurs in all age groups and about equally in men and women. People with psoriasis may suffer discomfort, restricted motion of joints, and emotional distress. When psoriasis develops, patches of skin thicken, redden, and become covered with silvery scales. These patches are sometimes referred to as plaques. They may itch or burn. The skin at joints may crack. Psoriasis most often occurs on the elbows, knees, scalp, lower back, face, palms, and soles of the feet. The disease also may affect the fingernails, toenails, and the soft tissues inside the mouth and genitalia. About 10 percent of people with psoriasis have joint inflammation that produces symptoms of arthritis. This condition is called psoriatic arthritis. Psoriasis is not contagious in any way. It is not possible to "catch" psoriasis by touching a person afflicted with it. Living With Sarcoidosis The cause of sarcoidosis still remains unknown, so there is at present no known way to prevent or cure this disease. However, doctors have had a great deal of experience in management of the illness. It should be noted that most people with sarcoidosis lead normal lives. If you have sarcoidosis, you can help yourself by following sensible health measures. You should not smoke. You should also avoid exposure to other substances such as dusts and chemicals that can harm your lungs. Patients with sarcoidosis are best treated by a lung specialist or a doctor who has a special interest in sarcoidosis. Sarcoidosis specialists are usually located at major research centers. If you have any symptoms of sarcoidosis, see your doctor regularly so that the illness can be watched and, if necessary, treated. If it heals naturally, sarcoidosis, or are suspected of having the illness but have no symptoms now, be sure to have physical checkups every year, including an eye examination. Although severe sarcoidosis can reduce the chances of becoming pregnant, particularly for older women, many young women with sarcoidosis have given birth to healthy babies while on treatment. Patients planning to have a baby should discuss the matter with their doctor. Medical checkups all through pregnancy and immediately thereafter are especially important for sarcoidosis patients. In some cases, bed rest is necessary during the last 3 months of pregnancy. In addition to family and close friends, a number of local lung organizations, other nonprofit health organizations, and self-help groups are available to help patients cope with sarcoidosis. By keeping in touch with them, you can share personal feelings and experiences. Members also share specific information on the latest scientific advances, where to find sarcoidosis specialist, and how to improve one's self-image. Information above was contributed, in part, by the generosity of National Institutes of Health. Sarcoidosis At A Glance Sarcoidosis is a disease that causes inflammation of body tissues. The cause of sarcoidosis is not known. Sarcoidosis commonly affects the lungs and skin. Diagnosis is suggested by the patient's medical history, routine tests, a physical examination, and a chest x- ray. Many patients with sarcoidosis require no treatment. For more severe disease, cortisone-related medications are used. Other treatments are considered, as above, depending on what areas of the body are affected and to what degree. Additional Information on Sarcoidosis is available from a number of sources: CURRENT SARCOIDOSIS RESEARCH AND CLINICAL TRIALS National Heart, Lung, and Blood Institute (NHLBI) Division of Lung Diseases 5333 Westward Avenue Room 6A16 Bethesda, MD 20892 If you are interested in participating on NHLBI clinical studies of sarcoidosis, have your physician write to: National Heart, Lung, and Blood Institute Pulmonary Branch 9000 Rockville Pike Building 10, Room 6D06 Bethesda, MD 20892 INFORMATION AND PUBLICATIONS FOR PATIENTS AND FAMILIES National Institute of Allergy and Infectious Diseases 9000 Rockville Pike Building 31, 7A32 Bethesda, MD 20892 Sarcoidosis Family Aid and Research Foundation 460A Central Avenue East Orange, NJ 07018 Many local chapters of the American Lung Association host support groups for sarcoidosis patients. The address and telephone number of the chapter nearest to you should be in your local telephone directory. Or you can write or call the association's national headquarters: American Lung Association 1740 Broadway New York, NY 10019-4374 (212) 315-8700 What is fibromyalgia? Fibromyalgia is a chronic condition causing pain, stiffness, and tenderness of the muscles, tendons, and joints. Fibromyalgia is also characterized by restless sleep, awakening feeling tired, fatigue, anxiety, depression, and disturbances in bowel function. Fibromyalgia was formerly known as fibrositis. While fibromyalgia is one of the most common diseases affecting the muscles, its cause is currently unknown. The painful tissues involved are not accompanied by tissue inflammation. Therefore, despite potentially disabling body pain, patients with fibromyalgia do not develop body damage or deformity. Fibromyalgia also does not cause damage to internal body organs. Therefore, fibromyalgia is different from many other rheumatic conditions (such as rheumatoid arthritis, systemic lupus, and polymyositis). In those diseases, tissue inflammation is the major cause of pain, stiffness and tenderness of the joints, tendons and muscles, and it can lead to joint deformity and damage to the internal organs or muscles. What causes fibromyalgia? The cause of fibromyalgia is not known. Patients experience pain in response to stimuli that are normally not perceived as painful. Researchers have found elevated levels of a nerve chemical signal, called substance P, and nerve growth factor in the spinal fluid of fibromyalgia patients. The brain nerve chemical serotonin is also relatively low in patients with fibromyalgia. Studies of pain in fibromyalgia have suggested that the central nervous system (brain) may be somehow supersensitive. Scientists note that there seems to be a diffuse disturbance of pain perception in patients with fibromyalgia. Also, patients with fibromyalgia have impaired non-Rapid-Eye-Movement, or non-REM, sleep phase (which likely explains the common feature of waking up fatigued and unrefreshed in these patients). The onset of fibromyalgia has been associated with psychological distress, trauma, and infection. Who does fibromyalgia affect? Fibromyalgia affects predominantly women (over 80 percent) between the ages of 35 and 55. Rarely, fibromyalgia can also affect men, children, and the elderly. It can occur independently, or can be associated with another disease, such as systemic lupus or rheumatoid arthritis. The prevalence of fibromyalgia varies in different countries. In Sweden and Britain, 1 percent of the population is affected by fibromyalgia. In the United States, approximately 2 percent of the population have fibromyalgia. Total Knee Replacement Medical Editor: William C. Shiel Jr., MD, FACP, FACR What is a total knee replacement? What patients should consider a total knee replacement? What are the risks of undergoing a total knee replacement? What is involved with the preoperative evaluation for total knee replacement? What happens in the postoperative period? How does the patient continue to improve as an outpatient after discharge from the hospital? Total Knee Replacement At A Glance What is a total knee replacement? A total knee replacement is a surgical procedure whereby the diseased knee joint is replaced with artificial material. The knee is a hinge joint which provides motion at the point where the thigh meets the lower leg. The thigh bone (or femur) abuts the large bone of the lower leg (tibia) at the knee joint. During a total knee replacement, the end of the femur bone is removed and replaced with a metal shell. The end of the lower leg bone (tibia) is also removed and replaced with a channeled plastic piece with a metal stem. Depending on the condition of the kneecap portion of the knee joint, a plastic "button" may also be added under the kneecap surface. The posterior cruciate ligament is a tissue that normally stabilizes each side of the knee joint so that the lower leg cannot slide backward in relation to the thigh bone. In total knee replacement surgery, this ligament is either retained, sacrificed, or substituted by a polyethylene post. Each of these various designs of total knee replacement has its benefits and risks. Green Tea May Ease Rheumatoid Arthritis By Kathleen Doheny HealthDay Reporter MONDAY, April 30 (HealthDay News) -- Green tea, already touted for its cardiovascular and anticancer benefits, may also help ease the inflammation and pain of rheumatoid arthritis, a new study suggests. The study was conducted in the laboratory, and its findings are preliminary, stressed lead researcher Salah-uddin Ahmed, an investigator at the University of Michigan Health System, in Ann Arbor. "It's too early" to fully recommend green tea to ease rheumatoid arthritis, he said, but the study "is a starting point." Ahmed was scheduled to present the research Sunday at the Experimental Biology meeting, in Washington, D.C. For the study, Ahmed isolated cells called synovial fibroblasts from the joints of patients with rheumatoid arthritis. These cells form a lining of tissue surrounding the capsule of the joints. In patients with rheumatoid arthritis, this lining is inflamed, leading to long-term joint damage and chronic pain. About 2.1 million Americans have rheumatoid arthritis, according to the Arthritis Foundation. Ahmed's team next cultured these cells and exposed them to the active ingredient in green tea, a compound named epigallocatechin-3-gallate (EGCG). Next, the cells were stimulated with a protein of the immune system known to play a role in causing joint degradation in rheumatoid arthritis. The protein is called cytokine interleukin-1 beta or IL-1B. "IL-1B is a major player in mediating cartilage degradation," Ahmed explained. In an earlier study, Ahmed's team found that fibroblasts pretreated with EGCG and then stimulated with cytokine IL-1B were better able to block IL-1B's ability to produce damaging proteins and enzymes. Those proteins and enzymes can infiltrate the joints and cause the cartilage breakdown seen in people with rheumatoid arthritis. In the more recent study, the researchers focused on whether EGCG had the ability to block the activity of two potent molecules, IL-6 and cyclooxygenase-2 (Cox-2), which also play a role in breaking down bone in an RA joint. The two molecules were suppressed by the EGCG, Ahmed's team found. While he said it is difficult to quantify exactly the effect of the suppression, the EGCG "blocked them significantly," he said. EGCG also blocked the production of prostaglandin E2, another compound that can cause joint inflammation. One expert said the new green tea study was intriguing. "This study is very specific," said Stephen Hsu, an associate professor of dentistry, molecular medicine and genetics at the medical College of Georgia in Augusta. In his own research, Hsu has found that green tea may help protect against certain autoimmune diseases, in which the body triggers an immune response, basically attacking its own cells. Hsu studied EGCG's effect in helping to inhibit an autoimmune disorder known as Sjogren's syndrome, in which the salivary glands are affected, and in lupus, in which the skin is affected. The new research by Ahmed is one of the first to focus on rheumatoid arthritis and green tea, Hsu said. If it bears out, it could be good news for rheumatoid arthritis patients, perhaps offering them a non-drug option to keep pain under control, he said. Ahmed cautioned that it's too soon to advise rheumatoid arthritis patients to drink green tea. On the other hand, drinking green tea certainly wouldn't hurt, he said, since it is known to have many health benefits and no known side effects. He said people might want to try drinking three or four 8-ounce cups of green tea per day. "Try different brands," he suggested. The flavors may taste slightly different. "Drink it continuously throughout the day," he said, to keep blood levels more constant. And you might want to consider popping some tart cherries along with that tea, according to another study presented at the same meeting. In the study, conducted by another team of University of Michigan researchers, powdered tart cherries appeared to lower total cholesterol and blood sugar and help the body handle fat and sugar -- at least in animals. SOURCES: Salah-uddin Ahmed, Ph.D., research professor, internal medicine-rheumatology, University of Michigan Health System, Ann Arbor, Mich.; Stephen Hsu, Ph.D., associate professor, dentistry, molecular medicine and genetics, Medical College of Georgia, Augusta; Experimental Biology 2007, April 29, 2007, Washington, D.C. Erythema nodosum: An inflammatory reaction deep in the skin characterized by the presence of tender red lumps or nodules ranging in size from 1 to 5 centimeters most commonly located over the shins but occasionally involving the arms or other areas. The causes of erythema nodosum include medications (sulfa-related drugs, birth control pills, estrogens, iodides and bromides), strep throat, cat scratch disease, fungal diseases, infectious mononucleosis, sarcoidosis, Behcet's disease, inflammatory bowel disease (Crohn's disease and ulcerative colitis), and normal pregnancy. In many cases, no cause can be determined. Erythema nodosum may be self-limited and go away on its own in 3 to 6 weeks. If treatment is needed, the underlying condition is treated and simultaneously treatment is directed toward the erythema nodosum. This can include antiinflammatory drugs and cortisone by mouth or injection. Colchicine is sometime used effectively to reduce inflammation. Common Misspellings: erythemia nodosum What is erythema nodosum? Erythema nodosum is a type of skin inflammation that is located in a certain portion of the fatty layer of skin. Erythema nodosum results in reddish, painful, tender lumps most commonly located in the front of the legs below the knees. The tender lumps, or nodules, of erythema nodosum range in size from 1 to 5 centimeters. The nodular swelling is caused by a special pattern of inflammation in the fatty layer of skin. Erythema nodosum can be self-limited and resolve on its own in 3 to 6 weeks. Upon resolution, it may leave only a temporary bruised appearance or leave a chronic indentation in the skin where the fatty layer has been injured. There are several scenarios for the outcome of erythema nodosum. Typically, these areas of nodular tenderness range in size from about a dime to a quarter and they may be tender and inflamed off and on for a period of weeks. They usually then resolve spontaneously, each one of the little areas of inflammation shrinking down and then becoming flat rather than raised and inflamed. They leave a bruised appearance. Then, they resolve spontaneously completely. Other lesions can sometimes pop up elsewhere. This may occur for periods of weeks to months and then eventually goes away. However, chronic erythema nodosum that may last for years is another pattern. Chronic erythema nodosum, with intermittent recurrences, can occur with or without an underlying disease present. What causes erythema nodosum? Erythema nodosum may occur as an isolated condition or in association with other conditions. Conditions that are associated with erythema nodosum include medications (sulfa-related drugs, birth control pills, estrogens), strep throat, Cat scratch disease, fungal diseases, infectious mononucleosis, sarcoidosis, Behcet's disease, inflammatory bowel diseases (Crohn's disease and ulcerative colitis), and normal pregnancy. How is erythema nodosum diagnosed? Usually, erythema nodosum is a straightforward, simple diagnosis for a doctor to make simply by examining a patient and noting the typical firm area of raised tenderness that is red along with areas which have had lesions resolved, which might show a bruised-like appearance. It is not a difficult diagnosis for an experienced doctor. It does not typically require other investigative tests. Sometimes a biopsy is done for confirmation, for example, if a patient presented with an isolated, singular area and a doctor was unable to make a diagnosis based on its appearance. The biopsy of the deeper layers of tissue of skin can prove that it is erythema nodosum. Those layers would show the specific fatty layers of inflammation. How is erythema nodosum treated? Erythema nodosum is initially managed by identifying and treating any underlying condition present. Simultaneously, treatment is directed toward the inflamed skin from the erythema nodosum. Treatments for erythema nodosum include antiinflammatory drugs, and cortisone by mouth or injection. Colchicine is sometime used effectively to reduce inflammation. Treatment must be customized for the particular patient and conditions present. It is important to note that erythema nodosum, while annoying and often painful, does not threaten internal organs and the long-term outlook is generally very good. Reference: Clinical Primer of Rheumatology, Lippincott Williams & Wilkens, edited by William Koopman, et. al., 2003. Kelley's Textbook of Rheumatology, W B Saunders Co, edited by Shaun Ruddy, et.al., 2000. Dr. Shiel, we have viewers who are interested in knowing about erythema nodosum (e-nodosum). What is e-nodosum and what causes it? Dr. Shiel: Erythema nodosum is an uncommon type of inflammation of the fatty layer of skin. This results in a localized, raised, tender, red area most commonly seen below the knees, but it can occur less commonly in the upper extremities. It is a result of inflammation of a special area within the lower levels of the skin in the fatty layers. If we think of the fat layer as a tissue that is designed with a honeycomb type pattern and fat cells within each of those honeycomb areas, it is actually the honeycomb portion that gets inflamed (that is referred to as "septa"). This is what occurs to cause the fat inflammation that is referred to as panniculitis in erythema nodosum. Dr. Lee: Who gets it? Dr. Shiel: Erythema nodosum (further referred to as "it") has a variety of different causes and those causes range from different diseases and conditions, to infections and as a side effect of different medications. It can even occur in the context of pregnancy or as a result or in association of pregnancy. It occurs more frequently in females, and it is felt that estrogens probably play a role. Birth control pills are one of the common medications to cause erythema nodosum. Erythema nodosum, though, can be caused by other medications, particularly sulfur medications and some medicines that are used to treat tuberculosis. It can be caused by infections, such as fungus infections, strep infections, and less common infections including tuberculosis. There are a variety of diseases that cause erythema nodosum such as; inflammatory bowel disease, sarcoidosis, and more rare diseases like Behcet's disease, and systemic lupus erythematosus. These are generally conditions that involve inflammation throughout the body and erythema nodosum is in sort of association with these diseases. Dr. Lee: So generally speaking, if erythema nodosum, if it is there, usually indicates that there might be an underlying associated disease or condition. Whether it is infection, medication, or inflammatory condition of the body. Dr. Shiel: It is commonly associated either as a medication, infection, or an underling condition but erythema nodosum can occur without any associated disease or medication identifiable and we call that erythema nodosum of unknown cause or idiopathic erythema nodosum. Some patients have no identifiable cause to treat. Dr. Lee: Here is a viewer question; this viewer has had red skin lesions, diagnosis of having erythema nodosum in the feet, legs and buttocks continuously for four years. The question is: Does erythema nodosum generally come and go or can it be persistent and continuous without ever going away for four years? Dr. Shiel: Actually, there are several scenarios for erythema nodosum. Typically these areas of nodular tenderness range in size from about a dime to a quarter and they may be tender and inflamed off and on for a period of weeks. They typically resolve spontaneously, each one of the little areas of inflammation by shrinking down and then becoming flat rather than raised and inflamed. Then having a bruised appearance. Then, basically, resolve spontaneously completely but then another lesions will pop up elsewhere. This can most commonly occur for periods of weeks to months and then eventually does go away. But chronic erythema nodosum for years is another pattern with intermittent recurrences persisting and this can occur with or without an underlying disease. Dr. Lee: The viewer also wants to know what is the best way to make a firm diagnosis of erythema nodosum? Dr. Shiel: Basically, erythema nodosum is a straightforward, simple diagnosis for a doctor to make simply by examining a patient and noting the firm area of raised tenderness that is red along with areas which have had lesions resolved, which might show a bruised-like appearance. It is not a difficult diagnosis for an experienced physician with erythema nodosum to make. It does not generally require other investigative tests. When a biopsy is done, let's say a patient presented with an isolated, singular area and a doctor was unable to specifically make a diagnosis based on its appearance, a skin biopsy of the deeper layers of tissue of skin can prove that it is erythema nodosum. Those layers would show the inflammation that I have described in the specific areas of fatty cell tissues. Dr. Lee: Do we really need to treat erythema nodosum or is it more important to identify and treat the underlying associated disease? Dr. Shiel: Absolutely I think that all patients with erythema nodosum should have a doctor's evaluation in order to detect and prevent a potentially treatable condition. Erythema nodosum can be very mild and respond to simple anti-inflammatory medications or it can be much more intense and functionally impair a patients' activities. In which case the actual erythema nodosum itself may require addressing with medications. Dr. Lee: You mentioned non-steroidal anti-inflammatory agents in the treatment of erythema nodosum? Dr. Shiel: Erythema nodosum is treated by a variety of methods. One is simple observation, and then gradually the lesions become less frequent and intense and calm down and go away. But for simple immediate treatment non-steroid anti-inflammatory medications can be very helpful. They are not universally helpful and in patients who have resistant erythema nodosum, corticosteroid medications (cortisone medicines like prednisone and prednisolone) have been used. Although in my experience, use of those medications, I like to generally limit to those medications for severely involved cases. Other options include colchicine, which is another anti-inflammatory medicine that is not cortisone and they can help with chronic colchicine intake to reduce the inflammation in the fatty layers of tissues. Sometimes doctors will actually inject cortisone medications directly into the area of erythema nodosum. In my experience, because of the lesions can recur and crop up in other areas, the use of local injections has not proved that rewarding and beneficial for patients. Dr. Lee: Thank you, Dr. Shiel. MedicineNet.com: The published answers represent the opinions and perspectives of the doctors and pharmacists of MedicineNet.com and are for educational purposes only. They should not be used to replace or substitute for timely consultation with your doctor. Accuracy of information cannot be guaranteed. Please remember, information can be subject to interpretation and can become obsolete. > MedicineNet.com: For more information, please see MedicineNet.com's Focus on Erythema Nodosum. Back to Doctors' Dialogue Index
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