Osteoarthritis

Osteoarthritis is a type of arthritis that is caused by the breakdown and eventual

loss of the cartilage of one or more joints. Cartilage is a protein substance that

serves as a "cushion" between the bones of the joints. Osteoarthritis is also known

as degenerative arthritis. Among the over 100 different types of arthritis

conditions, osteoarthritis is the most common, affecting over 20 million people in

the United States. Osteoarthritis occurs more frequently as we age. Before age 45,

osteoarthritis occurs more frequently in males. After age 55 years, it occurs more

frequently in females. In the United States, all races appear equally affected. A

higher incidence of osteoarthritis exists in the Japanese population, while South

African blacks, East Indians, and Southern Chinese have lower rates.

Osteoarthritis commonly affects the hands, feet, spine, and large weight-bearing

joints, such as the hips and knees. Most cases of osteoarthritis have no known

cause and are referred to as primary osteoarthritis. When the cause of the

osteoarthritis is known, the condition is referred to as secondary osteoarthritis.

Osteoarthritis is sometimes abbreviated OA.

Primary osteoarthritis is mostly related to aging. With aging, the water content of

the cartilage increases, and the protein makeup of cartilage degenerates.

Eventually, cartilage begins to degenerate by flaking or forming tiny crevasses. In

advanced cases, there is a total loss of cartilage cushion between the bones of the

joints. Repetitive use of the worn joints over the years can irritate and inflame the

cartilage, causing joint pain and swelling. Loss of the cartilage cushion causes

friction between the bones, leading to pain and limitation of joint mobility.

Inflammation of the

cartilage can also

stimulate new bone

outgrowths (spurs, also

referred to as

osteophytes) to form

around the joints.

Osteoarthritis

occasionally can develop

in multiple members of the same family, implying a hereditary (genetic) basis for

this condition.

Secondary osteoarthritis is caused by another disease or condition. Conditions that

can lead to secondary osteoarthritis include obesity, repeated trauma or surgery to

the joint structures, abnormal joints at birth (congenital

abnormalities), gout, diabetes, and other hormone disorders.

Obesity causes osteoarthritis by increasing the mechanical stress on the cartilage.

In fact, next to aging, obesity is the most powerful risk factor for osteoarthritis of

the knees. The early development of osteoarthritis of the knees among weight

lifters is believed to be in part due to their high body weight. Repeated trauma to

joint tissues (ligaments, bones, and cartilage) is believed to lead to early

osteoarthritis of the knees in soccer players. Interestingly, recent studies have not

found an increased risk of osteoarthritis in long-distance runners.

Crystal deposits in the cartilage can cause cartilage degeneration and

osteoarthritis.Uric acid crystals cause arthritis in gout, while calcium

pyrophosphate crystals cause arthritis in pseudogout.

Some people are born with abnormally formed joints (congenital abnormalities)

that are vulnerable to mechanical wear, causing early degeneration and loss of

joint cartilage. Osteoarthritis of the hip joints is commonly related to structural

abnormalities of these joints that had been present since birth.

Hormone disturbances, such as diabetes and growth hormone disorders, are also

associated with early cartilage wear and secondary osteoarthritis.

Coronary Heart Disease

Coronary heart disease (CHD), also called coronary artery disease, affects about

14 million men and women in the United States.

Disease develops when a combination of fatty material, calcium, and scar tissue

(plaque) builds up in the arteries that supply the heart with blood. Through these

arteries, called the coronary arteries, the heart muscle (myocardium) gets the

oxygen and other nutrients it needs to pump blood.

The plaque often narrows the artery so that the heart does not get enough

blood.

This slowing of blood flow causes chest pain, or angina.

If plaque completely blocks blood flow, it may cause a heart

attack(myocardial infarction) or a fatal rhythm disturbance (sudden cardiac

arrest).

A major cause of death and disability, coronary heart disease claims more

lives in the United States than the next 7 leading causes of death combined.

The heart consists of 4 chambers: an atrium and a ventricle on the right, and an

atrium and ventricle on the left.

Blood returning to the heart from veins all over the body flows into

the right atrium.

From there the blood flows into the right ventricle, which pumps it out to

the lungs for oxygenation.

The oxygen-rich blood returns to the left atrium.

From there the blood flows into the left ventricle, which pumps it at high

pressure into the arteries.

This entire process constitutes one heartbeat.

The pumping, or contraction, of the left ventricle must be very powerful because

that is what keeps the blood flowing throughout the body.

The strength of the heart muscle depends on the oxygen and nutrient

supply coming via the coronary arteries.

These arteries are usually strong, elastic, and quite flexible.

The heart has 3 major coronary arteries.

Two of these arteries arise from a common stem, called the left main

coronary artery.

The left main coronary artery supplies the left side of the heart.

Its left anterior descending (LAD) branch supplies the front part of the

heart.

The left circumflex (LCX) branch supplies the left lateral and back side of

the heart.

Finally, the right coronary artery (RCA) is separate and supplies the right

and the bottom parts of the heart.

As a child, the inner lining of the coronary arteries is quite smooth, allowing

blood to flow easily. As a person ages, the cholesterol and calcium content in the

walls of the coronary arteries increases, making them thicker and less elastic.

Unhealthy habits, such as a diet high in cholesterol and other fats,

smoking, and lack of exercise accelerate the deposit of fat and calcium within

the inner lining of coronary arteries.

This process is known as atherosclerosis, or hardening of the arteries. The

deposits, or plaques, eventually obstruct the blood vessel, which begins to

restrict blood flow.

Plaque is like a firm shell with a soft inner core containing cholesterol. As blood

hits it during each heartbeat, the plaque may crack open and expose its inner

cholesterol core, which promotes blood clotting. Clots may further reduce blood

flow, causing severe pain (angina), or even block it all together.

Osteoporosis

Osteoporosis (OS-tee-oh-poh-ROH-sis) is a disease of the bones. People with

osteoporosis have bones that are weak and break easily.

A broken bone can really affect your life. It can cause severe pain and disability. It

can make it harder to do daily tasks on your own, such as walking.

Osteoporosis affects all bones in the body. However, breaks are most common in

the hip, wrist, and spine, also called vertebrae (VUR-tuh-bray). Vertebrae support

your body, helping you to stand and sit up. See the picture below.

Osteoporosis in the vertebrae can

cause serious problems for

women. A fracture in this area

occurs from day-to-day activities

like climbing stairs, lifting

objects, or bending forward. Signs

of osteoporosis:

Sloping shoulders

Curve in the back

Height loss

Back pain

Hunched posture

Protruding abdomen

What increases my chances of getting osteoporosis?

There are several risk factors that raise your chances of developing osteoporosis.

Some of these factors are things you can control, while some you can’t control.

Factors that you can’t control:

Being female

Having a small, thin body (under 127 pounds)

Having a family history of osteoporosis

Being over 65 years old

Being white or Asian, but African American and Hispanic/Latina women

are also at risk

Not getting your period (if you should be getting it)

Having anorexia nervosa

Not getting enough exercise

Long-term use of certain medicines, including:

o Glucocorticoids (GLOO-koh-KOR-ti-koids) — medicines used to

treat many illnesses, including arthritis, asthma, and lupus

o Some antiseizure medicines

o Gonadotropin (GOH-nad-oo-TROO-pin) -releasing hormone —

used to treat endometriosis (en-doh-mee-tree-O-sis)

o Antacids with aluminum — the aluminum blocks calcium

absorption

o Some cancer treatments

o Too much replacement thyroid hormone

Factors that you can control

Smoking

Drinking too much alcohol. Experts recommend no more than 1 drink a

day for women.

A diet low in dairy products or other sources of calcium and vitamin D

Not getting enough exercise

You may also develop symptoms that are warning signs for osteoporosis. If you

develop the following, you should talk to your doctor about any tests or treatment

you many need:

Loss in height, developing a slumped or hunched posture, or onset of

sudden unexplained back pain.

You are over age 45 or a post-menopausal and you break a bone.

There are tests that can get to find out the bone density. This is related to how

strong or fragile the bones are. One test is called dual-energy X-ray

absorptiometry (DXA). A DXA scan takes X-rays of the bones. 

If we are age 65 and older, we should get a bone density test. Women age 60 to 64

with risk factors for osteoporosis and women over 45 who have broken any bones

should also get tested.

The best way to prevent weak bones is to work on building strong ones. No matter

how old you are, it is never too late to start. Building strong bones during

childhood and the teen years is one of the best ways to keep from getting

osteoporosis later. As you get older, your bones don’t make new bone fast enough

to keep up with the bone loss. And after menopause, bone loss happens more

quickly. But there are steps you can take to slow the natural bone loss with aging

and to prevent your bones from becoming weak and brittle.

1. Get enough calcium each day.

Bones contain a lot of calcium. It is important to get enough calcium in your

diet. You can get calcium through foods and/or calcium pills, which you can

get at the grocery store or drug store. Getting calcium through food is

definitely better since the food provides other nutrients that keep you healthy.

Talk with your doctor or nurse before taking calcium pills to see which kind is

best for you. Taking more calcium pills than recommended doesn’t improve

your bone health. So, try to reach these goals through a combination of food

and supplements.

Here’s how much calcium you need each day.

Daily Calcium Requirments

Ages Milligrams(mg) per day

9-18 1300

19-50 1000

51 and older 1200

Pregnant or nursing women need the same amount of calcium as other women

of the same age.

Here are some foods to help you get the calcium you need. Check the food

labels for more information.

Foods Containing Calcium

Food Portion Milligrams

Plain, fat free yogurt 1 cup 452

Milk (fat-free) 1 cup 306

Milk (1 percent low-fat) 1 cup 290

Tofu with added calcium 1/2 cup 253

Spinach, frozen 1/2 cup 146

White beans, canned 1/2 cup 106

The calcium amounts of these foods are taken from the United States

Department of Agriculture’s Dietary Guidelines for Americans. 

2. Get enough vitamin D each day.

It is also important to get enough vitamin D, which helps your body absorb

calcium from the food you eat. Vitamin D is produced in your skin when it is

exposed to sunlight. You need 10 to 15 minutes of sunlight to the hands, arms,

and face, two to three times a week to make enough vitamin D. The amount of

time depends on how sensitive your skin is to light. It also depends on your

use of sunscreen, your skin color, and the amount of pollution in the air. You

can also get vitamin D by eating foods, such as milk, or by taking vitamin

pills. Vitamin D taken in the diet by food or pills is measured in international

units (IU). Look at the pill bottle or food label for the IU amount.

Here’s how much vitamin D you need each day: 

Daily Vitamin D Requirements

Ages IU per day

19-50 200

51-70 400

71+ 600

Current research suggests that many people of all ages are not getting enough

vitamin D. Some experts think that for good health, daily doses of vitamin D

should be higher. Your doctor can help you make a plan for getting enough

vitamin D.

Although it’s difficult to get enough vitamin D through food, here are some

foods that can help. Check the food labels for more information.

Foods Containing Vitamin D

Food Portion IU

Salmon, cooked 3 1/2 oz 360

Milk, vitamin D fortified 1 cup 98

Egg (vitamin D is in the yolk) 1 whole 20

These foods and IU counts are from the National Institutes of Health Office on

Dietary Supplements.

White milk is a good source of vitamin D, most yogurts are not.

3. Eat a healthy diet.

Other nutrients (like vitamin K, vitamin C, magnesium, and zinc, as well as

protein) help build strong bones too. Milk has many of these nutrients. So do

foods like lean meat, fish, green leafy vegetables, and oranges.  

4. Get moving.

Being active helps your bones by:

Slowing bone loss

Improving muscle strength

Helping your balance

Do weight-bearing physical activity, which is any activity in which your body

works against gravity. There are many things you can do:

Walk

Dance

Run

Climb stairs

Garden

Jog

Hike

Play tennis

Lift weights

Yoga

Tai chi

5. Don’t smoke.

Smoking raises your chances of getting osteoporosis. It harms your bones and

lowers the amount of estrogen in your body. Estrogen is a hormone made by

your body that can help slow bone loss.

6. Drink alcohol moderately.

If you drink, don’t drink more than one alcoholic drink per day. Alcohol can

make it harder for your body to use the calcium you take in. And, importantly,

too much at one time can affect your balance and lead to falls.

7. Make your home safe.

Reduce your chances of falling by making your home safer. Use a rubber bath

mat in the shower or tub. Keep your floors free from clutter. Remove throw

rugs that may cause you to trip. Make sure you have grab bars in the bath or

shower.

8. Think about taking medicines to prevent or treat bone loss.

Talk with the doctor or nurse about the risks and benefits of medicines for

bone loss.

Act now to help her build strong bones to last a lifetime. Girls ages 9-18 are in

their critical bone-building years. Best Bones Forever!™ is a national education

effort to encourage girls ages 9-14 to eat more foods with calcium and vitamin D

and get more physical activity. There is also a Web site for the parents. This site

gives parents the tools and information they need to help their daughters build

strong bones during the critical window of bone growth — ages 9-18.

If you’re lactose intolerant, it can be hard to get enough calcium. Lactose is the

sugar that is found in dairy products like milk. Lactose intolerance means your

body has a hard time digesting foods that contain lactose. You may have

symptoms like gas, bloating, stomach cramps, diarrhea, and nausea. Lactose

intolerance can start at any age but often starts when you get older.

Lactose-reduced and lactose-free products are sold in food stores. There’s a great

variety, including milk, cheese, and ice cream. You can also take pills or liquids

before eating dairy foods to help you digest them. You can buy these pills at the

grocery store or drug store. Please note: If you have symptoms of lactose

intolerance, see your doctor or nurse. These symptoms could also be from a

different, more serious illness.

People who are lactose intolerant or who are vegans (eat only plant-based foods)

can choose from other food sources of calcium, including canned salmon with

bones, sardines, Chinese cabbage, bok choy, kale, collard greens, turnip greens,

mustard greens, broccoli, and calcium-fortified orange juice. Some cereals also

have calcium added. You can also take calcium pills. Talk to your doctor or nurse

first to see which one is best for you.

In the U.S., over two million men have osteoporosis. Men over age 50 are at

greater risk. So, keep an eye on the men in your life, especially if they are over 70

or have broken any bones.

To grow strong bones, a baby needs a lot of calcium. The baby gets his or her

calcium from what you eat (or the supplements you take). In some cases, if a

pregnant woman isn’t getting enough calcium, she may lose a little from her

bones, making them less strong. So, pregnant women should make sure they are

getting the recommended amounts of calcium and vitamin D. Talk to your doctor

about how much you should be getting.

Although bone density can be lost during breastfeeding, this loss tends to be

temporary. Several studies have shown that when women have bone loss during

breastfeeding, they recover full bone density within six months after weaning.

If you have osteoporosis, you may need to make some lifestyle changes and also

take medicine to prevent future fractures. A calcium-rich diet, daily exercise, and

drug therapy are all treatment options.

These different types of drugs are approved for the treatment or prevention of

osteoporosis:

Bisphosphonates (bis-fos-fo-nates) — Bisphosphonates are approved for

both prevention and treatment of postmenopausal osteoporosis. Drugs in this

group also can treat bone loss, and in some cases, can help build bone mass.

SERMs — A class of drugs called estrogen agonists/antagonists,

commonly referred to as selective estrogen receptor modulators (SERMs) are

approved for the prevention and treatment of postmenopausal osteoporosis.

They help slow the rate of bone loss.

Calcitonin (kal-si-TOE-nin) — Calcitonin is a naturally occurring

hormone that can help slow the rate of bone loss.

Menopausal Hormone Therapy (MHT) — These drugs, which are used to

treat menopausal symptoms, also are used to prevent bone loss. But recent

studies suggest that this might not be a good option for many women. The

Food and Drug Administration (FDA) has made the following

recommendations for taking MHT:

o Take the lowest possible dose of MHT for the shortest time to meet

treatment goals.

o Talk about using other osteoporosis medications instead.

Parathyroid Hormone or Teriparatide (terr-ih-PAR-a-tyd) — Teriparatide

is an injectable form of human parathyroid hormone. It helps the body build

up new bone faster than the old bone is broken down

Asthma

Asthma (AZ-ma) is a chronic (long-term) lung disease that inflames and narrows

the airways. Asthma causes recurring periods of wheezing (a whistling sound

when you breathe), chest tightness, shortness of breath, and coughing. The

coughing often occurs at night or early in the morning.

Asthma affects people of all ages, but it most often starts in childhood. In the

United States, more than 22 million people are known to have asthma. Nearly 6

million of these people are children.

Overview

The airways are tubes that carry air into and out of your lungs. People who have

asthma have inflamed airways. This makes the airways swollen and very

sensitive. They tend to react strongly to certain substances that are breathed in.

When the airways react, the muscles around them tighten. This causes the airways

to narrow, and less air flows to your lungs. The swelling also can worsen, making

the airways even narrower. Cells in the airways may make more mucus than

normal. Mucus is a sticky, thick liquid that can further narrow your airways.

This chain reaction can result in asthma symptoms. Symptoms can happen each

time the airways are irritated.

Asthma

Figure A shows the location of the lungs and airways in the body. Figure B shows

a cross-section of a normal airway. Figure C shows a cross-section of an airway

during asthma symptoms.

Sometimes symptoms are mild and go away on their own or after minimal

treatment with an asthma medicine. At other times, symptoms continue to get

worse. When symptoms get more intense and/or additional symptoms appear, this

is an asthma attack. Asthma attacks also are called flareups or exacerbations.

It's important to treat symptoms when you first notice them. This will help prevent

the symptoms from worsening and causing a severe asthma attack. Severe asthma

attacks may require emergency care, and they can cause death.

Outlook

Asthma can't be cured. Even when you feel fine, you still have the disease and it

can flare up at any time.

But with today's knowledge and treatments, most people who have asthma are

able to manage the disease. They have few, if any, symptoms. They can live

normal, active lives and sleep through the night without interruption from asthma.

For successful, comprehensive, and ongoing treatment, take an active role in

managing your disease. Build strong partnerships with your doctor and other

clinicians on your health care team.

Meningococcal Disease

Meningococcal disease is a potentially life-threatening bacterial infection that can

lead to meningococcal meningitis, an inflammation of the membranes surrounding

the brain and spinal cord, or meningococcal septicemia, an infection of the blood.

Meningococcal disease, caused by bacteria called Neisseria meningitidis, is the

leading cause of bacterial meningitis in older children and young adults in the

United States. It strikes 1,400 to 3,000 Americans each year and is responsible for

approximately 150 to 300 deaths.

Adolescents and young adults account for nearly 30 percent of all cases of

meningitis in the United States. In addition, approximately 100 to 125 cases of

meningococcal disease occur on college campuses each year, and five to 15

students will die as a result. Evidence shows approximately 70 to 80 percent of

cases in the college age group are caused by serogroup C, Y, or W-135, which are

potentially vaccine-preventable.

Meningococcal disease is contagious and progresses very rapidly. The bacteria are

spread person-to-person through the air by respiratory droplets (e.g., coughing,

sneezing). The bacteria also can be transmitted through direct contact with an

infected person, such as kissing.

Meningococcal bacteria attach to the mucosal lining of the nose and throat, where

they can multiply. When the bacteria penetrate the mucosal lining and enter the

bloodstream, they move quickly throughout the body and can cause damage to

various organs.

Many people in a population can be a carrier of meningococcal bacteria (up to 11

percent) in the nose and back of the throat, and usually nothing happens to a

person other than acquiring natural antibodies.

Symptoms of meningococcal disease often resemble those of the flu or other

minor febrile illness, making it sometimes difficult to diagnose, and may include

high fever, severe headache, stiff neck, rash, nausea, vomiting, fatigue, and

confusion. Students who notice these symptoms - in themselves, friends, or others

- especially if the symptoms are unusually sudden or severe, should contact their

college health center or local hospital.

If not treated early, meningitis can lead to death or permanent disabilities. One in

five of those who survive will suffer from long-term side effects, such as brain

damage, hearing loss, seizures, or limb amputation.

Meningococcal disease can affect people at any age. Infants are at the highest risk

for getting the disease. Disease rates fall through later childhood but begin to rise

again in early adolescence, peaking between the ages of 15 and 20 years.

Due to lifestyle factors, such as crowded living situations, bar patronage, active or

passive smoking, irregular sleep patterns, and sharing of personal items, college

students living in residence halls are more likely to acquire meningococcal disease

than the general college population.

Prior to 1971, military recruits experienced high rates of meningococcal disease,

particularly serotype C disease. The United States military now routinely

vaccinates new recruits. Since the initiation of routine vaccination of recruits,

there has been an 87 percent reduction in sporadic cases and a virtual elimination

of outbreaks of invasive meningococcal disease in the military.

In addition to increased risk because of crowded living situations, proximity to a

person diagnosed with disease (e.g., being a household contact) also increases

one's risk of disease. Other factors also increase risk, such as a compromised

immune system (which might be caused by HIV/AIDS or taking certain

chemotherapy or immuno-suppressants) or having no spleen. Even something as

simple as a respiratory tract infection may increase the risk of getting the disease.

Certain genetic risk factors also may increase susceptibility to infection.