2. The Itis Family Osteo Rheum Psoriatic Reactive Juvenile rheumatoid Gouty

3. 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.

4. 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 4 th -5 th decade

5. 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

6. 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

7. 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

8. 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

9. 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

13. Early ra

17. Moderate ra

18. Severe Ra

22. PAIN Biggest symptom Chronic (greater than 6 weeks) Escalating (after, with, before, at rest) Occasionally migrating Growing unresponsive to remedies Effecting ADL ’ s

23. Associated symptoms Stiffness Joint noise Heat Weakness Sleep disorder Emotional change Trigger points

24. 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

25. Time for a treat Electrical, needle Antiinflammatories- NSAID, Steroid Muscle relaxers Pain control agents Mood altering Injections- Steroids, HA DMARD’s Topicals, herbals

26. 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

27. Muscle relaxers Skelaxin Flexeril Soma

28. Narc’s Vicodin T 3 Darvocet Percocet Dilaudid Opiates

29. Mood altering SSRI’s Tricyclics Antidepressants

30. DMARD’s Disease Modifying Agents of Rheumatology Cytoxan, imuran, cyclosporine, methotrexate, leukoran, plaquenil Humira, remicade, orencia,

31. Herbal supplements Capsicum White willow bark Turmeric Ginger Devils claw Burdock Boswelia

32. Alternative supplements Omega 3 fish oil( eicosapentanoic acid, docosahexaenoic acid) Glucosamine sulfate Shark cartilage Plant based bioflavinoids (limbrel)

33. Diet no No dairy No refined sugar No intoxicants No Sweets No excess meat or protein from any source

34. 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

35. The consultants Rheumatology Physical medicine and rehabilitation Orthopedic surgeons Sportsmedicine specialists Primary care Chiropractor Naturopath

36. Hands on Physical therapist Chiropractor Massage therapist Acupuncturist Tai chi intructor Yogi Reiki therapist Reflexologist Iridologist, craniosacral therapist, ayurveda therapist

37. Counseling Nutrition / dietary Spiritual / prayer Herbalist Aromatherapy blender Naturopath Homeopath Human resources / disability

38. 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

40. Dr saguil’s shortcut Cool down Get moving Build up Get off meds (or shorter term goals) Maintain “Cut it out”

46. Be patient