Carrots ( Wortel )

Carrots  ( Wortel )
(Daucus carota, Linn.) 
Synonyms: 
Daucus carota, Linn. 
Familia: 
Apiaceae 
Description: 
Carrots (Daucus carota) is a plant grown vegetables year round.Especially in mountainous areas that have cold temperatures and moist, more or less at an altitude of 1200 meters above sea level.Carrot plants require sunlight and can grow in all seasons. Carrots have a rod in the form of a set of wet leaf midrib (leaf stalks) that arise from the base of the fruit of the top (root), like celery. Carrots prefer a loose, fertile soil. According to botanists, carrot (Daucus carota) can be divided into several types, including: CARROT (Daucus carota, Linn.) - The type of imperator, the carrot that has a root length with tapered ends and taste less sweet. - Chantenang types, namely carrot root having elliptic and sweet. - Type of Mantes, namely the combination of types of carrot carrots and chantenang imperator. Tuber roots typical orange-colored carrots. 

Local Name: 
Carrot (UK), Carotte (French), carrot (Netherlands); Wortel (Indonesia), Bortol (Sunda), Carrots, Ortel (Madura); Carrots, Wortol, Wertol, Wertel, Bortol (Java); 
Composition: 
CHEMICAL CONTENT: Carrots (Daucus carota) has the value of a high content of Vitamin A that is equal to 12 000 SI. While the composition of the content of another element is the calories by 42 calories, 1.2 grams protein, 0.3 grams fat, 9.3 grams carbohydrate, 39 milligrams calcium, 37 milligrams phosphorus, 0.8 milligrams iron, vitamin B 1 0, 06 milligrams, and vitamin C 6 milligrams. The above composition is measured per 100 grams. 
Curable Disease: 
Seizures Heart, Eczema, pinworms, Eye minus; 
Utilization: 
1. Angina pectoris 
    Material: roots of carrots, 2 tablespoons honey, and a piece of palm sugar; 
    Method: carrots grated and squeezed with 2 cups of water, 
    then is mixed with other ingredients until evenly distributed; 
    How to use: drink 1 a day. 
2. Eczema 
    a. Ingredients: 1 bulb carrot and 1 teaspoon of whiting; 
       Method: carrots grated and mixed with whiting 
       until evenly distributed; 
       How to use: affixed on the sick and 
       wrapped with bandages. 
    b. Ingredients: 3 carrots tubers; 
       Method: grated and brewed with 2 cups cooking water; 
       How to use: drink 2 times a day. 
3. Pinworms 
    Ingredients: 5-7 tubers carrots, coconut milk and salt to taste; 
    Method: grated carrots, then added with materials 
    other; 
    How to use: squeezed and filtered, then taken 
    bedtime. 

4. Mata Minus 
    Ingredients: carrot tubers taste; 
    Method: grated and squeezed to take water; 
    How to use: drink every morning regularly. 

Dangers of Child Obesity

Dangers of Child Obesity
By James Rouse

The child obesity epidemic and the dangers of childhood obesity are at the forefront of many health professionals discussion groups. The reason for this is the long lasting psychological and physical effects that children have to endure.

It's hard enough that they have to deal with the extra weight but not being able to participate in as many activities as the other kids affects them emotionally. What we don't see is their deep seeded pain.

Our first action in dealing with childhood obesity is a physical one. We want to help them look better. It is presumed that if they look better they will naturally feel better. This is true in many cases.

As they start to emotionally feel more accepted by their peers their self esteem improves. The problem is once they do start to look better, and they will if they get proper nutrition and exercise, is it may be too late. Has the physical dangers of childhood obesity been too much for their bodies to handle?

Dealing With An Adult Disease

Type 2 diabetes has for years been an adult disease that in most cases wasn't diagnosed until the later in life. It has become one of the biggest dangers of childhood obesity in recent years.

Type 2 diabetes is a non insulin dependent disease that is difficult to treat. In some cases it can lead to being insulin dependent.

Cardiovascular disease

Overweight and obese children are at a greater risk of contracting Cardiovascular disease later in life. The older the children are, the greater the risk is. In other words an obese teen is more likely to have a cardiovascular disease in adulthood than an obese pre-teen.

Sleep Apnea

Sleep apnea is a disorder when breathing is interrupted by blocked airway passages resulting in poor sleep quality. Obese children with sleep apnea will experience daytime fatigue, problems in school, and have a tendency to be hyperactive.

Osteoporosis

The development of bone mass during the growing years is essential. Children with a higher body fat percentage may be at risk of developing osteoporosis as adults. The reason for this is children who have more body fat have less bone mass.

Interestingly though is that adults who are heavy and have already built stronger bones from carrying the excess weight are at a lower risk of developing osteoporosis. The opposite is true for children. Their bone development is compromised.

Other dangers of childhood obesity worth noting are cancer, asthma and hypertension. In more severe cases: gall bladder disease, liver disease, and high cholesterol.

Evaluating all the dangers of childhood obesity is a difficult process. There are variables that need to be considered such as environmental and genetic issues which is why it needs to be done on an individual basis.

One of the biggest dangers of childhood obesity is the psychological effects that have occurred. With proper nutrition, exercise, and a diet plan we can treat childhood obesity. We all hope once the weight issue is under control and their self esteem has been restored that they live long, happy, and healthy lives

Health Benefits Of Tomatoes

Health Benefits Of Tomatoes
by: Tim Sousa

Did you know that tomatoes were once considered poison? It's true, the tomato is a member of the nightshade family, and was at one time considered to be toxic.

Tomatoes were first eaten in the U.S. in the early 1800's, when a gentleman by the name of Robert Johnson shocked his hometown by eating a basket of tomatoes in the middle of town. When he didn't die, or even get sick from the tomatoes, they became a part of the American diet.

We now know that tomatoes are not toxic, and in fact are quite nutritious. First of all, tomatoes contain a lot of vitamin C, which is quite beneficial, as you've probably heard.

Vitamin C helps the body to produce collagen, an important protein skin, scar tissue, tendons, ligaments, and blood vessels. Vitamin C is also an antioxidant, helping to prevent cell damage by free radicals.

Tomatoes also contain a powerful antioxidant called lycopene. Studies have shown that men consuming 10 servings of tomatoes a week cut the risk of prostate cancer by 45%. Lycopene also lower the risk of colorectal cancer and stomach cancer, and inhibits the growth of other types of cancer cells. Lycopene may also help older folks remain active.

Coumaric acid and chlorogenic acied are also found in tomatoes. These two compounds are thought to block the effects of nitrosamines, which are formed naturally in the body, but are also a strong carcinogen in tobacco smoke.

Tomatoes may also help to reduce the risk of heart disease. Tomatoes are a good source of potassium, niacin, vitamin B6, and folate. Niacin has been used for years to lower cholesterol. Potassium has been shown to lower high blood pressure. And vitamin B6 and folate are used by the body to convert a dangerous chemical called homocysteine into more benign compounds.
Vitamin K, found in tomatoes helps to maintain healthy bones. Vitamin K1 activates a protein in the bones called osteocalcin, which anchors calcium inside the bone. Without enough vitamin K, bone mineralization is impaired.

When you buy tomatoes, be sure to buy the ones with the brightest red color. This indicates high amounts of beta-carotene and lycopene. Lycopene is found in the cell walls of the tomato, so by cooking it in a bit of oil, more lycopene is fully released.

Also, cooking the tomato in a bit of olive oil helps your body to absorb the lycopene. If all you can find are canned tomatoes, that's fine. Cooking and canning don't cause tomatoes to lose any of their nutritional value. So cooked and processed tomatoes are just as beneficial as fresh tomatoes

SAMBILOTO : NATURE’S GIFT OF HEART ATTACK PREVENTION AND INFLAMMATION ERADICATION

The Secret to overcoming the Silent Epidemic that’s destroying your Health What Is It? Andrographis paniculata is known in Indonesia as Sambiloto which is the name used in Jamu - Indonesian traditional medicine - and will be used throughout this article. It is also known commonly as "King of Bitters," and is a member of the plant family Acanthaceae. The plant is an annual. It is branched, erect growing up to 1 meter in height. The leaves and stems of the plant are used to extract the active phytochemicals. It grows abundantly in southeastern Asia: Indonesia, India (and Sri Lanka), Pakistan and it is cultivated extensively in China and Thailand. It grows best in the tropical and sub-tropical areas of the world. It is normally grown from seeds, and is ubiquitous in its native areas: it grows in forest areas, and along roads and in villages. Because of its well-known medicinal properties, in Indonesia it is also commonly cultivated. It grows easily in all types of soil. In fact, it grows in poor soil types where almost no other plant can be cultivated. Chemical Properties  The primary medicinal component of Andrographis is andrographolide. It has a very bitter taste, is a colorless crystalline in appearance, and is called a "diterpene lactone". The other medicinal chemicals are also bitter principles: diterpenoids viz. deoxyandrographolide, -19ß-D-glucoside, and neo-andrographolide, all of which have been isolated from the leaves. Besides the related bitters mentioned, other active components include 14-deoxy-11,12- didehydroandrographolide (andrographlide D), homoandrographolide, andrographan, andrographon, andrographosterin, and stigmasterol - the last of which was isolated from an Astrographis preparation. The leaves contain the highest amount of andrographolide (2.39%), the most medicinally active phytochemical in the plant, while the seeds contain the lowest. What Is It Used For?  Sambiloto has been used for centuries in Asia and continues to be used today in Indonesia as a medicinal herb, to treat gastro-intestinal tract and upper respiratory infections, fever, herpes, sore throat, and a variety of other chronic and infectious diseases. It is found in several different medical traditions including Indian Ayurvedic medicine. As a preventive of heart attack, the powerful effect of “clot busting” is a significant benefit, especially for people in stressful occupations and those who are overweight, have little exercise, and are generally followers of the “Western Lifestyle”. Some practitioners have suggested a daily dose of aspirin for this purpose, but information is steadily accumulating about the serious negative side effects of such a drug regime. Macular degeneration (blindness), cataracts, gastro intestinal bleeding and even increased incidence of strokes and heart attacks as a result of asprin taking are now documented in authoritative Journals like the British Medical Journal and Opthalmology (reference 30, 31). In traditional Chinese medicine it is an important "cold property" herb, used to rid the body of heat, as in fevers, and to dispel toxins from the body. This alone is a major benefit in protecting against Western “Lifestyle diseases”. In Scandinavian countries, it is still commonly used to prevent and treat common colds. Research conducted since the '80's has confirmed that Sambiloto, properly administered, is a broad spectrum herb and has a surprisingly wide range of pharmacological effects, some of them extremely beneficial: BENEFITS   1) Analgesic: pain killer. 2) Anti-hyperglycaemic: has a blood glucose lowering effect. 3) Anti-inflammatory: reduces swelling and cuts down exudation from capillaries, anti-inflammatory action probably mediated, in part, by adrenal function.  4) Antibacterial: fights bacterial activity, although Sambiloto appears to have weak direct antibacterial action, it has remarkably beneficial effect in reducing diarrhea and symptoms arising from bacterial infections.  5) Antimalarial: prophylactic properties prevent infection and parasite multiplication in the blood stream. 6) Antihepatotoxic: eliminates liver toxins, such as products of alcohol consumption. 7) Antipyretic: fever reducer - both in humans and animals, caused by multiple infections or by toxins.  8) Antithrombotic: blood clot preventative. This is where the prevention of heart attack comes in.  9) Antiviral: inhibits viral activity. Inhibits HIV replication. 10) Antioxidant: operates against free radicals. 11) Cancerolytic: fights, even kills, cancer cells. 12) Cardioprotective: protects heart muscles. 13) Choleretic: alters the properties and increases the flow of bile.  14) Depurative: cleans and purifies the system, particularly the blood. 15) Expectorant: promotes clearance of mucus from the respiratory system. 16) Hepatoprotective: protects the liver and gall bladder. 17) Hypoglycemic: blood sugar reducer, protective against diabetes. 18) Immune Enhancer: increases white cell phagocytosis, inhibits HIV-1 replication, and improves CD4+ and T lymphocyte counts. 19) Thrombolytic: blood clot eliminator. 20) Vermicidal: kills intestinal worms. But it is primarily for the magnificent heart and cardio vascular protectant properties, and its anti inflammatory qualities that Sambiloto in the cabinet of the five best herbs in the world for followers of the Western Lifestyle. It also shows strong Liver protection and healing properties (hepatoprotective and antihepatotoxic), which adds to the protection given by Curcuma. These liver benefits are particularly valuable for people who consume alcohol on a regular basis. Cardiovascular Benefits – Prevents Heart Attack and Thrombosis   Hardening of the arteries, a buildup of plaque (made up of calcium and fats) on the blood vessel walls, seems to be a result of the Western lifestyle. It is often associated with high fat diets, high cholesterol, and a variety of other risk factors. Many of these factors, like the stress that many of us experience every day, seem to be unavoidable. Often, a piece of the artery wall plaque breaks off, forms a clot, and this results in an artery being blocked. As a result, our hospitals are full of patients undergoing surgery for cardiovascular procedures. The standard techniques are angioplasty and bypass surgery. Both of these are often a result of a cardiac emergency, from which many people die. Those who are lucky enough to survive, or who detect the growing blockages before it’s too late may need urgent surgical intervention to save their lives. Angioplasty is used to clear blocked blood vessels (usually arteries). A balloon is inserted into the artery and then inflated to clear away fatty deposits, widen the artery, and improve blood flow. The second treatment for coronary artery obstructions is bypass surgery. A new vein taken from another part of the body, from an animal, or a synthetic, replaces the obstructed artery. Today, angioplasty and bypass surgery are routine, with about 800,000 such procedures done in the United States each year. But unfortunately these treatments are not a cure-all. With angioplasty, restricted blood flow recurs in 30 percent of patients within six months; 50 percent of patients will require a repeat procedure. Many of these patients eventually require bypass surgery, which is successful in only 50 to 65% of cases. Clot-dissolving drugs used in the emergency treatment of heart attacks appear to be as effective as angioplasty and may prevent some of the heart attacks or strokes that occur within one month of angioplasty. The process of blood clotting in the body is not yet fully understood. There is a delicate balance between the clotting necessary to achieve healing and processes that will cause abnormal and unwanted clotting. Some research to understand the signals involved in bleeding and blood vessel development is focused on making use of signal transduction technology, which has been shown to be the mechanism of the active ingredients of Sambiloto. This is the key to its protective mechanism. It has been demonstrated that extracts of Sambiloto can increase the time it takes for blood clots to form, which decreases the risk of subsequent closing of blood vessels seen after angioplasty procedures. This has been shown in studies with laboratory animals (Reference 24). In 80 to 90% of patients with destroyed heart muscle resulting from an acute myocardial infarction (heart attack), clots are found in the heart shortly after the beginning of symptoms. When heart muscle is deprived of its blood supply, and therefore of oxygen, the tissue dies. Physicians believe that the best treatment is to limit the size of the myocardial infarction (the area of tissue damage) in order to preserve the pump function of the heart. Agents that dissolve the clots and increase blood flow through the blocked artery are constantly being sought. Sambiloto is being further researched to confirm its potential to be a part of the conventional medical treatment in such cases. Researchers in China have demonstrated that Sambiloto extract given to laboratory dogs one hour after development of heart attack decreased the damage that occurred to the heart muscle (Reference 12). This damage occurs after the blood supply is restored to the muscle. This is due to a sudden influx of oxygen (which produces free radicals that damage tissue) and abnormally high amounts of calcium. The researchers also found that further clotting was reduced, damage to heart muscle was reduced, and the healing process was enhanced. Anti-Hypertensive (High Blood Pressure)   Another way to prevent cardiovascular disease is to correct high blood pressure. Researchers have reported that an extract of Sambiloto produced antihypertensive (blood pressure lowering) effects (reference 26). The extract was given intravenously to hypertensive rats. Noradrenaline, a hormone secreted by the brain, acts to constrict blood vessels and increase heart rate, blood pressure, and blood sugar levels. Sambiloto extract inhibited the increase in blood pressure that is caused by noradrenaline. Researchers believe that Sambiloto has this antihypertensive effect because it relaxes the smooth muscle in the walls of blood vessels. This relaxation prevents the blood vessel from constricting and limiting blood flow to the heart, brain, and other organs in the body. Sambiloto keeps blood, and therefore oxygen, flowing to the brain. Diminished blood flow to the brain can cause short-term memory loss, ringing in the ears, dizziness, headaches, depression, and impaired mental performance. Liver & Gallbladder Protection   Sambiloto’s four related medicinal compounds were tested for a protective effect against liver toxicity (hepatotoxicity) produced in mice by giving them carbon tetrachloride (a cleaning solvent), alcohol, or other toxic chemicals (Reference 14, 16). These chemicals damage the liver by causing lipid peroxidation. This is a process whereby free radicals produced by the chemical attack and destroy cellular membranes that surround liver cells. When the Sambiloto compounds were given to animals in two separate trials three days before the toxic chemicals, there was a significant protective effect in the liver. This effect was attributed to the antioxidant ability of the Sambiloto compounds. This is a significant finding for followers of the Western lifestyle, which often involves high consumption of alcohol, which is a liver toxin with serious consequences taken over the long term. In another study, andrographolide from Sambiloto was shown to produce a significant increase in bile flow (Reference 32) . Bile is produced in the liver and stored in the gallbladder and aids in digestion. When a chemical, paracetamol, was given to animals pretreated with Sambiloto, the usual decrease in bile production seen with this chemical was prevented. In this case Sambiloto was more potent than Silymarin, another similar but inferior herb. Infective hepatitis is an acute inflammatory condition of the liver. It is often followed by liver cirrhosis and may progress to a coma and death. In Indonesia, there is much anecdotal evidence to confirm that Sambiloto is an effective cure for Hepatitis, particularly when taken in combination with Curcuma. Other indications of effectiveness of Sambiloto included improvement in liver function tests, and many recorded cases of hepatitis cures in Indonesian literature. The andrographolides present in Sambiloto are potent stimulators of gallbladder function. In animal experiments, those that received andrographolides for seven consecutive days showed an increase in bile flow, bile salts, and bile acids. These increases are beneficial and result in enhanced gallbladder function. Use of Sambiloto is therefore likely to decrease the probability of gallstone formation and also aid fat digestion. The andrographolides also prevented decreases in the amount of bile that are caused by acetaminophen toxicity (Reference 33). Immunological Benefits: Cancer   Studies using laboratory animal models have shown that Sambiloto is a potent stimulator of the immune system in two ways: (1) Antigen-specific response: antibodies are made to counteract invading microbes, and (2) Nonspecific immune response: macrophage cells scavenge and destroy invaders. Sambiloto activates both responses - making it effective against a variety of infectious and cancer-causing agents (Reference 35). The mechanisms of effective treatment from Sambiloto are rooted in its effects in boosting immunity. Cancer results when cells do not respond to signals that are intended to limit growth. When cells develop normally, at each stage of development the cells become more specialized in order to be able to perform the duties of that particular cell. For example, cells that will make insulin will develop the cellular machinery to do so. When cancer upsets normal development, cells do not mature -- they more closely resemble immature body cells. The more they resemble immature cells, the more unfavorable the outcome: the cancer grows and spreads (metastasizes) more rapidly. Sambiloto has been shown to cause cancer cell maturity or differentiation, thus breaking the cancer proliferation. In addition Sambiloto extracts have also been shown to be cytotoxic (cell-killing) against cancer cells in laboratory work. This cancer cell-killing ability was demonstrated against human epidermoid carcinoma (squamous cell carcinoma) of the skin lining of the nasopharynx and against lymphocytic leukemia cells (Reference 13,14). It was the andrographolide component that was found to have the cancer cell-killing ability. This ability to kill cancer cells was superior to the levels of the effectiveness recommended by the National Cancer Institute for a cytotoxic substance. Effect of Sambiloto on Lyme disease   There are evidences for curing other spirochetal infections such as Leptospirosis through treatment using herbs like Sambiloto. Extract of this herb, in the form of an injection or tablets of the crude extract or of the isolated lactones, was reported to effectively treat leptospirosis. In one evaluation, 31 of 35 cases were said to be cured by the Andrographis lactones. There are people who had used Sambiloto treating the Lyme disease (Sambiloto is the best all around herb for Lyme!).  Anti-Oxidant and Antihyperglycaemic (Blood Sugar) Benefits   Studies conducted in Singapore in 2000 showed Sambiloto to be an effective anti-oxidant in laboratory animal trials (Reference 20). It was also shown by the same work to be anti-hyperglycaemic in diabetic animals, and important sugar regulating effect. More recent research in China (in 2002) has also shown that Sambiloto prevents formation of oxygen radicals in an inflammatory response in laboratory animals (Reference 23). Scavenging of free radicals, the powerful effect we are looking for was confirmed in some research in USA, also in 2002 (Reference 1). Screening of antihyperglycaemic activity in of several herbs in Malaysia in 2004 showed that Sambiloto produced significant reduction in blood concentrations of sugar, and the most significant results of the herbs screened (Reference 7). This is a magnificent confirmation of the anti-diabetic properties of Sambiloto. Anti HIV   Work has continued to show strong promise as a treatment for HIV infection. As early as 1991, Sambiloto was shown in some laboratory testing in California, USA to be effective in preventing HIV virus from reproducing (Reference 11). In 2000 work with human volunteers in Washington USA showed that the bodies natural defense mechanisms were enhanced when Sambiloto was administered, in the absence of the retroviral drugs usually used in HIV patients. The patients showed no increase in HIV virus during the trial, indicating that the virus was unable to multiply (Reference 21). More research is continuing, but we believe, in line with the antiviral benefits that Sambiloto has shown in trials and over hundreds of years in traditional medicine records, that it will prove to be a valuable inclusion in the fight against AIDS. Anti-fertility   Sambiloto has clear anti-fertility as well as pregnancy-terminating effects in larger amounts. In India, where Sambiloto is used for common ailments such as diarrhea, fever, and other digestive disorders, it is recommended that the herb be used only for short-term treatment. This is due to the content of compounds that are contraceptive in nature. The authors of the study done on the rats concluded that the observations suggested an antispermatogenic (sperm production blocking) or antiandrogenic (blocking effects of sex hormones known as androgens) ability of the plant. It should be noted that many herbal extracts have effects on reproductive functions and thus should not be used during pregnancy (Reference 10, 29). Known Mechanisms of Action   Sambiloto (Andrographis paniculata) has been extensive studied, most of it in the last half of the 20th century, and much of it concentrating on Sambiloto’s pharmacological composition, safety, efficacy, and mechanisms of action. A good deal of this research has centered around a screening technique called signal transduction technology - probably best explained in a seminal work by Jean Barilla, M.S.(Reference 34): ”One of the criticisms made by the conventional medical and scientific community regarding dietary supplements is that their development and use have been based on folklore, not science. Using signal transduction technology to investigate the effect on a botanical or other nutrition supplement on the cell-level processes of cells is good science. This approach will legitimize the nutritional approach to the prevention and treatment of disease and speed the process of development of new and more effective supplements. Importantly, this technology avoids the use of animal testing, which often lasts for years before a supplement is approved for human use; not using animals is an additional benefit those who consider animal testing to be inhumane. In addition to saving time and animals, this technology reduces the costs involved in getting a supplement to market - a saving which will be passed on to consumers. “Using signal transduction technology, extracts of Andrographis paniculata (Sambiloto) have been found to counteract interference with the cell cycle. Such interference is the basis for the development of cancer or infection with viruses such as HIV. Andrographolides are thought to enhance immune system functions such as production of white blood cells (scavengers of bacteria and other foreign matter), release of interferon, and activity of the lymph system. Interferon is a protein (called a cytokine) made by cells in response to viruses. It is a potent antiviral agent and is also antiproliferative (stops the reproduction of viruses). The lymph system is an important part of the immune system. Briefly, it is another circulatory system (like the vascular system) that carries a fluid, the lymph. The lymph carries away the by-products of cellular metabolism and also acts as a shuttle for invading bacteria and viruses, taking them to the lymph nodes where the white blood cells (lymphocytes) destroy them. Sambiloto, a superb immune system enhancer, is even more effective when combined with immune stimulators, such as the herb Meniran. The theory behind the mechanism of operation also confirms that Andrographolides are also likely to be useful in conventional cancer therapy after suitable scientific confirmation. Several studies have looked at the disposition of andrographolide in various organs of the body (Reference 37). Biodistribution experiments have been done in experimental animals. Following injection of radioactively labeled andrographolide, this compound appears to be widely distributed in the body. High concentrations are noted in the central nervous system (brain and spinal cord) and other organs with high blood flow, including the colon, spleen, heart, lungs, and kidneys. Andrographolide appears to have a relatively short half-life of approximately two hours. The term "half-life" refers to the time when the concentration of the compound in the body is half of what it originally was when it entered the body. This is what is left after the compound has been metabolized (broken down), changed into other forms (called metabolites), and excreted by one of several routes (urine, feces, exhaled air, sweat, or other body excretions). Compounds with short half-lives need to be given often since they do not stay in the body for long. Andrographolides are excreted fairly rapidly from the body via the urine and gastrointestinal tract. In some studies, 80 percent of the administered dose of andrographolide is removed from the body within eight hours, with excretion rates of more than 90 percent of the compound within forty-eight hours. A daily dose is needed for effectiveness. The wide tissue and organ distribution and the immune-stimulating and regulatory actions of Sambiloto make it an ideal candidate in the prevention and treatment of many diseases and conditions.

Breast cancer

Breast cancer

Breast cancer (malignant breast neoplasm) is cancer originating from breast tissue, most commonly from the inner lining of milk ducts or the lobules that supply the ducts with milk.  Cancers originating from ducts are known as ductal carcinomas; those originating from lobules are known as lobular carcinomas.

The size, stage, rate of growth, and other characteristics of the tumor determine the kinds of treatment. Treatment may include surgery, drugs (hormonal therapy and chemotherapy), radiation and/or immunotherapy.  Surgical removal of the tumor provides the single largest benefit, with surgery alone being capable of producing a cure in many cases. To somewhat increase the likelihood of long-term disease-free survival, several chemotherapy regimens are commonly given in addition to surgery. Most forms of chemotherapy kill cells that are dividing rapidly anywhere in the body, and as a result cause temporary hair loss and digestive disturbances. Radiation may be added to kill any cancer cells in the breast that were missed by the surgery, which usually extends survival somewhat, although radiation exposure to the heart may cause heart failure in the future.  Some breast cancers are sensitive to hormones such as estrogen and/or progesterone, which makes it possible to treat them by blocking the effects of these hormones.

Prognosis and survival rate varies greatly depending on cancer type and staging. With best treatment and dependent on staging, 5-year relative survival varies from 98% to 23, with an overall survival rate of 85%.

Worldwide, breast cancer comprises 22.9% of all non-melanoma skin cancers in women.In 2008, breast cancer caused 458,503 deaths worldwide (13.7% of cancer deaths in women). Breast cancer is more than 100 times more common in women than breast cancer in men, although males tend to have poorer outcomes due to delays in diagnosis.

Classification

Breast cancers can be classified by different schemata. Every aspect influences treatment response and prognosis. Description of a breast cancer would optimally include multiple classification aspects, as well as other findings, such as signs found on physical exam. Classification aspects include stage (TNM), pathology, grade, receptor status, and the presence or absence of genes as determined by DNA testing:

Stage. The TNM classification for breast cancer is based on the size of the tumor (T), whether or not the tumor has spread to the lymph nodes (N) in the armpits, and whether the tumor has metastasized (M) (i.e. spread to a more distant part of the body). Larger size, nodal spread, and metastasis have a larger stage number and a worse prognosis.

The main stages are:

Stage 0 is a pre-cancerous or marker condition, either ductal carcinoma in situ (DCIS) or lobular carcinoma in situ (LCIS).

Stages 1–3 are defined as 'early' cancer with a good prognosis.

Stage 4 is defined as 'advanced' and/or 'metastatic' cancer with a poor prognosis.

Histopathology. Breast cancer is usually classified primarily by its histological appearance. Most breast cancers are derived from the epithelium lining the ducts or lobules, and these cancers are classified as ductal or lobular carcinoma. Carcinoma in situ is growth of low grade cancerous or precancerous cells in particular tissue compartment such as the mammary duct without invasion of the surrounding tissue. In contrast, invasive carcinoma does not confine itself to the initial tissue compartment and invades the surrounding tissue.

Grade (Bloom-Richardson grade). When cells become differentiated, they take different shapes and forms to function as part of an organ. Cancerous cells lose that differentiation. In cancer grading, tumor cells are generally classified as well differentiated (low grade), moderately differentiated (intermediate grade), and poorly differentiated (high grade). Poorly differentiated cancers have a worse prognosis.

Receptor status. Cells have receptors on their surface and in their cytoplasm and nucleus. Chemical messengers such as hormones bind to these receptors, and this causes changes in the cell. Breast cancer cells may or may not have three important receptors: estrogen receptor (ER), progesterone receptor (PR), and HER2/neu.

ER+ cancer cells depend on estrogen for their growth, so they can be treated with drugs to block estrogen effects (e.g. tamoxifen), and generally have a better prognosis.

HER2+ breast cancer had a worse prognosis,  but HER2+ cancer cells respond to drugs such as the monoclonal antibody, trastuzumab, (in combination with conventional chemotherapy) and this has improved the prognosis significantly.  Cells with none of these receptors are called basal-like or triple negative.

DNA assays of various types including DNA microarrays have compared normal cells to breast cancer cells. The specific changes in a particular breast cancer can be used to classify the cancer in several ways, and may assist in choosing the most effective treatment for that DNA type.

Signs and symptoms

Breast cancer showing an inverted nipple, lump, skin dimpling

The first noticeable symptom of breast cancer is typically a lump that feels different from the rest of the breast tissue. More than 80% of breast cancer cases are discovered when the woman feels a lump. The earliest breast cancers are detected by a mammogram. Lumps found in lymph nodes located in the armpits  can also indicate breast cancer.

Indications of breast cancer other than a lump may include changes in breast size or shape, skin dimpling, nipple inversion, or spontaneous single-nipple discharge. Pain ("mastodynia") is an unreliable tool in determining the presence or absence of breast cancer, but may be indicative of other breast health issues.

Inflammatory breast cancer is a special type of breast cancer which can pose a substantial diagnostic challenge. Symptoms may resemble a breast inflammation and may include pain, swelling, nipple inversion, warmth and redness throughout the breast, as well as an orange-peel texture to the skin referred to as peau d'orange.

Another reported symptom complex of breast cancer is Paget's disease of the breast. This syndrome presents as eczematoid skin changes such as redness and mild flaking of the nipple skin. As Paget's advances, symptoms may include tingling, itching, increased sensitivity, burning, and pain. There may also be discharge from the nipple. Approximately half of women diagnosed with Paget's also have a lump in the breast.

In rare cases, what initially appears as a fibroadenoma (hard movable lump) could in fact be a phyllodes tumor. Phyllodes tumors are formed within the stroma (connective tissue) of the breast and contain glandular as well as stromal tissue. Phyllodes tumors are not staged in the usual sense; they are classified on the basis of their appearance under the microscope as benign, borderline, or malignant.

Occasionally, breast cancer presents as metastatic disease, that is, cancer that has spread beyond the original organ. Metastatic breast cancer will cause symptoms that depend on the location of metastasis. Common sites of metastasis include bone, liver, lung and brain. Unexplained weight loss can occasionally herald an occult breast cancer, as can symptoms of fevers or chills. Bone or joint pains can sometimes be manifestations of metastatic breast cancer, as can jaundice or neurological symptoms. These symptoms are "non-specific", meaning they can also be manifestations of many other illnesses.

Most symptoms of breast disorder do not turn out to represent underlying breast cancer. Benign breast diseases such as mastitis and fibroadenoma of the breast are more common causes of breast disorder symptoms. The appearance of a new symptom should be taken seriously by both patients and their doctors, because of the possibility of an underlying breast cancer at almost any age.

Risk factors

The primary risk factors for breast cancer are sex,  age,lack of childbearing or breastfeeding, higher hormone levels,  race, economic status and dietary iodine deficiency.

Most cases of breast cancer cannot be prevented through any action on the part of the affected person. The World Cancer Research Fund estimated that 38% of breast cancer cases in the US are preventable through reducing alcohol intake, increasing physical activity levels and maintaining a healthy weight.  It also estimated that 42% of breast cancer cases in the UK could be prevented in this way, as well as 28% in Brazil and 20% in China.

Smoking tobacco also increases the risk of breast cancer with the greater the amount smoking and the earlier in life smoking begins the higher the risk.

In a study of attributable risk and epidemiological factors published in 1995, later age at first birth and not having children accounted for 29.5% of U.S. breast cancer cases, family history of breast cancer accounted for 9.1% and factors correlated with higher income contributed 18.9% of cases. Attempts to explain the increased incidence (but lower mortality) correlated with higher income include epidemiologic observations such as lower birth rates correlated with higher income and better education, possible overdiagnosis and overtreatment because of better access to breast cancer screening, and the postulation of as yet unexplained lifestyle and dietary factors correlated with higher income. One such factor may be past hormone replacement therapy, which was typically more widespread in higher income groups.

The genes associated with hereditary breast-ovarian cancer syndromes usually increase the risk slightly or moderately; the exception is women and men who are carriers of BRCA mutations. These people have a very high lifetime risk for breast and ovarian cancer, depending on the portion of the proteins where the mutation occurs. Instead of a 12 percent lifetime risk of breast cancer, women with one of these genes have a risk of approximately 60 percent.

In more recent years, research has indicated the impact of diet and other behaviors on breast cancer. These additional risk factors include a high-fat diet, alcohol intake, obesity, and environmental factors such as tobacco use, radiation, endocrine disruptors and shiftwork. Although the radiation from mammography is a low dose, the cumulative effect can cause cancer.

In addition to the risk factors specified above, demographic and medical risk factors include:

Personal history of breast cancer: A woman who had breast cancer in one breast has an increased risk of getting a second breast cancer.

Family history: A woman's risk of breast cancer is higher if her mother, sister, or daughter had breast cancer, the risk becomes significant if at least two close relatives had breast or ovarian cancer. The risk is higher if her family member got breast cancer before age 40. An Australian study found that having other relatives with breast cancer (in either her mother's or father's family) may also increase a woman's risk of breast cancer and other forms of cancer, including brain and lung cancers.

Certain breast changes: Atypical hyperplasia and lobular carcinoma in situ found in benign breast conditions such as fibrocystic breast changes are correlated with an increased breast cancer risk.

Those with a normal body mass index at age 20 who gained weight as they aged had nearly double the risk of developing breast cancer after menopause in comparison to women who maintained their weight. The average 60-year-old woman's risk of developing breast cancer by age 65 is about 2 percent; her lifetime risk is 13 percent.

Prevention

Exercise may decrease breast cancer risk. Also avoiding alcohol and obesity. Prophylactic bilateral mastectomy may be considered in patients with BRCA1 and BRCA2 mutations.A 2007 report concluded that women can somewhat reduce their risk by maintaining a healthy weight, drinking less alcohol, being physically active and breastfeeding their children.

Kidney stones

Kidney stones
Kidney stones (called renal calculi (from Latin ren, renes, "kidney" and calculi, "pebbles" in medical parlance) are solid concretions or crystal aggregations formed in the kidneys from dietary minerals in the urine. Kidney stones are typically classified by their location in the kidney (nephrolithiasis), ureter (ureterolithiasis), or bladder (cystolithiasis), or by their chemical composition (calcium-containing, struvite, uric acid, or other compounds). Kidney stones are a significant source of morbidity. 80% of those with kidney stones are men. Men most commonly experience their first episode between age 30–40 years, while for women the age at first presentation is somewhat later.
Kidney stones typically leave the body by passage in the urine stream, and many stones are formed and passed without causing symptoms. If stones grow to sufficient size (usually at least 2–3 millimeters), they can cause obstruction of the ureter. Ureteral obstruction causes postrenal azotemia and hydronephrosis (distension and dilation of the renal pelvis and calyces), as well as spasm of the ureter. This leads to pain, most commonly felt in the flank, lower abdomen and groin (a condition called renal colic). Renal colic can be associated with nausea, vomiting, fever, blood in the urine, pus in the urine, and painful urination. Renal colic typically comes in waves lasting 20 to 60 minutes, beginning in the flank or lower back and often radiating to the groin or genitals. The diagnosis of kidney stones is made on the basis of information obtained from the history, physical examination, urinalysis, and radiographic studies. ultrasound examination and blood tests may also aid in the diagnosis.
When a stone causes no symptoms, watchful waiting is a valid option. For symptomatic stones, pain control is usually the first measure, using medications such as non-steroidal anti-inflammatory drugs (NSAIDs) or opioids. More severe cases may require surgical intervention. For example, some stones can be shattered into smaller fragments using extracorporeal shock wave lithotripsy (ESWL). Some cases require more invasive forms of surgery. Examples of these are cystoscopic procedures such as laser lithotripsy, or percutaneous techniques such as percutaneous nephrolithotomy. Sometimes, a tube may be placed in the ureter (a ureteral stent) to bypass the obstruction in the ureter and alleviate the symptoms.

Classification
Kidney stones are typically classified by their location or their chemical composition.
Location

Urolithiasis refers to stones originating anywhere in the urinary system, including the kidneys and bladder. Nephrolithiasis (from Greek νεφρός (nephros, "kidney") and λίθoς (lithos, "stone")) refers to the presence of such calculi in the kidneys. Calyceal) calculi refers to aggregations in either the minor or major calyx, parts of the kidney which pass urine into the ureter (the tube connecting the kidneys to the urinary bladder). The condition is called ureterolithiasis when a calculus or calculi are located in the ureter. Stones may also form or pass into the bladder, a condition referred to as cystolithiasis.

Chemical composition
By far the most common type of kidney stones worldwide are those which contain calcium. For example, calcium-containing stones represent about 80% of all cases in the United States; these typically contain calcium oxalate either alone or in combination with calcium phosphate in the form of apatite or brushite. Factors that promote the precipitation of oxalate crystals in the urine, such as primary hyperoxaluria, are associated with the development of calcium oxalate stones. The formation of calcium phosphate stones is associated with conditions such as hyperparathyroidism and renal tubular acidosis.
Struvite stones
About 10–15% of urinary calculi are composed of struvite (ammonium magnesium phosphate, NH4MgPO4•6H2O). Struvite stones (also known as "infection stones", urease or triple-phosphate stones), form most often in the presence of infection by urea-splitting bacteria. Using the enzyme urease, these organisms metabolize urea into ammonia and carbon dioxide. This alkalinizes the urine, resulting in favorable conditions for the formation of struvite stones. Proteus mirabilis, Proteus vulgaris and Morganella morganii are the most common organisms isolated; less common organisms include Ureaplasma urealyticum, and some species of Providencia, Klebsiella, Serratia, and Enterobacter. These infection stones are commonly observed in people who have factors which predispose them to urinary tract infections, such as those with spinal cord injury and other forms of neurogenic bladder, ileal conduit urinary diversion, vesicoureteral reflux, and obstructive uropathies. They are also commonly seen in people with underlying metabolic disorders, such as idiopathic hypercalciuria, hyperparathyroidism, and gout. Infection stones can grow rapidly, forming large calyceal staghorn calculi requiring invasive surgery such as percutaneous nephrolithotomy for definitive treatment.
Uric acid stones
About 5–10% of all stones are formed from uric acid. People with certain metabolic abnormalities, including obesity, may produce uric acid stones. Uric acid stones may form in association with conditions that cause hyperuricosuria (an excessive amount of uric acid in the urine) with or without high hyperuricemia (an excessive amount of uric acid in the serum). They may also form in association with disorders of acid/base metabolism where the urine is excessively acidic (low pH), resulting in precipitation of uric acid crystals. A diagnosis of uric acid urolithiasis is supported by the presence of a radiolucent stone in the face of persistent urine acidity, in conjunction with the finding of uric acid crystals in fresh urine samples.
Other types
People with certain rare inborn errors of metabolism have a propensity to accumulate crystal-forming substances in their urine. For example, those with cystinuria, cystinosis, and Fanconi syndrome may form stones composed of cystine. People afflicted with xanthinuria often produce stones composed of xanthine. People afflicted with adenine phosphoribosyltransferase deficiency may produce 2,8-dihydroxyadenine stones, alkaptonurics produce homogentisic acid stones, and iminoglycinurics produce stones of glycine, proline and hydroxyproline. Urolithiasis has also been noted to occur in the setting of therapeutic drug use, with crystals of drug forming within the renal tract in some patients currently being treated with agents such as indinavir, sulfadiazine and triamterene.

Signs and symptoms
Signs of urolithiasis include oliguria (reduced urinary volume) caused by obstruction of the bladder or urethra by a stone or rarely, simultaneous obstruction of both ureters by two separate stones. Postrenal azotemia and hydronephrosis (distension and dilation of the renal pelvis and calyces)[  can be observed following the obstruction of urine flow through one or both ureters.[
Hallmark symptoms of kidney stones include renal colic, fever, hematuria, pyuria, and dysuria. Pain caused by kidney stones, referred to as renal colic, is often described as one of the strongest pain sensations felt by humans. Renal colic, which typically comes in waves lasting 20 to 60 minutes, is caused by peristaltic contractions of the ureter as it attempts to expel the stone. It typically begins in the flank or lower back, often radiating to the groin or in men, to the testes. The embryological link between the urinary tract, the genital system and the gastrointestinal tract is the basis of the radiation of pain to the gonads, as well as the nausea and vomiting that are also common in nephrolithiasis and ureterolithiasis.

Causes
Supersaturation of urine
When the urine becomes supersaturated (when the urine solvent contains more solutes than it can hold in solution) with one or more crystal-forming substances, a seed crystal may form through the process of nucleation. Heterogeneous nucleation (where there is a solid surface present on which a crystal can grow) proceeds more rapidly than homogeneous nucleation (where a crystal must grow in liquid medium with no such surface), because it requires less energy. Adhering to cells on the surface of a renal papillae, a seed crystal can grow and aggregate into an organized mass. Depending on the chemical composition of the crystal, the stone-forming process may proceed more rapidly when the urine pH is unusually high or low.
Supersaturation of the urine with respect to a crystal-forming compound is pH-dependent. For example, at a pH of 7.0, the solubility of uric acid in urine is 158 mg/100 mL. Reducing the pH to 5.0 decreases the solubility of uric acid to less than 8 mg/100 mL. One can readily see that the formation of uric acid stones requires a combination of hyperuricosuria (high urine uric acid levels) and low urine pH; hyperuricosuria alone is not associated with uric acid stone formation if the urine pH is alkaline. Supersaturation of the urine is a necessary but not a sufficient condition for the development of any urinary calculus. Supersaturation is likely the underlying cause of uric acid and cystine stones, but calcium-based stones (especially calcium oxalate stones) may have a more complex etiology.
Inhibitors of stone formation
Normal urine contains chelating agents such as citrate that inhibit the nucleation, growth, and aggregation of calcium-containing crystals. Other endogenous inhibitors include calgranulin (an S-100 calcium binding protein), Tamm-Horsfall protein (THP), glycosaminoglycans, uropontin (a form of osteopontin), nephrocalcin (an acidic glycoprotein), prothrombin F1 peptide, and bikunin (uronic acid-rich protein). The biochemical mechanisms of action of these substances have not yet been thoroughly elucidated. However, when these substances fall below their normal proportions, stones can form out of an aggregation of crystals.
Kidney stones often result from a combination of factors, rather than a single, well-defined cause. Stones are more common in people whose diet is very high in animal protein or vitamin C or who do not consume enough water or calcium. They can result from an underlying metabolic condition, such as renal tubular acidosis, Dent's disease, hyperparathyroidism, primary hyperoxaluria or medullary sponge kidney.  Kidney stones are also more common in patients with Crohn's disease.[27] Patients with recurrent kidney stones are often screened for these disorders. This is typically done with a 24–hour urine collection that is chemically analyzed for deficiencies and excesses that promote stone formation.
Calcium
Some studies suggest that people who take supplemental calcium have a higher risk of developing kidney stones, and these findings have been used as the basis for setting the Recommended Daily Intake (RDI) for calcium in adults. In the Women's Health Initiative, postmenopausal women who consumed 1,000 milligrams of supplemental calcium and 400 IU of vitamin D per day for 7 years had a 17% higher risk of developing kidney stones than subjects taking a placebo. The Nurses' Health Study also showed an association between supplemental calcium intake and kidney stone formation.
Unlike supplemental calcium, high intakes of dietary calcium do not appear to cause kidney stones and may actually protect against their development. This is perhaps related to the role of calcium in binding ingested oxalate in the gastrointestinal tract. As the amount of calcium intake decreases, the amount of oxalate available for absorption into the bloodstream increases; this oxalate is then excreted in greater amounts into the urine by the kidneys. In the urine, oxalate is a very strong promoter of calcium oxalate precipitation, about 15 times stronger than calcium. In fact, current evidence suggests that the consumption of diets low in calcium is associated with a higher overall risk for the development of kidney stones. For most individuals however, other risk factors for kidney stones, such as high intakes of oxalates from food and low intakes of fluid, probably play a bigger role than calcium intake.
Role of dietary animal protein
Diets in Western nations typically contain more animal protein than the body needs, and as the excess amino acids are broken down and excreted, the sulfurous amino acids (typically derived from animal rather than vegetarian foods) cause calcium to be excreted in the urine; calcium is one component of the most common type of human kidney stones, calcium oxalate. Red meat also contains acids that need to be excreted and this acidity constitutes another risk factor for kidney stones. High intake of animal protein also presents a greater uric acid load to be excreted by the kidney. This in turn acidifies the urine, increasing the risk of uric acid stones. In either case, the body often balances this acidic urinary pH by leaching calcium from the bones.
Other
There is some evidence that water fluoridation may increase the risk of kidney stone formation. In one study, patients with symptoms of skeletal fluorosis were 4.6 times as likely to develop kidney stones.
Despite a widely-held belief in the medical community that ingestion of vitamin C supplements is associated with an increased incidence of kidney stones, the evidence for a causal relationship between vitamin C supplements and kidney stones is inconclusive.
There are no conclusive data demonstrating a cause and effect relationship between alcohol consumption and kidney stones. However, some have theorized that certain behaviors associated with frequent and binge drinking can lead to systemic dehydration, which can in turn lead to the development of kidney stones.[43]
The American Urological Association has projected that increasing global temperatures will lead to an increased incidence of kidney stones in the United States by expanding the "kidney stone belt" of the southern United States. Astronauts seem to show a higher risk of developing kidney stones during or after space flights of long duration.
Prevention
Specific therapy should be tailored to the type of stones involved. Dietary intake can have a profound influence on the development of kidney stones. Preventive strategies may include dietary modifications and medication with the goal of reducing the excretory load on the kidneys.
A key principle for the prevention of kidney stones is to increase urine volume. The relative probability of kidney stone formation decreases as urinary volume increases. Because of this, maintenance of dilute urine by means of vigorous fluid therapy is beneficial in all forms of nephrolithiasis. Fluid intake should be sufficient to maintain a urine output of 2–3 liters per day. A high fluid intake has been associated with a 40% reduction in recurrence risk.
Available data suggest that the type of fluid ingested is important. For example, orange juice may help prevent calcium oxalate stone formation, blackcurrant juice may help prevent uric acid stones, and cranberry juice may help with struvite stones. Lemons have the highest concentration of citrate of any citrus fruit, and daily consumption of lemonade has been shown to decrease the rate of stone formation. Beer appears to decrease the rate of stone formation, while grapefruit juice appears to increase the risk. One study indicated that intake of caffeinated beverages increases risk of kidney stones. While it may be advised to avoid caffeinated cola beverages because of their high phosphate content, this does not include coffee or tea. In fact, prospective cohort studies of coffee and tea actually indicate that they may prevent kidney stones. Though caffeine does acutely increase urinary calcium excretion, several independent epidemiologic studies have shown that coffee intake overall is protective against the formation of stones.
Calcium binds with available oxalate in the gastrointestinal tract, thereby preventing its absorption into the bloodstream. A randomized controlled trial published in 2002 assigned men with hypercalciuria to follow either a diet containing a normal amount of calcium (30 mmol per day) but with restricted intake of animal protein and salt, or a low-calcium (10 mmol per day) diet. At 5 years, the group on the normal calcium, low animal protein and low salt diet had a 51% lower rate of stone recurrence than those following a low-calcium diet. Some nephrologists and urologists recommend chewing calcium tablets during meals containing oxalate foods. Calcium citrate supplements can be taken with meals if dietary calcium cannot be increased by other means. The preferred calcium supplement for people at risk of stone formation is calcium citrate because it helps to increase urinary citrate excretion.
Aside from vigorous oral hydration and consumption of more dietary calcium, prevention strategies include avoidance of large doses of vitamin C and restriction of oxalate-rich foods. Measurements of food oxalate content have been difficult and issues remain about the proportion of oxalate that is bioavailable, versus a proportion that is not absorbed by the intestine. Oxalate-rich foods are usually restricted to some degree, particularly in patients with high urinary oxalate levels, but no randomized controlled trial of oxalate restriction has been performed to test that hypotheses.

Arthritis

Arthritis

Arthritis (from Greek arthro-, joint + -itis, inflammation; plural: arthritides) is a form of joint disorder that involves inflammation of one or more joints.

There are over 100 different forms of arthritis. The most common form, osteoarthritis (degenerative joint disease) is a result of trauma to the joint, infection of the joint, or age. Other arthritis forms are rheumatoid arthritis, psoriatic arthritis, and related autoimmune diseases. Septic arthritis is caused by joint infection.

The major complaint by individuals who have arthritis is joint pain. Pain is often a constant and may be localized to the joint affected. The pain from arthritis occurs due to inflammation that occurs around the joint, damage to the joint from disease, daily wear and tear of joint, muscle strains caused by forceful movements against stiff, painful joints and fatigue.

Classification

Primary forms of arthritis:

Osteoarthritis

Rheumatoid arthritis

Septic arthritis

Gout and pseudo-gout

Juvenile idiopathic arthritis

Still's disease

Ankylosing spondylitis

Secondary to other diseases:

Ehlers-Danlos Syndrome

Sarcoidosis

Henoch-Schönlein purpura

Psoriatic arthritis

Reactive arthritis

Haemochromatosis

Hepatitis

Wegener's granulomatosis (and many other vasculitis syndromes)

Lyme disease

Familial Mediterranean fever

Hyperimmunoglobulinemia D with recurrent fever

TNF receptor associated periodic syndrome

Inflammatory bowel disease (Including Crohn's Disease and Ulcerative Colitis)

An undifferentiated arthritis is an arthritis that does not fit into well-known clinical disease categories, possibly being an early stage of a definite rheumatic disease.

Differential diagnosis

Osteoarthritis

Osteoarthritis is the most common form of arthritis. It can affect both the larger and the smaller joints of the body, including the hands, feet, back, hip or knee. The disease is essentially one acquired from daily wear and tear of the joint, however, osteoarthritis can also occur as a result of injury. Osteoarthritis begins in the cartilage and eventually leads to the two opposing bones eroding into each other. Initially, the condition starts with minor pain while walking but soon the pain can be continuous and even occur at night. The pain can be debilitating and prevent one from doing some activities. Osteoarthritis typically affects the weight bearing joints such as the back, spine, and pelvis. Unlike rheumatoid arthritis, osteoarthritis is most commonly a disease of the elderly. More than 30 percent of females have some degree of osteoarthritis by age 65. Risk factors for osteoarthritis include: prior joint trauma, obesity, sedentary lifestyle.

Osteoarthritis, like rheumatoid arthritis, cannot be cured but one can prevent the condition from worsening. Weight loss is the key to improving symptoms and preventing progression.[citation needed] Physical therapy to strengthen muscles and joints is very helpful. Pain medications are widely required by individuals with osteoarthritis. When the disease is far advanced and the pain is continuous, surgery may be an option. Unlike rheumatoid arthritis, joint replacement does help many individuals with osteoarthritis.

Rheumatoid arthritis

Rheumatoid arthritis is a disorder in which, for some unknown reason, the body's own immune system starts to attack body tissues. The attack is not only directed at the joint but to many other parts of the body. In rheumatoid arthritis, most damage occurs to the joint lining and cartilage which eventually results in erosion of two opposing bones. Rheumatoid arthritis affects joints in the fingers, wrists, knees and elbows. The disease is symmetrical and can lead to severe deformity in a few years if not treated. Rheumatoid arthritis occurs mostly in people aged 20 and above. In children, the disorder can present with a skin rash, fever, pain, disability, and limitations in daily activities. No one knows why rheumatoid arthritis occurs and all treatments are focused on easing the symptoms. With earlier diagnosis and aggressive treatment, many individuals can lead a decent quality of life. The drugs to treat rheumatoid arthritis range from corticosteroids to monoclonal antibodies given intravenously. The latest drugs like Remicade can significantly improve quality of life in the short term. In rare cases, surgery may be required to replace joints but there is no cure for the illness.

Lupus

This is a common collagen vascular disorder that can be present with severe arthritis. Other features of lupus include a skin rash, extreme photosensitivity, hair loss, kidney problems, emotional lability, lung fibrosis and constant joint pain.

Gout

Gout is caused by deposition of uric acid crystals in the joint, causing inflammation. There is also an uncommon form of gouty arthritis caused by the formation of rhomboid crystals of calcium pyrophosphate known as pseudogout. In the early stages, the gouty arthritis usually occur in one joint, but with time, it can occur in many joints and be quite crippling. The joints in gout can often become swollen and lose function

sign and symptoms

Regardless of the type of arthritis, the common symptoms for all arthritis disorders include varied levels of pain, swelling, joint stiffness and sometimes a constant ache around the joint(s). Arthritic disorders like lupus and rheumatoid can also affect other organs in the body with a variety of symptoms.

Inability to use the hand or walk

Malaise and a feeling of tiredness

Fever

Weight loss

Poor sleep

Muscle aches and pains

Tenderness

Difficulty moving the joint

It is common in advanced arthritis for significant secondary changes to occur. For example, in someone who has limited their physical activity:

Muscle weakness

Loss of flexibility

Decreased aerobic fitness

These changes can also impact on life and social roles, such as community involvement.

Disability

Arthritis is the most common cause of disability in the USA. More than 20 million individuals with arthritis have severe limitations in function on a daily basis. Absenteeism and frequent visits to the physician are common in individuals who have arthritis. Arthritis makes it very difficult for individuals to be physically active and soon become home bound.

It is estimated that the total cost of arthritis cases is close to $100 billion of which nearly 50% accounts from lost earnings. Each year, arthritis results in nearly 1 million hospitalizations and close to 45 million outpatient visits to health care centers.

Arthritis makes it very difficult for the individual to remain physically active. Many individuals who have arthritis also suffer from obesity, high cholesterol or have heart disease. Individuals with arthritis also become depressed and have fear of worsening symptoms.

Diagnosis

Diagnosis is made by clinical examination from an appropriate health professional, and may be supported by other tests such as radiology and blood tests, depending on the type of suspected arthritis. All arthritides potentially feature pain. Pain patterns may differ depending on the arthritides and the location. Rheumatoid arthritis is generally worse in the morning and associated with stiffness; in the early stages, patients often have no symptoms after a morning shower. Osteoarthritis, on the other hand, tends to be worse after exercise. In the aged and children, pain might not be the main presenting feature; the aged patient simply moves less, the infantile patient refuses to use the affected limb.

Elements of the history of the disorder guide diagnosis. Important features are speed and time of onset, pattern of joint involvement, symmetry of symptoms, early morning stiffness, tenderness, gelling or locking with inactivity, aggravating and relieving factors, and other systemic symptoms. Physical examination may confirm the diagnosis, or may indicate systemic disease. Radiographs are often used to follow progression or help assess severity.

Prevention

Treatment

There is no cure for either rheumatoid or osteoarthritis. Treatment options vary depending on the type of arthritis and include physical therapy, lifestyle changes (including exercise and weight control), orthopedic bracing, medications. Joint replacement surgery may be required in eroding forms of arthritis. Medications can help reduce inflammation in the joint which decreases pain. Moreover, by decreasing inflammation, the joint damage may be slowed.

Physical Therapy

In general, studies have shown that physical exercise of the affected joint can have noticeable improvement in terms of long-term pain relief. Furthermore, exercise of the arthritic joint is encouraged to maintain the health of the particular joint and the overall body of the person.

Individuals with arthritis can benefit from both physical and occupational therapy. In arthritis the joints become stiff and the range of movement can be limited. Physical therapy has been shown to significantly improve function, decrease pain, and delay need for surgical intervention in advanced cases. Exercise prescribed by a physical therapist has been shown to be more effective than medications in treating osteoarthritis of the knee. Exercise often focusses on improving muscle strength, endurance and flexibility. In some cases, exercises may be designed to train balance. Occupational therapy can teach you how to reduce stress on your joint from daily living activities. Occupation therapy can also teach you how to modify your home and work environment so that you do reduce movements that may worsen your arthritis. There are also assist devices available that can help you drive, getting a bath, dressing and also in housekeeping labors.

Occupational therapy can help you do everyday activities without worsening pain or causing joint damage. The techniques can help you distribute pressures to minimize stress on any one joint. Ways to accomplish daily living tasks are made easier.

Medications

Treatment typically begins with medications that have the fewest side effects with further medications being added if insufficiently effective.Treatment depends on the type of the arthritis. The first-line treatment for osteoarthritis is acetaminophen while for inflammatory arthritis it involves non-steroidal anti-inflammatory drugs like ibuprofen.