11

AllopurinolAllopurinol

Prof. Dr. Shah MuradProf. Dr. Shah Murad

shahmurad655@yahoo.comshahmurad655@yahoo.com

22

ZYLOPRIM (allopurinol)ZYLOPRIM (allopurinol)

33

ZYLOPRIM is known chemically as ZYLOPRIM is known chemically as 1,5-dihydro-41,5-dihydro-4HH-pyrazolo [3,4--pyrazolo [3,4-dd]pyrimidin-4-one. ]pyrimidin-4-one.

It is a It is a xanthinexanthine oxidase inhibitor oxidase inhibitor which is administered orally. which is administered orally.

44

Xanthine oxidaseXanthine oxidase is an is an enzymeenzyme that that catalyzes the catalyzes the oxidationoxidation of of hypoxanthinehypoxanthine to to xanthinexanthine and can and can further catalyze the oxidation of further catalyze the oxidation of xanthine to xanthine to uric aciduric acid. .

This enzyme plays an important role This enzyme plays an important role in the catabolism of purines in some in the catabolism of purines in some species, including humanspecies, including human

55

Xanthine oxidase can be converted Xanthine oxidase can be converted to to xanthinexanthine dehydrogenasedehydrogenase by by reversible sulfhydryl oxidation reversible sulfhydryl oxidation

66

ReactionReaction

The following chemical reactions are The following chemical reactions are catalyzed by xanthine oxidase:catalyzed by xanthine oxidase:

hypoxanthine + H2O + hypoxanthine + H2O + O2>>>>xanthine+ H2O2 O2>>>>xanthine+ H2O2

xanthine + H2O + O2 >>>> uric acid + xanthine + H2O + O2 >>>> uric acid + H2O2 H2O2

77

Hypoxanthine Hypoxanthine XanthineXanthine

88

Protein structureProtein structure The protein is large, having a The protein is large, having a

molecular weightmolecular weight of 270,000, and has 2 of 270,000, and has 2 flavinflavin molecules (bound as FAD), 2 molecules (bound as FAD), 2 molybdenummolybdenum atoms, and 8 atoms, and 8 ironiron atoms atoms bound per enzymatic unit. bound per enzymatic unit.

The molybdenum atoms are contained as The molybdenum atoms are contained as molybdopterinmolybdopterin cofactors and are the cofactors and are the active sites of the enzyme. active sites of the enzyme.

The iron atoms are part of [2Fe-2S] The iron atoms are part of [2Fe-2S] ferredoxinferredoxin iron-sulfur clustersiron-sulfur clusters and participate in electron and participate in electron transfer reactionstransfer reactions

99

Catalytic mechanismCatalytic mechanism The active site of XO is composed of a The active site of XO is composed of a

molybdopterin unit with the molybdenum atom molybdopterin unit with the molybdenum atom also coordinated by terminal oxygen (also coordinated by terminal oxygen (oxooxo), ), sulfur atoms and a terminal sulfur atoms and a terminal hydroxidehydroxide. .

In the reaction with xanthine to form uric acid, In the reaction with xanthine to form uric acid, an oxygen atom is transferred from an oxygen atom is transferred from molybdenum to xanthine. molybdenum to xanthine.

The reformation of the active molybdenum The reformation of the active molybdenum center occurs by the addition of water.center occurs by the addition of water.

Like other known molybdenum-containing Like other known molybdenum-containing oxidoreductases, the oxygen atom introduced oxidoreductases, the oxygen atom introduced to the to the substratesubstrate by XO originates from water by XO originates from water rather than from rather than from dioxygendioxygen (O2) (O2)

1010

Clinical significanceClinical significance

In humans, xanthine oxidase is normally In humans, xanthine oxidase is normally found in the found in the liverliver and not free in the and not free in the blood. blood.

During severe liver damage, xanthine During severe liver damage, xanthine oxidase is released into the blood, so a oxidase is released into the blood, so a blood assay for XO is a way to determine blood assay for XO is a way to determine if if liverliver damage has happened damage has happened

1111

As well, because xanthine oxidase is a As well, because xanthine oxidase is a metabolic pathwaymetabolic pathway for for uric aciduric acid formation, the xanthine oxidase inhibitor formation, the xanthine oxidase inhibitor allopurinolallopurinol is used in the treatment of is used in the treatment of goutgout. .

Since xanthine oxidase is involved in the Since xanthine oxidase is involved in the metabolism of metabolism of 6-mercaptopurine6-mercaptopurine, caution , caution should be taken before administering should be taken before administering allopurinol and 6-mercaptopurine, or its allopurinol and 6-mercaptopurine, or its prodrug prodrug azathioprineazathioprine, in conjunction., in conjunction.

1212

XanthinuriaXanthinuria is a rare is a rare genetic disordergenetic disorder where the lack of xanthine oxidase leads where the lack of xanthine oxidase leads to high concentration of xanthine in blood to high concentration of xanthine in blood and can cause health problems such as and can cause health problems such as renal failurerenal failure. .

There is no specific treatment, sufferers There is no specific treatment, sufferers are advised by doctors to avoid foods are advised by doctors to avoid foods high in high in purinepurine and to maintain a high fluid and to maintain a high fluid intake.intake.

1313

InhibitorsInhibitors

XanthineXanthine oxidaseoxidase inhibitor inhibitor

Inhibitors of XO include Inhibitors of XO include allopurinolallopurinol, , oxypurinoloxypurinol,and ,and phyticphytic acid acid

1414

Allopurinol is taken in tablet form (oral). Allopurinol is taken in tablet form (oral).

It is taken in low dosages at first. It is taken in low dosages at first.

The dosage is gradually increased to The dosage is gradually increased to control uric acid levels.control uric acid levels.

1515

MOAMOA

Allopurinol prevents the release of a Allopurinol prevents the release of a substance called xanthine oxidase, substance called xanthine oxidase, which helps in the formation of uric which helps in the formation of uric acid. acid.

In treatment for In treatment for goutgout, allopurinol , allopurinol blocks the production of blocks the production of uric aciduric acid in in the body.the body.

1616

Allopurinol may be prescribed to prevent gout Allopurinol may be prescribed to prevent gout attacks. It also may be used because of:attacks. It also may be used because of:

Overproduction of uric acid. Overproduction of uric acid. Frequent gout attacks. Frequent gout attacks. Presence of gritty, chalklike clumps of uric acid Presence of gritty, chalklike clumps of uric acid

crystals (crystals (tophitophi). ). Failure of other medicines to adequately reduce Failure of other medicines to adequately reduce

uric acid levels. uric acid levels. Allergy to uricosuric medications, which Allergy to uricosuric medications, which

increase the elimination of uric acid, or serious increase the elimination of uric acid, or serious side effects from these medicines. Uricosuric side effects from these medicines. Uricosuric medications include probenecid (Probalan) and medications include probenecid (Probalan) and sulfinpyrazone (Anturane). sulfinpyrazone (Anturane).

Poor kidney function. Poor kidney function. History of uric acid kidney stones. History of uric acid kidney stones.

1717

Allopurinol may also be used for the Allopurinol may also be used for the prevention of kidney disease in people prevention of kidney disease in people going through treatment for cancer.going through treatment for cancer.

The dose of allopurinol may need to be The dose of allopurinol may need to be lower for people who have chronic kidney lower for people who have chronic kidney disease or are taking azathioprine.disease or are taking azathioprine.

1818

Allopurinol is not Allopurinol is not recommended for people recommended for people

whowho

Have a known sensitivity to allopurinol. Have a known sensitivity to allopurinol. Have a condition in which there is too Have a condition in which there is too

much iron in the body (much iron in the body (hemochromatosishemochromatosis). ).

Allopurinol should not be started for the Allopurinol should not be started for the first time by people who are still having first time by people who are still having symptoms caused by a gout attack.symptoms caused by a gout attack.

1919

Allopurinol lowers the amount of uric acid in the Allopurinol lowers the amount of uric acid in the body. body.

After the proper dose is reached, the uric acid After the proper dose is reached, the uric acid levels should return to normal. levels should return to normal.

doctor will monitor uric acid level within one doctor will monitor uric acid level within one month of starting or changing a dose of month of starting or changing a dose of allopurinol.allopurinol.

Treatment with allopurinol can reduce the size Treatment with allopurinol can reduce the size of of tophitophi. .

2020

Side EffectsSide Effects

Skin rash is a common side effect. Skin rash is a common side effect.

Because a skin rash may be a symptom Because a skin rash may be a symptom of an allergic reaction to allopurinol, have of an allergic reaction to allopurinol, have your doctor evaluate any skin rash that your doctor evaluate any skin rash that develops while you are taking this develops while you are taking this medicine.medicine.

2121

Rare, serious side effects Rare, serious side effects includeinclude

Inflammation of the liver (Inflammation of the liver (hepatitishepatitis). ). Failure of bone marrow to produce blood Failure of bone marrow to produce blood

cells (cells (aplasticaplastic anemia anemia). ). Inflammation of blood vessels (Inflammation of blood vessels (vasculitisvasculitis). ). Allopurinol hypersensitivity syndrome (a Allopurinol hypersensitivity syndrome (a

widespread rash, fever, mouth sores, widespread rash, fever, mouth sores, poor kidney function, liver inflammation, poor kidney function, liver inflammation, and other complications), which can be and other complications), which can be life-threateninglife-threatening. .

2222

Allopurinol interferes with many other Allopurinol interferes with many other medicines. medicines.

It may increase or decrease the levels It may increase or decrease the levels of other medicines, which may of other medicines, which may increase the toxicity of these increase the toxicity of these medicines or reduce their medicines or reduce their effectiveness.effectiveness.

2323

Allopurinol should not be used until the symptoms Allopurinol should not be used until the symptoms of a gout attack are gone. But if you are already of a gout attack are gone. But if you are already taking allopurinol, continue to take it (even during taking allopurinol, continue to take it (even during an attack). an attack).

Gout attacks may increase at first for some people Gout attacks may increase at first for some people taking allopurinol. taking allopurinol.

To avoid this, doctors may prescribe either To avoid this, doctors may prescribe either colchicine, which blocks the inflammation caused by colchicine, which blocks the inflammation caused by uric acid crystals, or low-dose nonsteroidal anti-uric acid crystals, or low-dose nonsteroidal anti-inflammatory drugs (inflammatory drugs (NSAIDsNSAIDs) to be taken at the ) to be taken at the same time. same time.

After normal uric acid levels have been maintained After normal uric acid levels have been maintained for 6 to 12 months and no further attacks occur, for 6 to 12 months and no further attacks occur, colchicine or NSAIDs do not need to be taken. colchicine or NSAIDs do not need to be taken.

Because of the rare risk of serious side effects, Because of the rare risk of serious side effects, many doctors may prefer uricosuric medications to many doctors may prefer uricosuric medications to allopurinol. allopurinol.

2424

Laboratory studies, including a Laboratory studies, including a complete blood countcomplete blood count (CBC) and liver (CBC) and liver and kidney function studies, may be and kidney function studies, may be done after a few months of using done after a few months of using allopurinol. allopurinol.

2525

NSAIDsNSAIDs

INDOCIN is a non-steroidal anti-INDOCIN is a non-steroidal anti-inflammatory drug (NSAID) that inflammatory drug (NSAID) that exhibits exhibits antipyreticantipyretic and and analgesicanalgesic properties. properties.

2626

MOAMOA INDOCIN is a potent inhibitor of INDOCIN is a potent inhibitor of

prostaglandinprostaglandin synthesissynthesis. . Prostaglandins sensitize Prostaglandins sensitize afferentafferent nerves nerves

and potentiate the action of bradykinin in and potentiate the action of bradykinin in inducing pain in animal models.inducing pain in animal models.

prostaglandins are known to be among prostaglandins are known to be among the mediators of inflammation. the mediators of inflammation.

Since indomethacin is an inhibitor of Since indomethacin is an inhibitor of prostaglandin synthesis, its mode of prostaglandin synthesis, its mode of action may be due to a decrease of action may be due to a decrease of prostaglandins in peripheral tissues.prostaglandins in peripheral tissues.

2727

Other usesOther uses INDOCIN has been shown to be an INDOCIN has been shown to be an

effective anti-inflammatory agent, effective anti-inflammatory agent, appropriate for long-term use in appropriate for long-term use in rheumatoid arthritisrheumatoid arthritis, , ankylosing spondylitisankylosing spondylitis, and , and osteoarthritisosteoarthritis..

INDOCIN affords relief of symptoms; it INDOCIN affords relief of symptoms; it does not alter the progressive course of does not alter the progressive course of the underlying disease.the underlying disease.

2828

INDOCIN suppresses inflammation in rheumatoid INDOCIN suppresses inflammation in rheumatoid arthritis as demonstrated by relief of pain, and arthritis as demonstrated by relief of pain, and reduction of fever, swelling and tenderness. reduction of fever, swelling and tenderness.

Improvement in patients treated with INDOCIN Improvement in patients treated with INDOCIN for rheumatoid arthritis has been demonstrated for rheumatoid arthritis has been demonstrated by a reduction in joint swelling, average number by a reduction in joint swelling, average number of joints involved, and morning stiffness; by of joints involved, and morning stiffness; by increased mobility as demonstrated by a increased mobility as demonstrated by a decrease in walking time; and by improved decrease in walking time; and by improved functional capability as demonstrated by an functional capability as demonstrated by an increase in grip strength. increase in grip strength.

INDOCIN may enable the reduction of steroid INDOCIN may enable the reduction of steroid dosage in patients receiving steroids for the dosage in patients receiving steroids for the more severe forms of rheumatoid arthritis. more severe forms of rheumatoid arthritis.

In such instances the steroid dosage should be In such instances the steroid dosage should be reduced slowly and the patients followed very reduced slowly and the patients followed very closely for any possible adverse effects.closely for any possible adverse effects.

2929

Capsules INDOCIN have been found Capsules INDOCIN have been found effective in relieving the pain, effective in relieving the pain, reducing the fever, swelling, redness, reducing the fever, swelling, redness, and tenderness of acute and tenderness of acute gouty arthritisgouty arthritis

3030

PKPK Following single oral doses of Capsules Following single oral doses of Capsules

INDOCIN 25 mg or 50 mg, indomethacin INDOCIN 25 mg or 50 mg, indomethacin is readily absorbed, attaining peak is readily absorbed, attaining peak plasmaplasma concentrations of about 1 and 2 concentrations of about 1 and 2 mcg/mL, respectively, at about 2 hours. mcg/mL, respectively, at about 2 hours.

Orally administered Capsules INDOCIN Orally administered Capsules INDOCIN are virtually 100% bioavailable, with 90% are virtually 100% bioavailable, with 90% of the of the dose absorbeddose absorbed within 4 hours. within 4 hours.

A single 50 mg dose of Oral Suspension A single 50 mg dose of Oral Suspension INDOCIN was found to be bioequivalent to INDOCIN was found to be bioequivalent to a 50 mg INDOCIN capsule when each was a 50 mg INDOCIN capsule when each was administered with foodadministered with food

3131

Indomethacin is eliminated via Indomethacin is eliminated via renalrenal excretion, excretion, metabolismmetabolism, and , and biliarybiliary excretion. excretion.

Indomethacin undergoes appreciable Indomethacin undergoes appreciable enterohepatic enterohepatic circulationcirculation. .

The mean half-life of indomethacin is The mean half-life of indomethacin is estimated to be about 4.5 hours. estimated to be about 4.5 hours.

With a typical therapeutic With a typical therapeutic regimenregimen of 25 or 50 of 25 or 50 mg mg t.i.d.t.i.d., the steady-state plasma , the steady-state plasma concentrations of indomethacin are an concentrations of indomethacin are an average 1.4 times those following the first average 1.4 times those following the first dosedose

3232

The rate of The rate of absorptionabsorption is more rapid from is more rapid from the the rectalrectal suppository than from Capsules suppository than from Capsules INDOCIN. INDOCIN.

Ordinarily, therefore, the total amount Ordinarily, therefore, the total amount absorbed from the suppository would be absorbed from the suppository would be expected to be at least equivalent to the expected to be at least equivalent to the capsule. capsule.

3333

Indomethacin exists in the plasma as the Indomethacin exists in the plasma as the parent drug and its desmethyl, parent drug and its desmethyl, desbenzoyl, and desmethyl-desbenzoyl desbenzoyl, and desmethyl-desbenzoyl metabolites, all in the unconjugated form. metabolites, all in the unconjugated form.

About 60 percent of an oral dosage is About 60 percent of an oral dosage is recovered in recovered in urineurine as drug and as drug and metabolites (26 percent as indomethacin metabolites (26 percent as indomethacin and its glucuronide), and 33 percent is and its glucuronide), and 33 percent is recovered in recovered in fecesfeces (1.5 percent as (1.5 percent as indomethacin).indomethacin).

3434

About 99% of indomethacin is bound to About 99% of indomethacin is bound to proteinprotein in plasma over the expected in plasma over the expected range of therapeutic plasma range of therapeutic plasma concentrations. concentrations.

Indomethacin has been found to cross Indomethacin has been found to cross the the blood-brain barrierblood-brain barrier and the and the placentaplacenta..

3535

ProbenecidProbenecid (Benuryl) (Benuryl) is a is a uricosuricuricosuric drug that increases drug that increases

uric aciduric acid excretion in the excretion in the urineurine. .

It is primarily used in treating It is primarily used in treating goutgout and and hyperuricemiahyperuricemia..

Probenecid competitively inhibits the Probenecid competitively inhibits the renal excretion of some drugs, thereby renal excretion of some drugs, thereby increasing their plasma concentration increasing their plasma concentration and prolonging their effects.and prolonging their effects.

3636

In the In the kidneyskidneys probenecid is filtered at the probenecid is filtered at the glomerulusglomerulus, secreted in the , secreted in the proximal tubuleproximal tubule and reabsorbed in the and reabsorbed in the distal tubuledistal tubule..

Probenecid's exact mechanism is explained as Probenecid's exact mechanism is explained as follows. The kidney's follows. The kidney's organic anion transporterorganic anion transporter (OAT) reclaims uric acid from the urine and (OAT) reclaims uric acid from the urine and returns it to the plasma. Probenecid interferes returns it to the plasma. Probenecid interferes with these systems.with these systems.

If probenecid (an organic acid) is If probenecid (an organic acid) is administered to a patient, the OAT binds to administered to a patient, the OAT binds to probenecid instead of to uric acid, probenecid instead of to uric acid, preventing the reabsorption of uric acid. preventing the reabsorption of uric acid.

As a result, more uric acid leaves the body in the As a result, more uric acid leaves the body in the urine, lowering the uric acid concentration in the urine, lowering the uric acid concentration in the plasmaplasma..

3737

UsesUses probenecid was shown to more than double probenecid was shown to more than double

blood concentrations of blood concentrations of oseltamiviroseltamivir (trade name (trade name Tamiflu), an Tamiflu), an antiviral drugantiviral drug used to combat used to combat influenzainfluenza..

This is significant because nations are currently This is significant because nations are currently stockpiling oseltamivir in anticipation of an stockpiling oseltamivir in anticipation of an influenza pandemicinfluenza pandemic, and there could be supply , and there could be supply shortages.shortages.

During World War II, probenecid was used to During World War II, probenecid was used to extend limited supplies of extend limited supplies of penicillinpenicillin, and is still , and is still currently used to increase antibiotic currently used to increase antibiotic concentrations in serious infections.concentrations in serious infections.

It has also found use as a It has also found use as a masking agentmasking agent

3838

CORTICOSTEROIDSCORTICOSTEROIDS

corticosteroids are naturally produced corticosteroids are naturally produced by your own body and may help reduce by your own body and may help reduce swelling, redness and pain in joints. swelling, redness and pain in joints.

Systemic corticosteroids come in a pill Systemic corticosteroids come in a pill form or as an injection form or as an injection

3939

There is inconclusive evidence for the There is inconclusive evidence for the efficacy and effectiveness of systemic efficacy and effectiveness of systemic corticosteroids in the treatment of corticosteroids in the treatment of acute gout. acute gout.

Patients with gout did not report Patients with gout did not report serious adverse effects from systemic serious adverse effects from systemic corticosteroids, when used for short corticosteroids, when used for short term. term.

4040

USES of corticosteroidsUSES of corticosteroids

Gout attacks that are limited to a single Gout attacks that are limited to a single joint. joint.

Gout attacks that do not respond to Gout attacks that do not respond to nonsteroidal anti-inflammatory drugs (nonsteroidal anti-inflammatory drugs (NSAIDsNSAIDs) or colchicine. ) or colchicine.

People who cannot take NSAIDs or People who cannot take NSAIDs or colchicine, such as those with kidney colchicine, such as those with kidney disease or a history of serious disease or a history of serious ulcerulcer disease and gastrointestinal bleeding. disease and gastrointestinal bleeding.

Corticosteroids may also be used by people who Corticosteroids may also be used by people who have congestive heart failure or take the blood-have congestive heart failure or take the blood-thinner warfarin, or who are allergic to aspirin.thinner warfarin, or who are allergic to aspirin.

4141

Side EffectsSide Effects

Mood swings. Mood swings. Nervousness. Nervousness. InsomniaInsomnia. . Weight gain. Weight gain. Fluid retention. Fluid retention. Very rounded (moon) face. Very rounded (moon) face. Poor wound healing. Poor wound healing. Increased risk of infection. Increased risk of infection. High blood pressureHigh blood pressure. . DiabetesDiabetes. .

4242

Uncommon short-term side Uncommon short-term side effects effects

Muscle weakness. Muscle weakness. GlaucomaGlaucoma. . Stomach ulcersStomach ulcers. . AcneAcne. .

Long-term side effects includeLong-term side effects include OsteoporosisOsteoporosis. . CataractsCataracts (uncommon). (uncommon). Damage to the hip, shoulder, or knee Damage to the hip, shoulder, or knee

joints (uncommon). joints (uncommon).

4343

ACTHACTH Corticotropin alone or in combination with Corticotropin alone or in combination with

colchicine is more rapidly effective and colchicine is more rapidly effective and associated with fewer adverse effects associated with fewer adverse effects than indomethacin.than indomethacin.

This regimen may be considered an This regimen may be considered an alternative, especially for patients with alternative, especially for patients with medical problems in which other medical problems in which other regimens are contraindicated. regimens are contraindicated.

4444

adrenocorticotropic hormone (ACTH) adrenocorticotropic hormone (ACTH) possess potent antirheumatic properties. possess potent antirheumatic properties.

rheumatoid arthritis, rheumatoid arthritis, rheumatoid (ankylosing) spondylitis, rheumatoid (ankylosing) spondylitis, acute rheumatic fever, acute rheumatic fever, disseminated lupus erythematosus, disseminated lupus erythematosus, periarteritis nodosa, periarteritis nodosa, psoriatic arthritis, psoriatic arthritis, dermatomyositis, and dermatomyositis, and gout gout

4545

In general the effects of ACTH/Cortisone are In general the effects of ACTH/Cortisone are temporary and they cause suppression temporary and they cause suppression rather than cure of the disease processes. rather than cure of the disease processes.

Improvement is maintained usually only by Improvement is maintained usually only by continuing administration, and on hormonal continuing administration, and on hormonal withdrawal prompt or fairly prompt relapse withdrawal prompt or fairly prompt relapse of the disease manifestations ensues of the disease manifestations ensues

4646

ACTHACTH Its chief function is to stimulate the cortex Its chief function is to stimulate the cortex

of the of the adrenal glandadrenal gland to secrete to secrete adrenocortical steroids, chief among them adrenocortical steroids, chief among them cortisonecortisone. .

The release of adrenocorticotropic hormone The release of adrenocorticotropic hormone (ACTH), also known as corticotropin, is (ACTH), also known as corticotropin, is stimulated by corticotropin-releasing factor stimulated by corticotropin-releasing factor (CRF), a secretion of the hypothalamus. (CRF), a secretion of the hypothalamus.

4747

ACTH secretion is an excellent ACTH secretion is an excellent example of the regulation of a example of the regulation of a biological system by a negative-biological system by a negative-feedback mechanism; high levels of feedback mechanism; high levels of adrenocortical steroids in the blood adrenocortical steroids in the blood tend to decrease ACTH release, tend to decrease ACTH release, whereas low steroid levels have the whereas low steroid levels have the opposite effect. opposite effect.

4848

ACTH has the same pharmacologic ACTH has the same pharmacologic and clinical effects as cortisone when and clinical effects as cortisone when given intravenously or given intravenously or intramuscularly;intramuscularly;

however, it has no value when applied however, it has no value when applied externally and cannot be taken orally externally and cannot be taken orally since it is deactivated by digestive since it is deactivated by digestive enzymes enzymes

4949

ARTHRITISARTHRITIS

5050

Arthritis literally means joint Arthritis literally means joint

inflammation. inflammation. Arthritis is not a Arthritis is not a single diseasesingle disease. .

Arthritis refers to a group of more than Arthritis refers to a group of more than 100 rheumatic diseases and other con100 rheumatic diseases and other conditionsditions that can cause pain, stiffness and that can cause pain, stiffness and swelling in the swelling in the joints.joints.

5151

The most common form, The most common form, osteoarthritisosteoarthritis (degenerative joint disease) is a result of (degenerative joint disease) is a result of trauma to the joint, infection of the joint, trauma to the joint, infection of the joint, or age. Other arthritis forms are or age. Other arthritis forms are rheumatoid arthritisrheumatoid arthritis and and psoriatic arthritispsoriatic arthritis, , autoimmune diseasesautoimmune diseases in which the body in which the body attacks itself. attacks itself.

Septic arthritisSeptic arthritis is caused by joint is caused by joint infectioninfection. . Gouty arthritisGouty arthritis is caused by deposition is caused by deposition of of uric aciduric acid crystals in the joint, causing crystals in the joint, causing inflammation. inflammation.

5252

Any part of your body can become Any part of your body can become inflamed or painful from arthritis. inflamed or painful from arthritis. Some rheumatic conditions can Some rheumatic conditions can result in debilitating, even life-result in debilitating, even life-threatening complications or may threatening complications or may affect other parts of the body affect other parts of the body including including the musclesthe muscles, , bonesbones, and , and internal organs.internal organs.

5353

OsteoarthritisOsteoarthritis

Rheumatoid Arthritis

5454

Psoriatic Arthritis Psoriatic Arthritis Fibromyalgia Fibromyalgia Scleroderma Scleroderma Lupus / SLE Lupus / SLE

5555

Extra-articular features of joint Extra-articular features of joint diseasedisease

CutaneousCutaneous nodulesnodules CutaneousCutaneous vasculitis vasculitislesionslesions LymphadenopathyLymphadenopathy OedemaOedema OcularOcular inflammation inflammation UrethritisUrethritis Tenosynovitis (tendon sheath effusions)Tenosynovitis (tendon sheath effusions) Bursitis (swollen bursa)Bursitis (swollen bursa) Diarrhea Diarrhea ulcerationulceration

5656

Treatment options vary depending on the Treatment options vary depending on the type of arthritis and include Physical type of arthritis and include Physical therapy, lifestyle changes (including exercise therapy, lifestyle changes (including exercise and weight control), medications and dietary and weight control), medications and dietary supplements (symptomatic or targeted at supplements (symptomatic or targeted at the disease process causing the arthritis). the disease process causing the arthritis).

Arthroplasty (joint replacement surgery) may Arthroplasty (joint replacement surgery) may be required in eroding forms of arthritis.be required in eroding forms of arthritis.

5757

In general, studies have shown that In general, studies have shown that physical exercising of the affected joint physical exercising of the affected joint can have noticeable improvement in can have noticeable improvement in terms of long-term pain relief. terms of long-term pain relief.

Furthermore, exercising of the arthritic Furthermore, exercising of the arthritic joint is encouraged to maintain the joint is encouraged to maintain the health of the particular joint and the health of the particular joint and the overall body of the personoverall body of the person