Heart Disease Prevention

Heart disease is the leading cause of death in the United States. According to the American Heart Association, at least 58.8 million American suffer from heart disease of any form. Around 950.000 people die every year from cardiovascular causes. It is also a major cause of disability for the survivors. Even though increased age is a risk factor, it's a big misconception to think that heart disease only happens to the elderly. One out of every 20 people below the age of 40 has heart disease.

The good news is that there are many ways to prevent heart disease. Studies show that nearly everyone, even those with unmodifiable risk factors such as old age and racial background, can become more heart healthy by following a few key steps, such as eating a healthy diet, exercising, quitting smoking, and maintaining a healthy body weight.

Quit Smoking

Smoking or tobacco use is one of the most significant risk factors for developing heart disease. Even occasional social smoking increases the chance of getting heart disease, as is exposure to second-hand smoke. Pipe smoking or using low-tar, low-nicotine products does not reduce the risk by much. However, when you quit smoking, your heart disease risk drops dramatically within just one year. No matter how long or how much you smoked, you'll start reaping rewards as soon as you quit.

Exercise regularly

Try getting at least 30 minutes of moderate physical activity most days of the week. You can break up your exercise time into three times 10 sessions. Casual activities such as gardening, housekeeping, and taking the stairs all count toward your total.

Eat a heart-healthy diet

Following the DASH (Dietary Approaches to Stop Hypertension) eating plan can help protect your heart. The diet is rich in fruits, vegetables, whole grains and low-fat dairy products. Limiting saturated and trans fat will also reduce your LDL cholesterol which plays an important role in the development of heart disease.

Omega-3 fatty acids is a type of polyunsaturated fat that decreases your risk of heart attack by lowering blood pressure and prevents irregular heart beats. Omega-3 is present in salmon, mackerel, flaxseed oil, soybean oil and canola oil. They can also be found in form of food supplements.

Moderate amount of alcohol, such as red wine can have a protective effect on your heart. Limit consumption to no more than two drinks a day for men, and one a day for women.

Maintain a healthy weight

As you put on weight in adulthood, your weight gain mostly consists of fat rather than muscle. Even a small weight loss can be beneficial. Reducing your weight by just 10% can decrease your blood pressure, lower your blood cholesterol level and reduce your risk of diabetes which in turn reduce your overall risk for cardiovascular diseases.

One way to see if your weight is healthy is to calculate your body mass index (BMI). If your BMI is 25 or higher, you have an increased risk of heart disease and stroke. The BMI is a good, but imperfect guide. Muscle weighs more than fat, and women and men who are very muscular and physically fit can have high BMIs without added health risks. Because of that, waist circumference also is a useful tool to measure how much abdominal fat you have. Men are considered overweight if their waist measurement is greater than 40 inches (101 cm). Women are overweight if their waist measurement is greater than 35 inches (88 cm).

Regular screening for heart disease risk factors

Check your blood pressure at least every 2 years starting from 18 years old. Check your cholesterol level every 5 years (more frequently if you are at an increased risk for heart disease) starting from 20 years old. Check your blood sugar level every five years (more frequently if you have other risk factors such as obesity or high blood pressure) starting from age 30 years old.

Practical Tips for Stress Management

Let's start with the four 'A's mentioned in the previous entry about healthy coping strategies for stress management: avoid, alter, adapt, and accept.

Avoid unnecessary stress

When doing this remember that not all stress can be avoided and it’s not healthy to avoid a situation that needs to be addressed.

Manage your time and personal limits.

• Set your priorities and move the tasks that aren’t truly necessary to the bottom of your to-do list, or eliminate them when possible. 
• Don't spend too much time with people who stress you out or if possible, avoid them entirely. This is not the same as social withdrawal where you avoid friends and people who are not causing you stress as well.
• Set your personal limits and stick to them. Learn how to say no when you think people are demanding more than you can handle.
• Take control of your environment. If the evening news makes you anxious, turn the TV off. If traffic’s got you tense, take a longer but less-traveled route.
• Avoid conversation topics that have the tendency to develop into heated arguments, like religion or politics.

Alter the situation

If you can’t avoid a stressful situation, try to alter it and figure out what you can do to prevent the problem from presenting itself in the future.

• Plan ahead and make sure you have enough time to do important tasks, but still have time to get enough rest.
• Communicate your needs and feelings. If you have an exam tomorrow and a friend plan to drop by, tell him or her you need to study. If something or someone is bothering you, voice your feelings openly in a respectful way. Holding everything inside will likely to build up resentment while the situation remains the same.
• Be willing to compromise. If you ask someone to change their behavior, be prepared to do the same. If you both are willing to bend at least a little, you’ll have a good chance of finding a happy middle ground. 

Communicate your needs and feelings.

Adapt to the stressor

If you can’t change the stressor, change yourself.

• Change your point of view and look at stressful situations from a more positive perspective. If you fail at something, look at it as a chance to learn from your mistakes and do better in the future. Look at the big picture and ask yourself how important it will be in the long run. Don't sweat the little things.
• Set reasonable standards for yourself and others. Try not to demand everything to be perfect, learn to accept things that are good enough.
• Focus on the positive things in your life: your family and friends, your own achievements and talents, including physical properties like your home. Learn to appreciate and be grateful for them.
• Avoid thinking negative thoughts, especially about yourself. Eliminate words such as 'always', 'never', 'should', and 'must' when you talk to yourself.

Accept the things you can’t change

There are things in life in which you have no power to do anything about, such as the death of a loved one, a natural disaster, or a war. Acceptance may be difficult, but it’s easier than ramming yourself against a situation you can’t change. Learn to forgive yourself and others for the mistakes they made.

Other strategies to reduce stress

Besides the four 'A's, listed below are other ways to manage stress:

• Spare some time to relax and have fun. Try to do at least one thing you enjoy doing every day.
• Maintain a good sense of humor, including the ability to laugh at yourself
• Eat a healthy diet. Avoid too much caffeine, alcohol, and sugar.
• Exercise regularly
• Get enough sleep

Stress Management: Coping The Inevitable

Human is equipped with a fight or flight response when faced with any challenges, physical or mental.

An adult who tells you he or she had never felt stressful in his or her life is either a saint or a liar. Let's face it, stress in inevitable. In fact, stress is part of a normal psychological and physical reaction to the ever increasing demands of life. There will never be more hours in a day, there will always be bills to pay, and there will always be occupational and social responsibility for you to deal with. Even with great coping strategies, stress won't disappear entirely from your life.

The human body is equipped with a fight or flight response when faced with any challenges, be it physical or mental. When facing a threat, our brain reacts by telling the body to increase the production of hormones, charging it up so it will be ready to respond. Once the threat is gone, our body is meant to return to a normal relaxed state. Unfortunately, the nonstop stress of modern life places a demand so that our body has to be constantly on alerted state.

Overworking is an unhealthy coping strategy.

Realizing that you are not powerless against life's challenges is the foundation of stress management. Managing stress is all about taking control. It may be hard to change the conditions of your environment, but your thoughts, emotions, and choices are your own. With practice, you can increase your coping ability and switch from unhealthy strategies to healthier ones.

"Healthy coping strategies require change."

Unhealthy ways to cope with stress include smoking, drugs and alcohol abuse, overeating or undereating, social withdrawal, sleeping too much, procrastinating, overworking, and taking out your stress on others by lashing out or physical violence. 

Generally, healthy coping strategies require change. That's why they are more difficult to implement than the easier, unhealthy ones. The change can be applied either to the situation or to your reaction. When deciding which option to choose, it’s helpful to think of the four As: avoid, alter, adapt, or accept.

Since everyone has a unique response to stress, no single method works for everyone or in every situation. Experiment with different techniques and focus on the ones that makes you feel calm and in control.

Cancer 102: How It Grows and Spreads

Previous entry talks about how a cancer starts. If only the cancer would stay in place, then it won't be difficult to treat with surgery. Unfortunately, the way most cancers grow and spread complicates things a bit.

Specific cancers may have different preferences, but in general the characteristics of cancer growth and spread are:

• Initiation: the transformation process of a normal cell into a cancer cell, from the first mutation until it escapes the body's defense mechanism. 
• Proliferation: the process in which the rate of cell growth of the cancer cells overcome the rate of cell death. Hormones and growth factors plays important role in affecting the rate of growth of certain cancers. Even though cancer cells are dubbed immortal, they do die because the body's immune system is constantly at work and because they grow so fast, from lack of nutrients. It is believed that the cancer cells achieve their proliferation through the initiation of stem cells which are normally abundant in actively growing tissues, such as in tissue repair.
• Invasion: the process in which the cancer cells overcome the natural boundaries of different types of tissues in our body. Invasion is one of the hallmark characteristics of a malignant tumor. Normally different types of tissues have very well defined borders. You won’t find skin cells growing in deep muscle, or liver cells growing in the stomach.
• Angiogenesis: the formation of new blood vessels to provide nutrients for the growing cancer cells. Tumors could only reach a certain size before they would exhaust themselves of nutrients if it were not for angiogenesis. In other words, this is the process where a cancer steals the body's resources to feed itself.
• Metastases: is the ability of cancer cells to spread to different parts of the body via the bloodstream or the lymphatic system. Metastases is another hallmark of malignant tumors. 

Every stage of development mentioned above can be interfered by different types of cancer treatment such as radiation or chemotherapy. Cancers that are growing rapidly and prone to metastases are more likely to be affected by these treatments compared to slow growing cancers which may yield better result with surgery. 

Cancer 101: How It Starts

Being immortal is not always a good thing. Take cancer cells, for example.

A normal cell carries genes inside its nucleus. These genes carries information that controls the cell's behavior including when it will grow and when it will die. Normally if something goes wrong within the cell, it is programmed to die. However, sometimes this fail-safe mechanism misses, allowing a cell to keep dividing uncontrollably until it forms a tumor.

Technically, every abnormal growth is called a tumor. It can be either benign or malignant. A benign tumor usually grows slowly or stop growing at one point and does not spread to other parts of the body. Cancer is a malignant tumor, which keeps growing and may spread to other places through the bloodstream or the lymphatic system.

The Mutation

Mutation is the start of a cancer.

Mutation means that a gene has been damaged or lost. Genes decide what kind of protein a cell will produce. Therefore, a mutated cell may produce too much or too little protein. Some proteins controls how a cell behaves. For example, when a hormone acts on a structural protein, it then sends a series of signals which tell the cell to reproduce by dividing into two.

Because of mutation, a signaling protein may be permanently switched on or proteins whose job is to control and limit cell division may be switched off. Often times, the cause of this mutation is a carcinogen. For example, there are carcinogens in cigarette smoke. Virus infection and ionizing radiation may also trigger these changes. Mutated genes can also be inherited.

The Genes

There are three different types of genes that plays important roles in cancer formation.

• Oncogenes are genes that encourage the cell to multiply. When people talk about cancer genes, this is what they usually meant.
• Tumor suppressor genes are the 'police' genes that stop the cell from multiplying. If one of these genes becomes damaged and stops working, then the cell will carry on dividing. In other words it becomes immortal, which is one of the properties of a cancer cell. The best known tumor suppressor gene is called p53.
• DNA repair genes repair other damaged genes. Mutations happen a lot more often than you may think. However, thanks to these repair genes, not every mutation will develop into cancer.

What happens after mutation?

It is not easy for a normal cell to turn into a cancer cell. Our body is equipped with means to prevent it from happening. Mutated cells often destroy themselves or the immune system might recognize them as abnormal and attack them. DNA repair genes are able to repair the mutations so that it takes more than a single mutation in order to start a cancer. It can take a long time before enough mutations happen for a cell to become cancerous. This is why most types of cancer are more common in older people.

The place where a cancer begins is called the primary cancer. Once developed, the cancer may spread locally into surrounding tissues. Cancer cells may also break away from the primary cancer and be carried off in the blood or lymphatic system, starting a new tumor in other parts of the body. A tumor that grow from from a cancer that have spread are called secondary cancer or 'metastases'.

Tips to Improve Sleep Habits

Everyone suffers from sleepless night every now and then. A lot of factors contribute to sleep problems, but fortunately most of them are modifiable. Stress, uncomfortable surrounding, occupation, dietary habit, pollution, and lack of physical activity are common things that can prevent you from falling and/or maintaining a quality sleep. 


The following tips will help you optimize your sleep habit so you can wake up feeling refreshed and energized for the rest of day.

1.   Create comfortable sleep environment

An ideal room for sleeping is usually cool, dark and quiet. Make sure your bed is comfortable and there is enough room for you stretch and turn if you share your bed with another person.

Try not to use an alarm clock to wake you up.

2.   Keep a regular sleep schedule

Consistency is important. If you keep a regular sleep schedule, your sleep-wake cycle (circadian rhythm) will become synchronized and it’s easier to sleep better this way. Go to bed and get up at the same time every day, even on weekends, holidays and days off. Try not to use an alarm clock to wake you up. If you are sleep deprived, it may take longer for you to wake up naturally.

3.   Pay attention to your diet

Avoid too much coffee or smoking. These stimulants will make it hard for you to fall asleep. Stay away from alcohol as well, because even though it makes you fall asleep faster, it reduces the quality of your sleep. Don’t drink too much fluid around bedtime because it will wake you up in the middle of the night to go to the toilet. Don’t eat too much either because a full stomach will keep you up until it finishes digesting the food.

4.   Stay active during the day

Regular physical activity will help you fall asleep faster and enjoy better sleep quality. Don’t exercise too close to bedtime, though. Avoid taking naps in the daytime if you can help it. If you can’t, limit them to 30 minutes at most in mid-afternoon.

5.   Try to regulate your circadian rhythm naturally

A light sensitive hormone called melatonin is produced by your brain to regulate your sleep-wake cycle. When it’s dark, melatonin levels increased, making you feel sleepy. On the contrary, when it’s bright, melatonin levels decreased making you feel awake. Getting enough sunlight in the daytime and avoid too much artificial light in the night will improve your sleep habit.

6.   Develop a bedtime ritual

Doing the same things each night before bed will help your body to relax and wind down, taking a hot bath, reading books, or listening to music for examples. Try not to include anything that requires you to look at an electronic screen like television, computer, or mobile phones.

7.   Deal with stress and anxiety

Easier said than done, but it’s not impossible. If you have a habit of worrying, try to evaluate your thoughts, sort the unrealistic ones out and replace them with productive ones. Even counting sheep is better than worrying. Stress management strategies like setting your personal limits, staying organized, and positive thinking will help you reduce the strain that’s keeping you from getting a good night sleep.  

OTC Painkillers - Use With Care

The two most commonly used over-the-counter pain relievers are acetaminophen (Paracetamol, Tylenol) and nonsteroidal anti-inflammatory drugs or NSAIDs (Aspirin, Ibuprofen, Aleve). There are many types of OTC painkillers marketed under different brand names with different prices, but there is no evidence that more expensive pills works better than cheaper ones.

Acetaminophen

Tylenol and Paracetamol belongs to the acetaminophen class. This type of drugs reduce pain and fever, but it does not have reduce inflammation and swelling. They are generally used to treat minor pain like tension headaches, influenza, and in chronic conditions where no inflammation is present.

Acetaminophen is metabolized in the liver and kidney. Therefore, people with liver and kidney condition or those who drinks alcohol should avoid taking it. Interaction with other medications like blood thinners and birth control pills also warrant precaution. Because acetaminophen is a common component in cough mixtures and in prescription medication, people often don't realize that they are taking products containing the same ingredient, resulting in overdose.

"People often don't realize that they are taking products containing the same ingredient."

Taking as little as 10-15 g of acetaminophen in 24 hours can cause life threatening liver damage which may not be apparent for 4-6 days. Symptoms of overdose includes nausea, vomiting, stomachache, kidney failure, and brain damage. Even though initial symptoms are not significant, patients should seek immediate medical attention.

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

NSAIDs relieve pain and is especially useful in reducing inflammation. There are three types of NSAIDs available for purchase without prescription: aspirin (Anacin, Bufferin, Empirin), naproxen (Aleve), ibuprofen (Advil, Motrin, Excedrin). Naproxen is more long-acting than aspirin and ibuprofen.

The most concerning side effect of NSAIDs is stomach bleeding. Symptoms includes black tarry stools, abdominal pain, or vomiting blood. Long term use may also cause kidney problems, even more prevalent than that caused by acetaminophen. That's why acetaminophen is a safer choice for chronic usage.

Children under 18 years old should not take aspirin because of the risk of developing Reye Syndrome, a potentially fatal condition. Aspirin also increases the risk of bleeding in people undergoing surgery. So be sure to tell your dentist or doctor that you take aspirin before they perform any procedure.

Normal Sadness or Depression?

Sadness, much like happiness, is a part of our life. Normal grief or sadness last only for a short while and rarely interferes with your daily functions. Depression, however, is a serious condition that not only affects a person's mood and behavior, but also one's bodily functions.

normal sadness or depression?

Depression is a common but serious illness. Each year depression affects 5-8% of adults in the United States. One in 10 people will have a depressive disorder in their lifetime and one of  those 10 cases will develop into major depression and even suicide. Depression occurs 70% more frequently in women than in men.

Signs and symptoms of depression varies depending on the individuals affected. Children may not display the same symptoms with adult. Also, if you display symptoms while under influence of substance abuse, you cannot be diagnosed with depression until the effect has cleared off. Listed below are common findings in people with depression:

• Persistent sadness or low mood most of the time for at least 2 weeks
• Loss of interest in pleasurable activities or hobbies
• Fatigue and decreased energy
• Feelings of hopelessness or pessimism
• Feelings of guilt, worthlessness, or helplessness
• Irritability or restlessness
• Difficulty concentrating and making decisions
• Sleep disturbances
• Loss of appetite or overeating
• Suicide thoughts or attempts
• Aches or pains, headaches, cramps, or digestive problems.

There are several forms of depression:

Minor depression is characterized by having symptoms of depression for of at least 2 weeks, but do not meet the criteria for major depression. If left untreated, minor depression can develop into major depression.

Major depression or major depressive disorder is characterized by severe, highly persistent depression, and a loss of interest or pleasure in everyday activities. The individual may have recurrent thoughts about death and suicide. Major depression is a disabling condition and prevents a person from functioning normally.

Dysthymic disorder or dysthymia is characterized by long-term (2 years or longer) symptoms that may not be severe enough to disable a person, but can prevent normal functioning.

A lot of people with depression never seek treatment. But the majority, even those with major depressive disorder, can get better with treatment. The earlier the treatment begins, the better the prognosis. Medications, psychotherapies, and other methods can effectively treat people with depression.

Different Types of Headaches

The head is one of the most common location of pain in the body.

The head is one of the most common location of pain in the body. There are many causes of headache, making it difficult to classify. In 2007, the International headache Society made a new classification system for headache in hopes that this new system will make the diagnosis more specific and treatment more effective.


The three major categories of headache are primary headaches, secondary headaches, and cranial neuralgias, facial pain, along with other headaches.

Primary Headaches

In primary headaches, the pain is not a result of an injury or underlying structural problem. This is the most common type of headache. Examples of primary headaches are:

• Tension headache or chronic non-progressive headaches is the most common form of primary headaches. Up to 90% of adults will experience tension headache in some point of their life. The pain comes from muscle contraction that cause mild to moderate pain that comes and go.
• Migraine headache is the second most common form of primary headache. Up to 18% of women and 6% of men will experience tension headache in some point of their life. The exact cause of migraine is unknown. The pain is moderate to severe, with pounding or throbbing quality, and maybe accompanied by nausea or vomiting and sensitivity to bright light, noise, or smell. It occurs episodically and each attack can last from several hours to three days.
• Cluster headache is a rare form of primary headache that affects only 0.1% of the population with men in their late twenties more commonly affected. The pain is severe, with constant burning, piercing, or throbbing quality, usually occurring in one side of the head and most intense behind the eye. During a cluster period, which may last from two weeks to two months, headaches occur 1-3 times per day.

Secondary Headaches

An underlying disease or injury in the head or neck is the cause of secondary headache. Not all of these structural problems are harmful, but problems like meningitis, brain tumor, or bleeding must always be considered. Some of the worst headaches resulted from secondary causes, such as subarachnoid bleeding that causes 'thunderclap' headache.

Cranial Neuralgias, Facial Pain, and Other Headaches

Cranial neuralgias and facial pain occur because of the inflammation on the nerves in the head and neck region. Unspecified headaches or when there is not enough information to classify the headache into other categories falls into 'other headaches' waste basket classification.

Headache could be a sign of a serious life threatening condition. Seek immediate medical attention if you experience any of the following:

Seek medical attention if you feel the intensity of pain is unusual.

• A perceived sensation of the worst headache of your life 
• Fever or stiff neck
• Seizures
• Headache associated with recent trauma
• Persistent nausea and vomiting
• Weakness in any part of the body
• Changes in levels of consciousness, speech, or vision
• Headaches not responding to pain medication

Systemic Lupus Erythematosus: The Great Imitator

butterfly or malar rash in SLE

Systemic Lupus Erythematosus (SLE) is an autoimmune disease that can affect any part of the body, hence the term systemic. Most commonly affected organs are the joints, skin, heart, lungs, kidneys, liver, blood vessels, and nervous system. In 2008, around 250.000 Americans have SLE. Women aged 20-30 years old are nine time more likely to be affected than men. African American and Asians are more commonly affected and the disease tend to be more severe in these ethnic groups.

Diagnosis

As in any autoimmune disorder, the immune system lost the ability to differentiate self and non self, producing auto antibody that attacks normal cells. Why our immune system turned against us is still unknown, but viral infection, sunlight and allergies may trigger the changes.

SLE is dubbed the great imitator because the symptoms can mimic other diseases, making the diagnosis a challenging one to make. The course of disease is completely unpredictable with flare-ups alternating with remissions. Severity ranges from mild to life threatening. Initially, most patients unspecific symptoms like fatigue, rashes, painful joints, and low grade fever.

Based on The American College of Rheumatology's criteria, a person is said to have SLE if he or she has at least four of the symptoms listed below.

the location of rashes in SLE

• Butterfly shaped rashes over the cheeks (malar rash), oval shaped rashes with raised borders (discoid rash), or rash over sun exposed skin
• Arthitis in two or more joints lasting more than a few weeks
• Chest pain when taking deep breaths, a sign of inflammation of the outer linings of the lung (pleuritis) or the heart (pericarditis)
• Kidney problems ranging from mild protein or blood in the urine to renal failure
• Nervous system disturbances like seizures, stroke, or delirium
• Sores in the mouth
• Abnormal lab results: 
• low red blood cells, low white blood cells, or low platelets
• positive auto antibodies like anti nuclear antibody (ANA) or anti double stranded DNA (anti-dsDNA), anti Smith (referred to as anti-Sm) or antiphospholipid antibodies, or a false positive test for syphilis

Treatment

Sadly there is no cure for SLE and its management can be rather complicated. The good news is that immunosuppresive therapy can greatly improve survival. Maintaining a good quality of life remains the greater challenge, however.

The medications commonly used for SLE includes:

• Nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce joint pain and inflammation.
• Antimalarial drugs such as hydroxychloroquine help with fatigue, rashes, joint pain, and mouth sores.
• Immunosuppressants such as azathioprine, cyclophosphamide, cyclosporin are used in patients with more severe and wide-spread symptoms.
• Corticosteroids is also used in the more severe form of SLE.
• Biological agents such as rituximab and abatacept modulate the faulty immune system.

Rheumatoid Arthritis: More Than Just Aching Joints

Rheumatoid arthritis is more than just aching joints. Unlike osteoarthritis where the primary damage occurs in the cartilage, rheumatoid arthritis is an autoimmune disease where the main problem lies in faulty immune system. Chronic inflammation of the joints and its surrounding tissue are not the only problems because the disease can also cause problems with your lungs, heart, and eyes.

In 2007 about 1.5 million people in the United States had rheumatoid arthritis. It usually starts in the middle ages, between 25 to 55 years old. Incidence increases with age and women are more likely to get it than men.

As with other autoimmune diseases, the exact cause of rheumatoid arthritis is unknown. Genetic factor, infection, and hormones may play a role in the development of this condition. Unlike the wear-and-tear damage of osteoarthritis, rheumatoid arthritis causes inflammation on the synovium (the lining of your joints), causing damage to the cartilage that eventually result in bone erosion and joint deformity.

What are the symptoms?

Rheumatoid arthritis begins gradually, affecting small joints of the hands and feet at first, causing minor joint pain and stiffness that are accompanied by fatigue or low grade fever. Over time, symptoms often spread to the knees, ankles, elbows, hips and shoulders. Severity varies and symptoms may come and go. Periods of when the disease gets worse (flare-up), alternate with periods when the pain and swelling gets better (remission).

Joint symptoms may include:

• Joint pain that oftentimes affects the same joint on both sides of the body, accompanied with warmth and swelling.
• Morning stiffness that usually lasts for more than 1 hour. 
• Deformity of joints and the surrounding structure with limited range of motion

small joints of the hands and feet are usually affected first

Systemic symptoms may include:

• Fatigue
• Low grade fever
• Weight loss
• Anemia 
• Chest pain or shortness of breath 
• Dry eyes and mouth 
• Buring sensation and itchiness in both eyes
• Lumps under the skin, called rheumatic nodules.

What are the tests to support the diagnosis?

The two lab tests that often came up with abnormal results are rheumatoid factor test and Anti-CCP antibody test. Complete blood count any show anemia. C-reactive protein and erythrocyte sedimentatio rate may be elevated, a sign of chronic inflammation. Your physician may also preform joint imaging like x-ray, ultrasound, or MRI and synovial fluid analysis.

What are the complications?

Rheumatoid arthritis can affect almost every part of the body. Complications may include:

• Lung damage and scarring causing shortness of breath
• Inflammation of the heart muscle and the outer lining of the heart can progress to heart failure
• Hardening of the arteries which in turn leads to nerve, skin, and brain problems
• Spinal injury if the neck joints are affected
• Osteoporosis

What are the treatment options?

A treatment plan usually includes medications, physical therapy, exercise, and even surgery. Early and aggressive treatment can delay joint destruction, but the drugs can have significant side effects especially because they will be used for life-long.

The most important drugs that are used to treat rheumatoid arthritis are the disease modifying antireheumatic drugs (DMARDs) like methotrexate, leflunomide, and chloroquine. Anti-inflammatory drugs like aspirin, acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), and corticosteroids are used to reduce inflammation and joint pain. Biologic agents like rituximab, infliximab, etanercept, and tocilizumab may be used when the other drugs failed to give improvements. They work by suppressing the immune system and thus carry risks of infection.

The Basics of Autoimmune Diseases

The immune defense system is designed to defend our body from foreign substance and other harmful invaders. A healthy immune system has the ability to differentiate between self and non-self, that is knowing what to kill and what to leave alone. In autoimmune diseases, the immune system lost the ability to tell the difference and attacks normal cells by mistake.

There are more than 80 different types of autoimmune diseases affecting more than 23.5 million people in the United States, causing disability due to the chronic nature of these disorders. In general, women especially the ones of African American, Hispanics, and Native American racial background have higher risks.

What happens in autoimmune diseases?

An antigen is a substance that has the ability to trigger the immune system. It can be bacteria, virus, fungi, blood or tissue from another person or species, and toxin. When an antigen entered our body, white blood cells produces antibodies to destroy it. There is also a type of white blood cells called the T cells that keeps antibody production in check and make sure it doesn't attack what it's not supposed to. In autoimmune diseases, the antibody turned to attack our own cells and is called auto antibody.

What causes the changes in our immune system behavior resulting in autoimmune diseases is unknown. Some have proposed that the antigen itself triggers this conversion. A similarity between the bacteria or virus genes with our own may confuses our immune system.

An autoimmune disease can target any organ in our body. It can also affect more than one bodily systems at the same time. Blood vessels, red blood cells, glands, joints, muscles, connective tissues, and the skin are commonly affected. Some examples of autoimmune diseases are systemic lupus erythematosus, multiple sclerosis, type 1 diabetes, rheumatoid arthritis, and Graves' disease.

Symptoms

Diagnosing autoimmune diseases provides one the most difficult challenges for physician because the symptoms varies greatly, may come and go, and can mimic other diseases. For most people, the initial symptoms are quite vague: fatigue, muscle aches, low grade fever, and general unwell feeling. Over time, symptoms will develop depending on affected organs.

Management

It's difficult to cure autoimmune diseases because the exact cause is unknown in the first place, but symptoms can be reduced and complications prevented. Treatment plan depends on the specific diseases. Often times, if the symptoms gets worse, immunosuppressive drugs may be needed. These drugs weakens your immune system and infection can be a problem for people who uses them for long terms.