By: Dr. Fabienne Langlois, Endocrinologist
Type 2 diabetes is a disease characterized by chronic hyperglycemia, which means too much glucose (sugar) in the blood. It usually occurs in older adults and is more common in people who are obese or overweight.
In a healthy individual, blood sugar control is achieved through insulin, a hormone secreted by the pancreas. Insulin allows sugar to enter the cells to be used as fuel, particularly in the muscles and liver. In a person with type 2 diabetes, the body becomes unable to regulate blood sugar, or the level of glucose in the blood. This is when blood glucose levels rise (called hyperglycemia). In the long term, if blood sugar levels are not lowered by treatment, this can cause serious health problems, especially cardiovascular problems.
This chronic disease requires individualized treatment and close monitoring by the affected person and the medical team. Healthy lifestyle habits are the basis of treatment. If these habits are not enough to lower blood sugar levels, medication may be used.
There are 2 main forms of diabetes, type 1 diabetes and type 2 diabetes, both characterized by chronic hyperglycemia.
Type 1 diabetes occurs in young people and often appears in childhood. It is caused by autoimmune destruction of the pancreas, which no longer produces insulin. The cause is poorly known and there is no prevention currently possible. People affected are therefore dependent on insulin, which must be administered by injection.
Type 2 diabetes, which accounts for 90% of diabetes cases, occurs later in life. It is mainly due to a state of insulin resistance and is associated with being overweight.
A disease in Strong Progression
The number of people with type 2 diabetes is steadily increasing and this trend is attributed to the “Western” lifestyle, which is associated with sedentary living and obesity, as well as an aging population. Globally, the International Diabetes Federation predicts that the number of people with diabetes could increase from 285 million in 2010 to 438 million in 2030.
In Canada, in 2009, 6% of people over the age of 12 years reported having diabetes. This rate increases with age, reaching nearly 18% among those 65 years and older. In total, more than 9 million Canadians have diabetes or prediabetes, including 650,000 Quebecers. In addition, many cases of diabetes are unknown because they are not detected.
Type 2 diabetes generally manifests itself after the age of 40, but is now affecting more and more children and adolescents because of obesity, which is affecting more and more young people.
Diabetes results from a combination of genetic, environmental and lifestyle factors. In general, each person carries a hereditary baggage that predisposes them to diabetes or protects them from it. Researchers now know several genes that put an individual at risk of developing type 2 diabetes. In people who are genetically predisposed to the disease, it is generally overweight and particularly the accumulation of fat in the organs of the abdomen that leads to insulin resistance, the first step towards type 2 diabetes.
Initially, to compensate for insulin resistance, the pancreas starts to produce more insulin. However, over time, the pancreas becomes depleted and insulin secretion decreases. As a result, there is a relative lack of insulin and blood glucose levels remain continuously high.
Type 2 diabetes is therefore the result of 2 phenomena: firstly, resistance to insulin, and secondly, the exhaustion of the pancreas.
Because type 2 diabetes rarely has early symptoms, it is often discovered incidentally during a routine medical examination.
Blood glucose tests can detect it: a fasting or random blood glucose test and sometimes a test for induced hyperglycemia. The latter test consists of a blood glucose reading 2 hours after ingesting a sweet juice containing 75 g of glucose. Fasting blood glucose levels often rise gradually over the years from a normal level to an intermediate state of prediabetes and then to the diabetic threshold.
Blood glucose levels can be measured by taking a blood sample or estimated using a blood glucose meter (glucometer), which allows the blood glucose level to be analysed on a drop of blood taken from the fingertip.
Even if the results are normal, it is usually recommended that these tests be done at regular intervals to detect disease as early as possible.
For information on acute complications (hypoglycemia and hyperglycemia due to treatment adjustment and hyperosmolar hyperglycemia syndrome in untreated diabetics), see our Diabetes Fact Sheet (Overview).
In the long term, many diabetics see their health condition worsen as a result of their disease, especially if the diabetes is not well controlled and monitored. Chronically high blood sugar levels gradually damage nerves and blood vessels, mainly in the eyes and kidneys. Diabetes can lead to cardiovascular disease, irreversible vision loss, pain due to nerve damage or kidney failure. For more information, see our Diabetes Complications fact sheet.
Symptoms of type 2 diabetes
In its early stages, type 2 diabetes causes few or no symptoms. It can go unnoticed for many years. However, some people may experience symptoms caused by high blood sugar, such as :
A frequent urge to urinate, especially at night. The kidneys produce more urine to try to eliminate excess glucose from the blood;
An increase in hunger and thirst, with a dry mouth feeling;
Excessive drowsiness, especially after meals;
More frequent bacterial or fungal infections (urinary tract infections, vaginitis, etc.).
Risk Factors for Type 2 Diabetes
Persons at Risk
People who have a first-degree relative (mother, father, brother or sister) with type 2 diabetes;
People who are obese or overweight, especially when the fat is concentrated in the abdomen rather than on the hips and thighs. This is because the fat in the organs of the abdomen (especially the liver) is the fat that interferes the most with insulin function. More than 80% of type 2 diabetics are overweight;
Certain populations are at higher risk, including Africans, Latin Americans, Asians and North American indigenous populations.
Being over 40 years old. Type 2 diabetes affects mostly adults, and its prevalence increases with age;
Have a sedentary lifestyle and consume too many calories;
For women, having had gestational diabetes or having given birth to a baby weighing more than 4 kg;
Have a metabolic syndrome. In the clinic, the physician will assess the presence of the following factors (3 are sufficient to diagnose this syndrome):
abdominal obesity, determined by measuring waist circumference;
high blood triglycerides;
Low blood HDL (“good”) cholesterol;
High blood pressure;
High fasting blood sugar.
Prevention of Type 2 Dabetes
The need for screening for diabetes in the absence of symptoms will be assessed with the physician.
The earlier the disease is detected – even before the onset of symptoms – and the earlier intervention to restore normal blood glucose levels, the lower the risk of complications (cardiovascular, eye, kidney or neurological disorders, etc.). There is growing evidence of the effectiveness of early intervention.
Here are some recommendations: :
Assessment of the risk of diabetes in adults should be done by the physician at the time of the annual check-up;
Fasting blood glucose testing should be undertaken every 3 years in all adults 40 years of age and older, with or without symptoms. This screening should be done earlier or more frequently when risk factors have been found. A test for induced hyperglycemia may be undertaken for further analysis to establish the diagnosis;
Screening for the disease in high-risk children every 2 years is advised.
Basic preventive measures: Weight control, healthy eating and exercise
Type 2 diabetes can be prevented by simple means. One study, the Diabetes Prevention Program, showed that at-risk individuals who participated in 30 minutes of physical activity per day and were able to lose 5% to 7% of their weight decreased their risk of developing diabetes by 58%.
Being overweight increases insulin requirements and overstrains the pancreas. A person’s healthy weight is determined by their body mass index (BMI). Calculate yours with our Body Mass Index (BMI) and Waist Circumference test. It’s not a question of aiming for a healthy weight at all costs, but a weight loss of 5% to 10% in 6 months already provides significant health benefits.
A healthy and varied diet helps maintain a healthy weight. It also helps maintain a relatively stable blood sugar level throughout the day, as well as good blood pressure. To do this, eat as many as possible 3 meals a day at regular times, avoid excess animal fat and added sugars (glucose, fructose, dextrose, etc.) and favour foods rich in fibre. For an overview of the basic principles to follow, see How to eat well?
Regular physical activity also contributes to maintaining a healthy weight or to eliminating excess weight if necessary. Being active also helps insulin work more effectively. It is recommended to be active for at least 2.5 hours a week, spreading physical activity throughout the week in periods of at least 10 minutes at a time (brisk walking, swimming, jogging, cycling, etc.). It is important to start gradually and gradually increase the duration and intensity of the activity. Physical activity in itself can significantly reduce the risk of becoming diabetic.
Measures to prevent complications
It is important that the antidiabetic treatment is well adjusted. Adequate control of blood glucose levels prevents complications. To ensure that treatment is effective, regular self-monitoring of blood glucose levels with a blood glucose meter and medical follow-up are essential. Your doctor will use the level of glycated or glycosylated hemoglobin (HbA1c) in your blood (measured at least twice a year), which reflects the average blood glucose levels over the last 3 months.
Blood glucose targets to aim for that reflect good control :
a blood glucose level of 4 mmol/l to 7 mmol/l before meals;
a blood glucose level between 7 and 10 mmol/l 2 hours after a meal;
a glycated hemoglobin level of less than 7%.
Medical Treatments for Type 2 Diabetes
Diabetics can expect to lead an active, independent and dynamic life without any limitations. It remains important to respect certain basic principles, in particular with regard to :
an appropriate diet;
the adoption of an active lifestyle;
monitoring of capillary blood glucose levels.
For more details on lifestyle management for type 2 diabetes, please see our Diabetes Overview fact sheet, where you will find :
A diagram of glucose absorption;
a video showing how to use a blood glucose meter;
a table of optimal blood glucose values for teenagers and adults with diabetes;
an eating plan (see also our Special Diet: Diabetes fact sheet).
Suggestions for physical exercise;
Ways to manage stress.
For some people, regular adherence to this lifestyle will be enough to control blood sugar levels, while for others, medication will also be necessary. The goal of treatment is to keep blood glucose (sugar) levels within normal ranges. The means to achieve this are different for each person.
There is no cure for diabetes. It is a chronic disease and lifelong treatment is necessary. However, better nutrition and regular physical activity is a real way to treat diabetes and can help avoid the need for medication. If these measures are not enough, doctors may prescribe one or more of the following diabetes medications, all of which have the effect of lowering blood sugar levels or helping to control them.
Metformin (Glucophage® or Glumetza®) is the cornerstone of treatment for the vast majority of people with type 2 diabetes. It works by decreasing insulin resistance, which helps the body use glucose more efficiently without the risk of hypoglycemia. It also promotes weight loss;
Medications that increase insulin secretion (or insulin secretors) include sulfonylureas (Diabeta®, Diamicron®, Diabeta®) and glinides (Starlix®, GlucoNorm®). They directly stimulate insulin production by the pancreas through various mechanisms. They are very effective in controlling blood sugar levels, but with the potential risk of causing hypoglycemia;
Thiazolidinediones (or glitazones), a class of drugs that includes rosiglitazone (Avandia®) and pioglitazone (Actos®), improve blood glucose levels by decreasing insulin resistance. These drugs are being prescribed less and less in Canada and warnings have been issued by regulatory agencies because of the risk of heart attacks and fractures in certain populations. It should be noted that rosiglitazone-based drugs were withdrawn from the European market at the end of 2010 due to their cardiovascular adverse effects;
Acarbose, which is an alpha-glucosidase inhibitor (Glucobay®), reduces the absorption of carbohydrates in the gut. They must be taken with a meal to be effective and may cause bloating and flatulence caused by unabsorbed sugars;
Incretinomimetics (or incretins) are a new family of drugs that includes Januvia® (sitagliptin), Byetta® (exaenatide), Onglyza® (saxagliptin) and Victoza® (liraglutide). They work by increasing insulin secretion after a meal without causing hypoglycemia. Oral medications (sitagliptin and saxagliptin) have a neutral effect on weight. Victoza® is a newcomer to the market, is administered by injection and is associated with weight loss. However, it is not indicated for first-line use and its long-term effects and safety are unknown.
Weight-loss medications such as orlistat (Xenical®) may be considered in diabetic patients suffering from obesity. They are useful for improving blood glucose levels by allowing weight loss. However, their cost is high and they are not appropriate for all patients.
Insulin treatment with injections is a very valid option, although it is often used after failure of oral medications. It can also be used temporarily, for example, in cases of severe hyperglycemia, infection, hospitalization, or surgery. Insulin injections may be required when medications are no longer sufficient because insulin secretion decreases over time in people with type 2 diabetes. Injections are usually given once a day, often in the evening. Some people can also be treated with an insulin pump.
Type 2 Diabetes – Our Doctor’s Opinion
If you have type 2 diabetes, you can have some control over your disease by taking an active role in your treatment. Diabetes is a demanding disease, but it has the advantage of being able to change the course of the disease by being involved in its treatment. You will reap long-term benefits.
There are many tools to improve your blood glucose levels, and adopting a healthy lifestyle is the basis of treatment. It is also important to monitor your blood glucose levels regularly. This will tell you right away if your diabetes is well controlled or not. The frequency of monitoring varies from person to person, but should be increased at least 1 week before your doctor’s appointment to allow him or her to analyze changes in your capillary blood glucose levels during the day and to better adjust your treatment. In addition, the prevention of complications related to diabetes involves, among other things, stopping smoking and controlling blood pressure and cholesterol levels, which your doctor will assess.
The goal is to achieve and maintain an acceptable average blood sugar level without hypoglycemia. This average is reflected in the measurement of glycated hemoglobin. You can ask your doctor to share your results with you so that you know where you stand in relation to the targets.
Finally, several avenues have been studied to prevent this disease, including medications. However, simple healthy eating and exercise are the most effective. These recommendations are achievable and free of side effects, but more importantly, they provide health benefits that go far beyond diabetes prevention.
Type 2 diabetes – Complementary Approaches
Warning. Self-medication for diabetes can cause serious problems. When you start treatment that changes your blood glucose levels, you must monitor your blood glucose levels very closely. It is also necessary to inform your doctor so that he or she can review the dosage of conventional blood-glucose-lowering drugs if necessary.
Ginseng (Panax ginseng and Panax quinquefolium). A growing number of good quality studies are validating the traditional use of ginseng roots and rootlets to treat diabetes, but trials involving a larger number of subjects would allow more reliable conclusions to be reached4. 4 Ginseng is thought to help normalize blood glucose levels in people with diabetes,28 particularly after meals.
Psyllium (Plantago ovata). The main effect of taking psyllium with a meal is to lower the total glycemic index of the meal. This causes glucose and insulin levels to decrease by 10% to 20% after the meal. Psyllium works in a similar way to acarbose, a medication used by some people with type 2 diabetes: it slows down the absorption of carbohydrates into the digestive system. A 2010 review of 7 randomized studies concluded that psyllium is an interesting treatment option for type 2 diabetics who are on medication and still have high blood glucose levels after meals.
Glucomannan. a soluble fibre, similar to psyllium but even more absorbent and emollient than psyllium. It is made from konjac flour (a type of tuber) in a purified form. The results of several clinical trials indicate that glucomannan may be useful in reducing or controlling blood sugar levels in people with diabetes or obesity.
Oats (Avena sativa). Research indicates that consumption of oatmeal helps to prevent the rise in blood glucose levels following a meal (postprandial hyperglycemia). Oatmeal may also help to control blood glucose levels over the long term. Like psyllium, oatmeal contains high levels of soluble fibre, which slows gastric emptying.
Chromium. a trace element essential to human health, naturally present in many foods. In particular, it increases tissue sensitivity to insulin, which helps normalize blood sugar levels. In 2007, a meta-analysis of 41 trials (including 7 in patients with type 2 diabetes) showed that chromium supplements decreased glycated hemoglobin levels by 0.6% and fasting blood glucose levels by 1 mmol/L41. However, the use of chromium supplements (from 200 μg to 1,000 μg per day) by people with diabetes remains controversial given the highly variable quality of the studies conducted to date.
Fenugreek (Trigonella foenum-graecum). The results of a few clinical studies in diabetics have shown that fenugreek seeds may help regulate blood glucose levels in type 216-18 diabetes. Although promising, these trials had a number of flaws, so it is not possible at this time to suggest a treatment protocol19.
Cinnamon (Cinnamomum verum or C. cassia). Some small studies have shown that cinnamon can reduce blood glucose levels in people with diabetes, but more comprehensive studies will be needed to confirm these results.
Tai-chi. Some researchers have speculated that tai-chi may help regulate blood glucose levels in people with diabetes. To date, the various studies have presented contradictory results. Some studies show improvements, others do not.
Aloe (Aloe vera). Aloe is one of the plants to which Ayurvedic medicine (from India) attributes hypoglycemic or anti-diabetic properties. Studies conducted to date tend to confirm this use, but are few in number. Dosage: Although the efficacy of the gel as a hypoglycemic substance is not clearly established, it is usually recommended to take 1 tbsp twice a day before meals.
Blueberry or bilberry (Vaccinium myrtilloides and Vaccinium myrtillus). In Europe, blueberry leaves have been used for more than 1,000 years to lower blood glucose levels. Tests carried out on animals tend to confirm this traditional use. However, the use of blueberry leaves for this disease has not been tested on humans. Dosage: Practitioners recommend infusing 10 g of leaves in 1 litre of boiling water and taking 2 to 3 cups of this infusion per day.
Gymnema (Gymnema sylvestre). In many countries (India, Japan, Vietnam, Australia…), traditional doctors use gymnnema to lower glucose levels in diabetics24,28,29. However, no double-blind clinical trial with placebo has been conducted, so there is no scientifically valid evidence of its effectiveness. Dosage: Rather than dried leaves, a standardized 24% gymnemic acid extract is used nowadays. This extract, often referred to as GS4, is the raw material for the majority of commercial products. Take 200 mg to 300 mg of this extract twice a day with food.
Momordica (Momordica charantia). Momordica, also known as margose, is a tropical climbing plant that produces fruits that look like cucumbers. Traditionally, several peoples have used its fruit to treat a variety of ailments. The consumption of fresh fruit juice is believed to help regulate blood sugar levels in diabetics, for example, by lowering blood sugar levels. This effect has been confirmed by several in vitro and animal tests. Studies in humans are at the preliminary stage. Dosage: Traditionally, it is recommended to drink 25 ml to 33 ml of fresh fruit juice (about the equivalent of 1 fruit) 2 to 3 times a day before meals.
Nopal (Opuntia ficus indica). The stems of the nopal, a cactus from the desert regions of Mexico, have been used in traditional medicine to reduce fasting blood glucose in diabetics. This effect has been observed in a few clinical trials conducted by Mexican researchers. Rich in dietary fibre, nopal is believed to act mainly by reducing glucose absorption. Dosage: In studies with positive results, 500 g of roasted nopal flesh was used per day.
Naturopathy. The American naturopath J.E. Pizzorno suggests, among other things, that diabetics should take a multivitamin and mineral supplement,36 as the disease would lead to an increased need for nutrients. In his experience, this practice improves blood glucose control and helps prevent the major complications of diabetes. A double-blind, placebo-controlled study of 130 subjects (45 years and older) showed that people with diabetes who took multivitamins for one year had fewer respiratory infections and flu than untreated diabetics.
Moreover, the naturopath considers important that diabetics consume a large quantity of flavonoids, in food form, for their antioxidant effect. Indeed, there are more oxidation and inflammation reactions in the body of people with diabetes. Flavonoids are found mainly in fruits and vegetables (artichoke, onion, asparagus, red cabbage and spinach) and in even greater quantities in berries. They are also found in the form of supplements.
Type 2 Diabetes – Websites and Support Groups
These do not treat diabetes but could improve overall health. See our Naturopathy fact sheet.
The mission of this association is to inform about diabetes and to promote research on this disease. Diabetes Québec also provides services and defends the socio-economic interests of people with the disease.
See suggestions for recipe books in the Books and Materials section: www.diabete.qc.ca
Canadian Diabetes Association (Association canadienne du diabète)
Very complete site in English (some documents are available in French): www.diabetes.ca
Of particular note on this site, about the exercise: www.diabetes.ca
Health Canada – Diabetes
An up-to-date dossier on diabetes, in French and English.
Programs and services for people with diabetes: www.phac-aspc.qc.ca
Prevention program for Aboriginal populations: www.phac-aspc.qc.ca
Quebec Government Health Guide
To learn more about drugs: how to take them, what are the contraindications and possible interactions, etc., click here.
American Diabetes Association
International Diabetes Federation: For its news articles, presentation of epidemiological data, announcement of international congresses, etc., it is the ideal partner for the company. (in English only, French and Spanish translations in development).
What Happens When breast Cancer Spreads to the Bones?
You may not know it, but most cancers can spread to bone. Once metastases have spread, they can cause unfortunate complications. However, there are different treatments for each type of problem. These include surgery and radiation therapy.
Bone metastases are a common problem in oncology, the specialty of medicine that treats cancers. Every year in United states, 150.000 cancer patients develop bone metastases, i.e. a secondary location of the main cancer in the bones. Bones are the organs most exposed to secondary lesions of a tumor. But some cancers have a higher risk of having bone metastases, with breast cancer, prostate cancer and multiple myeloma being the first to develop.
Complications caused by bone metastases decrease the patient’s autonomy and in some cases require emergency management. They can lead to fractures, severe pain, hypercalcemia (abnormally high levels of calcium in the blood), or spinal cord compression (bone exerting pressure on the spinal cord). But there are different treatments for each complication that can help relieve the patient.
Formation of Bone Metastases
Bone is composed of two types of cells that participate in its renewal: while osteoclasts destroy aging bone tissue, osteoblasts rebuild the skeleton. This process of formation and resorption is necessary for bone growth. But some cancers disrupt the balance maintained by the osteoblasts and osteoclasts, making the bone brittle.
Bone metastases are the main cause of pain in cancer patients, with the greatest intensity at night. Other problems can also arise, such as hypercalcemia, which affects 10 to 15% of patients, especially those with breast cancer, some lung cancers and multiple myeloma. Symptoms can include severe fatigue, loss of appetite, feelings of intense thirst, or the urge to vomit. Hypercalcemia can also lead to major confusion or kidney failure, requiring emergency hospitalization.
Once bone metastases have set in, the risk of pathologic fracture (a fracture that occurs without shock) is higher, sometimes with serious consequences. Indeed, if the vertebrae are affected, they can compress the spinal cord that connects the brain to the entire body and thus cause paralysis. This is called spinal cord compression and this complication requires emergency care of the patient.
For each Complication, its Treatment
Depending on the type of complications encountered, different solutions are available to patients. For example, in the case of localized bone pain, external radiotherapy (the use of radiation produced by a machine on the cancer cells) makes it possible to administer a dose of radiation that will reduce the pain. In 60% of cases, a single session is enough to make the pain disappear, but the irradiation can be repeated if it fails. When the pain is located in several places, metabolic radiotherapy may be considered. This consists of injecting a radioactive product into a vein that penetrates directly into the bone metastases and eliminates the pain. In all pain management situations, pain medication will be combined with pain medication to provide rapid relief to the patient.
Although radiotherapy also reduces the risk of fracture, surgery is sometimes necessary. Indeed, it stabilizes the bone but also prevents spinal cord compression or an imminent fracture. If there is a risk of fracture or in the case of poorly relieved pain, it is possible, under local anesthesia, to inject cement into the weakened bone to consolidate it.
Bone Targeted Medications
Two drugs can also be offered to patients. Administered orally or in the veins, biphosphonates reduce the risk of complications related to bone metastases. They have certain side effects (digestive disorders, renal insufficiency, flu-like symptoms, lower blood calcium levels), but these are well controlled. Another serious but rare complication (1.5% of cases), is necrosis (death of a cell or organic tissue) of the jaw, a risk that is however diminished by an administration generally not exceeding two years. In addition, patients whose kidneys are not functioning well cannot receive this treatment.
Denosumab, on the other hand, helps solidify bone and reduces the risk of complications. Unlike biphosphonates, it can be given to patients with malfunctioning kidneys. Its side effects are similar to those of the first drug.
Both treatments are equally effective in reducing complications related to bone metastases and prolonging the patient’s life. However, they cannot be taken for more than two years, because after that time, the risk of jaw necrosis increases considerably.
The various therapies that can be used to treat complications related to bone metastases are quite effective. In the near future, other solutions will also be offered to patients. Indeed, new therapies targeting the osteoclast are being evaluated while other products seek to treat the bone and the tumor simultaneously.
How long Can you Live with Stage 4 Metastatic Breast Cancer?
The staging of breast cancer makes it possible to determine the degree of extension of the pathology. The stage is determined by the elements of the assessment at the time of diagnosis (clinical examination by the doctor, additional tests such as mammography, ultrasound, MRI…). The staging of breast cancer will allow the disease to be assessed at several levels:
- Local: corresponds to the development of the tumor in the breast (size and infiltration).
- Regional: corresponds to the extension of the disease in the armpit on the same side, and therefore to the existence or not of lymph nodes affected by the disease.
- General or “distant”: corresponds to the extension of the disease outside the breast and armpit, and therefore the existence of metastasis.
What are the signs when breast cancer metastasizes?
Symptoms related to the presence of metastases can go unnoticed for a long time. However, unusual bone pain or headaches may be warning signs that should prompt women to seek help. Explanations by Dr. Mahasti Saghatchian, oncologist and breast cancer practitioner at the Gustave Roussy Institute.
Based on these elements, the stage of the cancer is defined according to the TNM classification (Tumor, Nodes (nodes), Metastasis) defined by the International Union Against Cancer (UICC) and the American Joint Committee on Cancer (AJCC).
“The stage is important to assess the extent of the disease, but insufficient on its own to determine the prognosis of the disease and therefore the necessary treatments,” explains Dr. Julien Seror, cancer surgeon at the Clinique St Jean de Dieu in Paris. For this, it will also be necessary to rely on the patient’s field (age, history, other pathologies…) and histology (biopsy result) which is an essential element in the evaluation of a breast cancer. This explains why management must be done on a case-by-case basis, after analyzing all the data, and after discussing the files in a PCR (multidisciplinary consultation meeting)”.
Depending on the extension, it will be possible to establish the “TNM” stage:
- T: the size of the tumor. Specifies the infiltrating or non-invasive character of the lesion (non-invasive lesions are limited to the canal or lobule, unlike infiltrating lesions that invade the fat around, but inside the breast), as well as the size of the lesion.
- N: the lymph node extension. Specifies whether there is an attack on the local-regional lymph nodes.
- M: The remote extension. Existence (M1) or not (M0) of metastases.
The TNM assessment determines a stage of progress in five stages :
- Stage 0 corresponds to a cancer in situ (non-invasive).
- Stage 1 corresponds to a single small tumor,
- Stage 2 corresponds to a more important local invasion,
- Stage 3 corresponds to an invasion of the lymph nodes or surrounding tissues,
- Stage 4 – metastatic cancer – corresponds to a distant extension, thus the existence of metastasis.
The choice of Treatments
The different treatments to treat breast cancer are determined by the stage and type of cancer. They have the following objectives:
- Remove the tumor or metastases
- Reduce the risk of recidivism
- Slow the development of the tumor or metastases
- Treating the symptoms caused by the disease
Sometimes one type of treatment is enough to treat breast cancer. In other cases, a combination of treatments is required. “Each patient’s case must be discussed in a multidisciplinary consultation meeting (MDC), during which at least one surgeon, one oncologist and one histologist meet, to determine a personalized care protocol,” continues the doctor.
The choice of the necessary treatments will be made according to: the patient’s background: age, associated pathologies, history of cancer and treatment…, the stage of the disease, the histological characteristics of the tumor (real identity card of the tumor, allowing to evaluate the potential aggressiveness), the tumor grade (I, II or III), the Ki 67: Index of tumor proliferation, the presence of hormonal receptors, which implies most often, in case of positivity, the introduction of hormone therapy. Overexpression of the HER2 protein, which, in the case of a positive result, usually implies treatment with antibodies (traztuzmab, HerceptinÓ ) combined with chemotherapy.
The Different Treatments of Metastatic Breast Cancer
“This is the treatment most often used in the first instance, its objective is to remove the tissue affected by the cancer cells,” confides Dr. Seror. Two types of surgeries are performed: a conservative breast surgery called lumpectomy or segmentectomy, and a non-conservative breast surgery called mastectomy.
- Conservative surgery involves removing the tumour and a small portion of the tissue surrounding the tumour so that most of the patient’s breast is preserved. This surgery is preferred as soon as possible, and is complemented by radiotherapy to avoid the risk of recurrence.
- Non-conservative surgery consists of removing the entire breast. In this case, if the patient’s condition allows it, breast reconstruction techniques are offered to the patient. In some cases it will be possible to preserve the areola and nipple.
- Surgery of the axillary lymph nodes: in the majority of cases, only removal of the sentinel lymph node, the first relay of the lymph node chain in the armpit, will be preferred. In the case of lymph node involvement, axillary curage, i.e. removal of the lymph node chain, is often required.
Radiotherapy uses high-energy ionizing radiation. This method helps to preserve surrounding healthy tissues and organs. For breast cancer, four areas can be treated according to different cases:
- The mammary gland after conservative surgery;
- The tumor bed after conservative surgery;
- The chest wall after non-conservative surgery;
- The lymph node areas
It is a treatment administered by a general route, usually intravenous, which requires the insertion of a catheter to administer the treatment. Side effects vary according to the treatment protocols.
It is an oral treatment, in tablet form, taken daily for 5 to 10 years. The type of treatment varies according to the patient’s status with respect to menopause.
Stages and life expectancy
“Since 2005, there has been a trend towards earlier detection and improved treatment, which improves survival,” says Dr. Seror. Thus, net survival at 5 years standardized on age has increased from 80% for women diagnosed in 1989-1993 to 87% for those diagnosed in 2005-2010. The 5-year net survival for women with breast cancer diagnosed in 2005-2010 is highest (9,293%) for women aged 45-74, slightly lower (90%) for those aged 15-44 and much lower (76%) for women aged 75 and older.
“Very few registries in the United States, as at the international level, provide data by stage of cancer for survival analyses,” concludes the specialist. Indeed, the stage is difficult to collect routinely, and can also be a source of error”.
Thanks to Dr Julien Seror, cancer surgeon at the Clinique Saint Jean de Dieu in Paris.
13 Shocking Facts About Metastatic Breast Cancer
When cancer cells are identified outside the breast, it is called metastatic breast cancer. Its management and treatments are then very specific. An update with Dr. Cyriac Blonz, medical oncologist at the Western Cancer Institute.
While in the vast majority of cases, breast cancer is detected and treated while it is still localized, sometimes cancer cells can migrate to other parts of the body via the blood and lymph to form metastases. They can be identified at the time of initial diagnosis, but most often they appear later, usually within 5 years of diagnosis. More rarely, a metastatic recurrence can sometimes occur late, sometimes 10 to 20 years after the initial diagnosis.
The 3 main types of cancer – Her2+, RH+ and triple-negative – are potentially metastatic.
Metastatic Breast Cancer Signs
While metastatic breast cancer can go undetected for a long time, metastases sometimes cause signs or symptoms. Identifying them quickly allows for faster and often more effective management of the disease.
The signs depend on the location of the metastases, which in turn depends on the nature of the cancer.
“Each type of cancer has its own tropism, i.e. a tendency to develop in a specific organ. Breast cancer will preferentially metastasize to bones, lungs, liver or brain for example,” Dr. Blonz describes.
> Bone metastases can cause bone pain at night and even fractures;
> Advanced lung metastases can cause shortness of breath;
> Liver metastases can cause jaundice, also known as jaundice;
> And finally, brain metastases can cause severe headaches.
What is the difference between osteoarthritis and rheumatoid arthritis?
Arthritis is a general term used to describe inflammation of the joints. Osteoarthritis and rheumatoid arthritis (RA) are two types of diseases known to affect the musculoskeletal system in many ways. Their prevalence in modern society is quite high, but with timely interventions, the negative impact on quality of life can be eliminated. The main difference between osteoarthritis and rheumatoid arthritis is that osteoarthritis is a degenerative disorder of the wear and tear type, whereas rheumatoid arthritis is an autoimmune disease.
What is osteoarthritis?
Also known as osteoarthritis, osteoarthritis is a degenerative type of disorder known to be the most common form of arthritis in the community.
It occurs as a result of wear and tear on the protective cartilage at the end of the joints over time. This cartilage acts as a cushion that absorbs friction, and its absence can lead to continuous friction generated by the bones rubbing against each other, ultimately resulting in a worn joint. Although this condition can damage all joints in the body, the joints most often affected are the hands, knees, hips and spine.
Advanced age, obesity, joint trauma, genetics, bone deformities (malformed/defective cartilage), long-term weight bearing and weightlifting may be risk factors for osteoarthritis; women are at higher risk than men. This is most often seen in people over the age of 40, but it can also be seen in young people after an accident or trauma.
Osteoarthritis patients usually have pain around the affected joints, difficulty moving them because of stiffness. The pain and stiffness worsens more towards the morning, just after waking up, which usually lasts more than 30 minutes. In addition, these people will also complain of loss of flexibility, limited range of motion, loss of muscle mass, and a grating sensation on moving joints and spurs presenting as hard, bony structures on the skin around the affected joints.
Osteoarthritis must be diagnosed as early as possible and interventions must be timely, as it can lead to a debilitating, lifelong disease in which patients will no longer be able to work.
Your doctor will take a full history and conduct a thorough physical examination to look for signs of inflammation such as pain, tenderness, swelling, redness, and difficulty moving around and make a general diagnosis. However, this will be confirmed by an x-ray (you may see worn bones, missing cartilage and spurs) with or without an MRI. In addition, blood (ESR) and joint fluid tests may also be important to exclude other mimetic conditions such as rheumatoid arthritis and gout.
Although there is no comprehensive treatment for osteoarthritis, lifestyle modifications and pharmacological interventions are known to help alleviate symptoms.
Although there is no complete treatment for osteoarthritis, lifestyle modifications and pharmacological interventions are known to help reduce symptoms.
Lifestyle modification – Regular exercise, maintaining a healthy body mass index, avoiding joint stress by lifting heavy weights
> Pain relief: Acetaminophen can be used to relieve mild to moderate pain, but long-term use may result in liver damage,
> Non-steroidal anti-inflammatory drugs (NSAIDs) – Ibuprofen, Naproxen sodium,
> Antidepressants such as duloxetine – to treat chronic pain,
Surgical procedures – corticosteroid injections to relieve severe pain and inflammation
> Hyaluronic lubrication injections,
> Realign the bones,
Arthroplasty- removal of damaged joint surfaces and replacement with metal or plastic parts
What is rheumatoid arthritis?
Rheumatoid arthritis is a chronic autoimmune disease characterized by pain, tenderness, swelling and stiffness in the affected joints, including the hands, feet and wrists, in a symmetrical fashion. It can also lead to extra-articular manifestations involving the skin, eyes, lungs, blood and nerves.
Although the exact etiology of rheumatoid arthritis is unclear, it is an autoimmune disease in which the body produces antibodies against its own cells. Some scientists suggest that microorganisms such as viruses and bacteria play a major role in pathophysiology.
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Rheumatoid arthritis generally affects people in their early 20s. The majority of patients with rheumatoid arthritis experience pain, tenderness, swelling and lameness of the joints throughout the body, which progresses gradually over the course of weeks. Fever, loss of appetite and weight, generalized body pain, red eyes, rheumatoid nodules on the skin, anemia, etc. can also cause extra-articular symptoms. Patients may also experience aggravated joint pain in the morning, which usually improves within 30 minutes. to arthrosic pain.
Doctors are able to diagnose this disease by analyzing the signs and symptoms derived from a complete history, as well as family history information. This can be further confirmed by imaging studies such as X-rays and MRI, as well as blood tests such as erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and cyclic anti-citrulline antibody (anti-CCP) testing.
The treatment plan for rheumatoid arthritis consists primarily of lifestyle modifications and pharmacological interventions.
Lifestyle modifications – Regular exercise when inflammation is controlled and appropriate rest during severe attacks.
> Anti-inflammatory agents,
> Analgesics (Narcotics),
Disease-modifying anti-rheumatic drugs (DMARDs) – Hydroxychloroquine, immunosuppressants such as methotrexate,
Although rheumatoid arthritis is not cured for life, timely interventions can certainly prevent disability.
Difference between osteoarthritis and rheumatoid arthritis
Type of diseases
The main difference between osteoarthritis and rheumatoid arthritis lies in the nature of its natural evolution. Although both conditions affect our musculoskeletal system, Osteoarthritis is a degenerative disorder of the wear and tear type, whereas rheumatoid arthritis is an autoimmune condition.
Both conditions have a significant female predominance, but osteoarthritis generally affects people over 40 years of age, while the incidence of rheumatoid arthritis is higher in young people around 20 years of age.
Osteoarthritis is the result of long-term pressure on large joints such as the hips, knee, elbow, causing wear and tear, while the exact etiology of rheumatoid arthritis is not very clear, suggesting the influence of genetic predisposition and long-term smoking.
Signs and symptoms
Joint pain, tenderness and stiffness around the hands, fingers and knees,
One side is more affected than the other,
Morning stiffness for more than 30 minutes,
Multiple joint pain, stiffness and tenderness,
Morning stiffness that improves within 30 minutes of activity,
Extra-articular manifestations such as fatigue, fever, weight loss and malaise,
A clear history can easily be diagnosed between these two conditions, but XRAY, MRI and blood tests can be used to confirm the diagnosis. X-rays of a patient with joint damage, missing cartilage and spurs are visible. Osteoarthritis.ESR, CPR, anti-CCP may be elevated in rheumatoid arthritis while there will be no change in osteoarthritis.
Pain relief, symptom management and prevention of destruction are the main goals of management. In particular, rheumatoid arthritis must be treated with immunosuppressants. Osteoarthritis and rheumatoid arthritis have no long-term curative treatment, but with timely interventions, complications can be stopped.
How to Prevent Arthritis? 6 Exercises to Prevent Arthritis
Arthritis pain is experienced differently from one person to another. Its intensity depends largely on the severity and extent of the disease. Sometimes the pain temporarily subsides. Daily activities often need to be reorganized accordingly.
We do not yet understand all the biological mechanisms involved in the genesis of arthritis pain. However, it appears that tissue oxygen depletion plays a major role. This lack of oxygen is itself caused by inflammation in the joints and tension in the muscles. That’s why anything that helps to relax muscles or promotes blood circulation in the joints relieves pain. On the other hand, fatigue, anxiety, stress and depression increase the perception of pain.
Moving around on a regular basis can help prevent and improve many health problems, including arthritis. Physical activity, such as swimming, walking and bicycling, also helps protect joints while strengthening muscles and building fitness. Strengthening your muscles provides support for your joints and reduces your risk of developing arthritis. Tai chi chuan and yoga also help reduce stress on your joints and improve your balance.
Here are 6 exercises to perform to keep arthritis at bay.
Target: knees and hips
A. Lie on your left side with your left leg bent and your right leg straight. Place your elbow on the floor and your head on the palm of your hand.
B. Lift your right leg and hold for a short moment while exhaling. Slowly lower the leg without letting go. Inhale. Do the exercise with the left leg.
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Lateral deltoid lift – standing
A. With a medium dumbbell in each hand, move the right foot forward 60 cm (at the next session, move the left foot forward). Bend the advanced leg and slightly bend the chest from the waist. Keep your back straight, abdominals contracted and body weight forward. Keep your shoulders low and backwards.
B. Extend your arms toward the ground, hands and dumbbells parallel to your shoulders. Slowly raise your arms at your sides, palms down and elbows slightly bent, to shoulder height (see illustration).
C. Return the arms to the starting position. Repeat 8 to 12 times.
A. Lie on your back with your legs extended and your hands behind your ears (or touching them lightly).
B. Contract your abdominal muscles. Raise your head and move your left knee toward your head, stopping when your knee is at your waist and your thigh is perpendicular to the ground. At the same time, bring your right elbow towards your high knee (your trunk will be slightly twisted) so that your elbow and knee are as close to your stomach as possible.
C. Slowly return to the starting position. Rest for one second and repeat with opposite limbs. Always begin your abdominal strengthening exercises by pushing your abdominal muscles towards your tailbone and keeping your back flat. Avoid arching your back. Use your stomach muscles rather than your neck muscles to lift your trunk.
Tip: This exercise should take about 5 seconds: 2 seconds to bring the knee and elbow together, and 3 seconds to return to the starting position. As you get stronger, reduce the rest time. All movements must be controlled, which will keep your muscles strong for a long time.
Do a series of 8 repetitions two to three times a week. Hold the position for 15 to 30 seconds.
Target: back and spine
A. Lie on your stomach, arms stretched out over your head, legs straight and the tops of your feet touching the floor.
B. Raise your feet, arms and shoulders at the same time off the floor, contracting the muscles of your lower back. Avoid making sudden movements or lifting your head during the exercise; in other words, keep your neck in line with your spine.
C. Hold the contraction for 2 seconds and then return to the “up” position.
Sweater over with dumbbells
A. Place your head and shoulders on the ball, lifting the basin.
B. Take the weight with both hands and slowly lower the arms until they are parallel to the ground.
C. The arms are slightly bent; begin the movement at the shoulders to return to the original position.
Tip: This exercise can be performed on a weight bench.
Forearm flexion in standing position
A. In the standing position, the feet are at shoulder height and the resistance band passes under both feet. Grasp the handles, palm forward.
B. Bend your arms, bringing your hands together at shoulder level. Elbows are glued to the body throughout the exercise.
C. Slowly return to the original position. Avoid immobilizing the shoulder.
What Does Arthritis Feel Like?
There are many diseases that can cause joint and bone disease. While they are known to affect the elderly, more and more young people are also suffering from these conditions. The causes of these disorders are very varied and it is essential to know them in order to better avoid and prevent them. In addition to consulting doctors and specialists, other methods can greatly help, especially in the prevention of disorders such as hernia, arthritis and gout problems.
Arthritis, a disease affecting more and more young people
When discussing joint disorders, arthritis is often mentioned. It is a general name for many diseases that affect muscles, joints and also bones. While some diseases, such as osteoarthritis, usually affect adults and the elderly, other forms are more common in young people, often from the age of 12.
How do you recognize an arthritis infection?
It is not easy to recognize this disease. In fact, symptoms differ from one form to another. While in most cases, the best known signs are inflammation, it is possible that some forms of infection do not have these symptoms. Therefore, consulting a specialist remains the best way to detect the disease.
What causes arthritis?
Despite much research in the field, the exact origins of this disease are not completely known. However, scientists have been able to determine some of the most common causes of arthritis. According to studies, trauma and infections are at the origin of this disease.
Natural wear and tear on certain parts of the body can also cause the disease. It is mostly a result of repeated physical exertion that strains the muscles and skeletal system.
Finally, arthritis can be the consequence of autoimmune diseases such as type 1 diabetes, thyroid disease, or rheumatoid arthritis.
Manifestations of arthritis
There are several forms of arthritis. They are categorized according to their manifestations and the parts of the body affected. In this case, there are two main forms of arthritis.
It is the most common manifestation of this disease. It is also known as degenerative arthritis because it is caused by the wear and tear of cartilage due to age. Osteoarthritis is most often located in the joints that support a large part of the body’s weight, such as the hip, knees, spine and feet.
Although it rarely appears before the age of 40, factors such as excess weight, repeated use of a joint or the practice of sports can promote its early onset.
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This inflammatory disease occurs mostly around the age of 40 to 60. It is initially characterized by inflammation of the joints in the hands, wrists and feet. If no measures or treatments are applied, the inflammation can affect other organs and then the entire body. Its cause is not yet known, but it is hypothesized to be hereditary and autoimmune in origin. However, this does not explain the fact that it is more common in women than in men.
Other common forms of arthritis
Other forms can also characterize an arthritis condition. While they are rarer, they are no less important and can lead to complications of varying degrees of severity.
Infectious arthritis: occurs when any infection directly affects a joint, which can lead to inflammation.
Gout: it is characterized by the deposition of materials from uric acid and calcium phosphate in the joints. This inevitably causes inflammation and pain.
Ankylosing Spondylitis: is a joint inflammation that affects the back and, in particular, the vertebrae. It is characterized by lumbar and hip pain that can gradually lead to back stiffness.
What is Rheumatoid Arthritis? – Symptoms and treatment
Rheumatoid arthritis is the most common form of chronic inflammatory rheumatism. This pathology leads to inflammation of several joints. It most often affects the hands, wrists and knees, but can extend to the shoulders, elbows, neck, hips, ankles, etc. It evolves in flare-ups and can be very painful and disabling. Early diagnosis is necessary in order to initiate treatment that will limit the evolution of the disease and relieve symptoms.
Rheumatoid arthritis: what is it?
Rheumatoid arthritis (RA) is a systemic connective tissue disease characterized by chronic joint inflammation that progresses in relapses. It gradually causes symmetrical deformities of the affected joints, with various manifestations affecting organs other than the joints.
The joints are lined by the synovial membrane, which secretes a lubricant: the synovium. Inflammation flushes out this layer of cells, causing the tissue to sprout and then erode the cartilage in the joint, which is no longer normally lubricated by the synovium. The joint is thus gradually destroyed and replaced by coarse tissue that almost welds the two ends of the bones together. This is what causes the more or less tight ankylosis of the joint.
Rheumatoid arthritis in figures
It is the most common chronic inflammatory rheumatic disease in adults. It affects about 0.5% of the population in the wrold, i.e. 200,000 people, with a clear predilection for women, who are three times more affected than men.
All ages are concerned, but the term rheumatoid arthritis only applies to patients over 15 years of age. Before this age, chronic joint inflammation takes several forms (ACJ or juvenile chronic arthritis, Still’s disease). Most often, however, the disease begins between 30 and 60 years of age, with a peak around the age of 45.
Rheumatoid arthritis is favored by the presence of the HLA-DR1 antigen found in 60% of patients and HLA-DR4 which is found in 30% of them.
Causes and risk factors of rheumatoid arthritis
Rheumatoid arthritis is first and foremost a chronic inflammatory rheumatism likely to develop into very disabling joint deformities and destruction linked to rheumatoid synovitis. Rheumatoid synovitis determines the formation of a pannus (thickening of the membrane) which can be assimilated, by its consequences, to the localized proliferation of an inflammatory tissue. It is a polyfactorial autoimmune disease, which may be due to :
A genetic factor: there are predisposition genes (such as HLA-DR1 or HLA-DR4) but they only represent 30% of the determinism of the disease;
Environmental factors: in particular, tobacco plays a very important role in the onset, severity of RA and response to treatment;
Infectious factors: Certain viruses and bacteria can be implicated, such as Porphiromonas gingivalis, but their role remains to be confirmed;
Psychological factors: in 20 to 30% of cases, RA occurs after a shock or significant event, such as bereavement, surgery, childbirth, etc.
Hormonal factors: it appears more often at the time of menopause.
The combination of several of these factors considerably increases the risk of developing the disease.
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Symptoms of rheumatoid arthritis
An evolution by pushes
The first joints affected are usually those of the hands and knees. The pain is permanent but often subsides at the beginning of the night, allowing the patient to fall asleep. The pain reappears in the second half of the night and wakes the patient up. On waking, the joints are stiff, swollen, warm and the morning “rusting” is painful. These symptoms persist for a few weeks or months, then subside and may even disappear…before coming back. Relapses and remissions then follow one another, but, without treatment, the joints become deformed and the disease spreads: shoulders, elbows, ankles, feet are affected.
The evolution is very variable and the severity of the disease is unpredictable, differing from one patient to another. In the majority of cases, the disease is of average severity, compatible with a tolerable life.
In some cases, it stabilizes, with or without joint deformities. In other, more severe cases, it leads to deformity and permanent ankylosis of several joints and thus to disability.
Signs of the disease
To facilitate this difficult diagnosis, the American Rheumatology Association (ARA) has developed criteria.
The presence of the first 4 criteria allows the diagnosis of rheumatoid arthritis to be retained:
- Morning stiffness of a joint lasting more than 1 hour for at least 6 weeks;
- Inflammation of at least 3 joints for more than 6 weeks;
- Inflammation of the wrist, metacarpophalangeal or interphalangeal joints for at least 6 weeks;
- Symmetrical joint inflammation for at least 6 weeks;
- Radiological signs on the hands;
- Subcutaneous nodules;
- Presence of rheumatoid factor in the blood.
The European League Against Rheumatism (EULAR) has developed and published a series of criteria which, if present, are scored. When the total score is equal to or greater than 6, the clinical diagnosis of rheumatoid arthritis can be made.
In practice, the diagnosis of rheumatoid polyarthritis is often difficult during the first year of evolution.
The extra-articular manifestations (affecting organs other than joints) of the disease are numerous:
- An alteration of the general state is noted during the outbreaks, with a fever of 38°, 38°5 ;
- Firm, subcutaneous nodules are seen especially on the extensor surfaces of the limbs;
- Renal damage is possible, but less frequent than in lupus;
- Cardiac, pleuro-pulmonary and ocular damage is possible;
- Sometimes there are adenopathies (lymph nodes).
Additional examinations and tests
Specific biological tests (rheumatoid serology) are often negative at the beginning and become secondarily positive during the first year: latex test, Waaler-Rose, presence of antibodies against citrullinated proteins. 15% of rheumatoid arthritis patients remain seronegative.
Conversely, many diseases that are not rheumatoid arthritis are accompanied by the presence of rheumatoid factors in the blood: Osler’s endocarditis, systemic lupus, various connective tissue diseases, Gougerot-Sjogren syndrome, syphilis, tuberculosis, leprosy, viral infections, tropical parasitosis, chronic bronchitis, pulmonary fibrosis, pneumoconiosis with fibrosis, lymphomas, Waldenstrom’s disease, hepatitis, cirrhosis, sarcoidosis. .. This presence is also possible during kidney transplants, in drug addicts (heroin), in elderly subjects.
In addition, 15 to 30% of rheumatoid arthritis patients have antinuclear antibodies (as in lupus), which is far from facilitating the diagnosis!
X-rays of the joints at the beginning of the course of rheumatoid arthritis are normal. Bone erosions often appear after one year of evolution.
Examination of the synovial fluid and biopsy of the synovium can provide interesting information.
Treatment of rheumatoid arthritis
The global management of rheumatoid arthritis combines:
- Medications for the basic treatment,
- Symptomatic or crisis treatments (analgesics, non-steroidal or steroidal anti-inflammatory drugs),
- local therapeutics (evacuating punctures, corticoid infiltrations, synoviorthesis with osmic acid…),
- functional rehabilitation measures (resting devices, occupational therapy, physiotherapy, etc.),
- psychological care,
- sometimes surgical procedures.
Overall, the objectives of rheumatoid arthritis management are to relieve pain, stabilize existing lesions and prevent the occurrence of new ones, limit damage and disease progression, and improve the patient’s quality of life. For this reason, it is recommended that this management and follow-up be carried out in a specialized setting with the inclusion of specialists and a multidisciplinary team of health professionals.
Pregnancy often leads to an improvement of the disorders but substantive treatments must be discontinued due to the risks to the fetus.
Tips for living better with rheumatoid arthritis
Various advice as well as information and education facilitate the daily life of the patients:
- Rest, especially during relapses;
- To be helped at home;
- At work, a reclassification procedure can be considered or a workstation layout can be negotiated;
- Designing the house with hand ankylosis in mind: modifications to doors, locks, faucets, toilets, washroom
- Use adapted instruments: brush and comb with long handles, cutlery with large handles, pencils and pens of large diameter
- Remove buttons on clothes and replace them with Velcro fasteners;
- Use shoes without laces and devices to put stockings on…
What is Psoriatic Arthritis?
Medically verified by Daniel Koch, Senior Specialist Medical Affairs, MSD Switzerland
What is psoriatic arthritis? Who is most often affected by this disease? How does psoriatic arthritis develop and progress? What is a flare-up? Can psoriatic arthritis be treated well? You will find the main information on this subject in this article.
Psoriatic arthritis is a chronic inflammatory disease affecting both the skin (psoriasis) and the joints. The term “chronic” means that the disease is long-lasting and can recur.
Most people first develop psoriasis before being diagnosed with psoriatic arthritis. But joint problems may also occur before pathological changes in the skin and nails.
Psoriatic arthritis is an autoimmune disease and belongs to the group of spondylitis (along with ankylosing spondylitis). The term “spondylitis” simply refers to a chronic inflammatory disease of the joints and spine.
Skin Changes in Psoriasis
Skin changes are triggered by a strongly accelerated growth of skin cells. While this process normally takes 28 days, the renewal of affected skin cells takes only one week in the case of psoriasis. The incomplete keratinization process leads to the formation of scales. The affected skin areas dry out and may bleed. Acute flare-ups may be accompanied by severe itching.
Joint changes in arthritis
In affected joints, the synovial membrane is inflamed and secretes more synovial fluid. This leads to an effusion. This inflammatory process leads to redness, excessive heat and swelling.
Read More : About Arthritis: What is Arthritis?
If the process becomes chronic, i.e. the inflammation does not stop, more connective tissue, called pannus, is formed. This connective tissue first covers the joint surfaces and can then proliferate into cartilage and bone, eventually destroying the joint structure.
Structures close to the joints such as capsules, tendons and ligaments can also be affected by inflammation, which can contribute to instability and misalignment of the joint.
How does psoriatic arthritis progress?
In psoriatic arthritis, skin changes usually appear first. Joint inflammation usually occurs later. It appears rather insidiously and is mainly limited to one side of the body. In rheumatoid arthritis, on the other hand, both sides of the body are usually affected in the same way. However, it is also possible that joint inflammation occurs first and psoriasis later.
Psoriatic arthritis usually progresses in flare-ups. About 5-20% of patients have severe joint damage and about 30% have milder damage.
What is a “Flare-Up”?
With current treatment options, psoriatic arthritis can generally be well controlled, and patients can live for longer periods of time without symptoms. A “flare-up” means that the disease suddenly reappears after an asymptomatic phase. The intervals without joint symptoms do not necessarily correspond to those without skin symptoms.
5 typical forms of psoriatic arthritis
Asymmetrical oligoarticular arthritis. Asymmetrical involvement of small finger or toe joints or large joints such as knee, shoulder or ankle joints. All joints of a finger or toe may be affected (“sausage attack”).
Distal interphalangeal arthritis (DIA). The end joints of the fingers and toes are more affected.
Symmetrical polyarthritis. Inflammatory changes in the joints are symmetrical: the same joints are often affected on the left and right sides of the body.
Spondylitis (spinal inflammation). This condition can lead to pain and stiffness in the spine or in the joint with the pelvis.
Mutilating arthritis. Mainly affects the small joints of the hands and feet.
Transitional and mixed forms are possible.
Who can suffer from psoriatic arthritis?
Psoriasis is a disease that can cause pathological changes in the skin and nails. It affects between 85,000 and 255,000 people in Switzerland. It is estimated that about 30% of these patients also develop psoriatic arthritis. Psoriatic arthritis affects women and men equally.
What Causes Arthritis Pain?
Arthritis is simply defined as an inflammation of the joint. People with arthritis may experience more than one inflamed joint. There are many types of arthritis, but the two most common types are rheumatoid arthritis and osteoarthritis. Joint stiffness and joint pain are the two most common symptoms of arthritis. Pain appears to be the most common, and there are many different causes of arthritis pain, including synovial inflammation of the membrane, fatigue, muscle tension, and inflammation of tendons and ligaments.
Synovial Membrane Inflammation
The synovial membrane is a tissue that lines the joints. When this tissue becomes inflamed, there is mild to severe pain and the result is stiffness. In some cases, it can limit a person’s mobility.
Inflamed Tendons and Ligaments
Tendons and ligaments connected to an affected joint can become inflamed in this way. Pain can result from this inflammation. Like the pain associated with an inflamed synovial joint, it can be mild to severe.
Straining the muscles around or near an affected joint can increase the pain of arthritis. Muscle strain can also lead to a temporary decrease in mobility, which can add stiffness, which in turn can lead to more pain. The increase in pain due to a tense muscle can be mild to severe.
Read More : About Arthritis: What is Arthritis?
Fatigue can increase the feeling of pain. Many people with arthritis are older, and therefore experience more fatigue and in turn more pain from arthritis. Often, reducing fatigue can reduce the pain associated with arthritis.
Damage, Heat and Swelling
When an arthritic joint is damaged, swollen or hot, the more pain it can cause. Many times, swelling is due to edema (water retention), so taking steps to reduce this factor can reduce swelling and pain. Heat can occur in joints affected by arthritis and often goes away on its own. The damage caused by the pain of arthritis can be due to a number of things, such as trauma and degeneration. Trauma, such as falls and traffic accidents, can lead to further damage to arthritic joints. Joint degeneration due to aging can also contribute to injury.
Physical, Emotional and Other Factors
Emotional factors such as anxiety and depression are thought to aggravate the pain of arthritis. These conditions can lead to decreased tolerance to pain and fatigue, which can make arthritis pain worse. Some people are simply more sensitive to pain and will automatically experience more. Some people develop hypersensitivity to the pain of arthritis due to tissue damage and inflammation in the affected joints.