Pandas syndrome what to know about it
February 9, 2022

What is Pandas Syndrome?

PANDAS is an acronym for pediatric autoimmune neuropsychiatric diseases associated with streptococcus. Following infection with Streptococcus pyogenes, children experience abrupt and typically substantial changes in personality, behavior, and mobility.

The majority of people who contract strep make a full recovery. However, a few weeks following infection, some younger people may experience abrupt physical and psychological problems. These symptoms tend to worsen quickly once they begin.

PANDAS Syndrome Symptoms

PANDAS symptoms appear abruptly, four to six weeks after a strep infection.

Psychological symptoms may include:

  • Obsessive, compulsive, and repetitive behaviors
  • Separation anxiety, fear, and panic attacks
  • Incessant screaming and frequent mood changes
  • Emotional and developmental regression
  • Visual or auditory hallucinations
  • Depression and suicidal thoughts

Physical symptoms may include:

  • Tics and unusual movements
  • Sensitivities to light, sound, and touch
  • Deterioration of motor skills
  • Hyperactivity or an inability to focus
  • Memory problems
  • Trouble sleeping

Also read: Attention Deficit Hyperactivity Disorder (ADHD): Everything You Need to Know

Causes of PANDAS Syndrome

The specific cause of PANDAS is still being investigated. According to one theory, it might be caused due to an inadequate immunological response to a strep infection. This is because strep bacteria are extremely adept at evading the immune system’s detection. They camouflage themselves using chemicals that resemble those found in the human body and affect your brain.

How is PANDAS Syndrome Diagnosed

There is currently no lab test that can diagnose PANDAS. Doctors usually depend on the reported symptoms and medical history of the kid. However, doctors will perform a throat examination to see if your child has an active strep infection in many cases. If the test comes back negative, the infection may be hidden elsewhere, like the genitals, and further testing will be required.

What is the Difference Between PANS And PANDAS?

The start of OCD symptoms or disordered eating following an illness or other immune system trigger is PANS (acute neuropsychiatric disorders). On the other hand, PANDAS is a subgroup of problems caused by Group A strep infections in children. While both PANS and PANDAS is common in children, PANS can also occur in adults.

What is the Relationship Between Pandas and Autism?

PANDAS does not appear to be more common in children with autism than in other children. However, PANDAS may be difficult to diagnose in kids with autism due to the overlapping symptoms. It might also be misdiagnosed as classic OCD, which frequently co-occurs with autism.

Generally, the quick onset of symptoms separates PANDAS from autistic symptoms or typical OCD. This might involve new concerns and obsessive habits, as previously indicated.

Treatment for PANDAS

PANDAS is treated by addressing both physical and psychological symptoms. To begin, your physician will ensure that the strep infection has been entirely resolved. We recommend consulting a registered mental health practitioner experienced with OCD and PANDAS.

Antibiotics help many children, and their symptoms improve or disappear. This isn’t always the case, though. When antibiotic treatment fails to relieve the child’s symptoms, they may require counseling and other long-term assistance. PANDAS is not a fatal illness, but it can hurt a child’s quality of life.

If your child is suffering from any of the symptoms mentioned above, or if you need help to treat your child from PANDAS syndrome, contact us today. At the Center for Occupational and Environmental Medicine, we have got a team of professional doctors who are committed to taking full care of you and your loved ones for a better quality of life.

February 8, 2017

Rheumatoid Arthritis is a chronic disease whereby various joints in the body are inflamed, leading to stiffness, pain, swelling and the possible loss of function. It usually affects the joints symmetrically i.e. on both the sides equally and may initially begin in couple of joints only and most frequently attacks knees, ankles, shoulders, wrists and hands.

Rheumatoid Arthritis is an autoimmune disease in which the body’s immune system – which generally protects its health by attacking foreign substances like viruses and bacteria – mistakenly attack the joints and other tissues causing chronic inflammation. The immune system contains complex organization of cells and anti bodies designed normally to find and destroy the invaders of our system, particularly infections. Though inflammation of the tissue around the joints and inflammatory arthritis are characteristics of rheumatoid arthritis, the disease also causes inflammation and injury to other organs of the body. As it can affect multiple other organs of the body, rheumatoid arthritis is referred to as a systemic (body-wide) illness and sometimes is also known as rheumatoid disease. Rheumatoid arthritis that affects children under 16 years of age is referred as juvenile idiopathic arthritis.

  • The process of disease leading to rheumatoid arthritis begins with synovium – the tissues that lines the inside of joints and around the joins that makes a fluid that lubricates joints making them move smoothly creating a protective sac.
  • In addition of lubrication of joints, this fluid also supplies nutrients and oxygen to cartilage, a slippery tissue that coats the ends of bones; it composes of collagen – the structural protein in the body that forms a network to give support and flexibility to joints.
  • In rheumatoid arthritis, an affected immune system produces destructive molecules that cause continuous and harmful inflammation of synovium. Gradually, the collagen is destroyed, hence narrowing the joint space and eventually damaging bone.
  • If the disease develops into a form called progressive rheumatoid arthritis, the destruction process accelerates.
  • Fluid and immune system cells gathers in synovium, producing a pannus – a growth composed of thickened synovial tissues. With the development of the disease, the pannus produces more enzymes that destroy nearby cartilage, aggravating the area and attracting more inflammatory white cells, thereby perpetuating the process.


The exact causes of Rheumatoid arthritis are still not known, but this condition is most likely triggered by a combination of factors such as abnormal autoimmune response, inflammatory process, genetic factors and at times environmental or biological factors like viral infections and/or hormonal changes.

  • Abnormal Autoimmune Response & Inflammatory Process

The immune system helps the body to fight and respond to the foreign substance and antigens – a substance that induces the formation of antibodies, since it is recognized as a threat by our immune system – like toxins and viruses. It helps the body fight these infections and accelerates the healing of wounds and injuries. The inflammatory process is an outgrowth of the immune system. There are two main components of the immune system that are associated with rheumatoid arthritis, namely, B cells and T cells, both belonging to a group of immune cells called lymphocytes – a type of white blood cell.

If the T cell recognizes an antigen as “non self”, it will result in producing chemicals (cytokines) which in turn causes B cell too multiply and release many antibodies (immune proteins). These antibodies spread in the bloodstream, and help identifying foreign substances and ultimately causing inflammation in order to get rid of these invaders of the body.

For unknown reasons, these T cells and B cells become over active in patients with Rheumatoid Arthritis.

  • Genetic Factors

Genetic Factors may play a significant role in either increasing the chances of developing RA condition or by worsening the process of the disease. The key genetic marker of RA is Human Leukocyte Antigen (HLA). HLA is not responsible is the development of Rheumatoid arthritis, but they can worsen the condition once developed. Other than that, STAT4 – a gene that plays an important role in the regulation and activation of immune system; TRAF1 and C5 – genes relevant to chronic inflammation; and PTPN22 – gene associated with both development and progression of RA, are connected to Rheumatoid Arthritis. Yet not all people with these genes develop RA and not all RA patients have these genes.

  • Environmental Factors

These factors include infectious agents like bacteria and viruses which may trigger the development of the disease in a person who is more likely to get RA. Research shows that factors like obesity, physical or emotional stress, exposure to cigarette smoke, air pollution, harmful chemicals, occupational exposure to mineral oil, silica etc.


Researchers have proven that about 1.3 million Americans e affected by Rheumatoid Arthritis. Although RA can develop in any age from childhood to old age, it normally begins between the ages of 30 – 50 years. Women are more likely to develop this condition than men.

The symptoms of Rheumatoid Arthritis are:

  • Swelling And Pain

Te inflamed joints are usually swollen and are often warm and spongy when touched. The pain occurs on both sides of the body and may be more severe on either side.

  • Building up of certain

Fluid may get accumulated in joints. The fluid gathered in the joint sac behind the knee forming a tumor like substance called Baker’s Cyst. This cyst sometimes extends down the back of the calf and causes severe pain.

  • Nodules

In some cases of RA, inflammation of small blood vessels may cause nodules or lumps, under the skin. These nodules are often situated near the elbow (it can show up at other places too) and are about the size of pea or slightly larger than that. These nodules can become sore and infected, particularly if their location is where stress occurs, for e.g. Ankles.

  • Specific Joint Pain

Although RA mostly develops in the wrists and knuckles, the balls of the foot and knees are often affected too. Joints like those in the cervical spine, shoulders, jaw, elbows and even the joints between the inner ear, gets eventually affected.

  • Flu like Symptoms

Fatigue, loss of weight and fever are also few symptoms.

Complications Involved

  • Anemia – RA patients tend to develop anemia i.e. decrease in the number of red blood cells.
  • Eye Problems – Inflammations of the blood vessels in the eyes, like scleritis and episcliritis that can result in corneal damage. Symptoms include redness of the eye and gritty sensation.
  • Skin Problems – Skin problems are common in RA patients, usually on the fingers and under the nails.
  • Infections – RA patients are at a higher risk of being affected by infections, because of the disease itself and also due the immune suppressing drugs used in the treatment.
  • Peripheral Neuropathy – RA condition affects the nerves, most often n hands and feet.
  • Joint Deterioration and Pain – Affected joints become deformed due to the disease.
  • Osteoporosis – Loss of bone density, is more common than average in postmenopausal women with RA. The hip is particularly affected. The risk for osteoporosis also appears to be higher in men with RA who are over 60 years old.
  • Lung Diseases – Chronic lung diseases like interstitial fibrosis, pulmonary hypertension etc. are also caused in RA condition.
  • Pregnancy Complications – Women with RA are more prone to premature delivery. They are also at higher risk of developing high blood pressure than in normal cases.
  • Kidney and Liver Problems
  • Heart Problems


The primary goal of treating RA is:

  • Stop inflammation
  • Prevent joint and organ damage
  • Relieve Symptoms
  • Improve physical functions
  • Reducing long term complications

The treatment is of different types:


Different drugs are used in the treatment of Rheumatoid Arthritis. Some are to ease the symptoms of RA, others to slower and eventually stop the different activities of RA.

Drugs used to ease the symptoms – Non-steroidal anti-inflammatory drug (NSAIDs) are used to ease the pain and inflammation involved in the condition of RA. These drugs include ibuprofen, ketoprofen and naproxen sodium. Patients with stomach ulcers are prescribed to take celecoxib, also known as COX-2 inhibitor, which is proven to be safer for stomach. These drugs can be taken by mouth or also can be applied to the skin.

Drugs that slower the RA activity– Corticosteroids medications like prednisolone, prednisone and methylprednisolone are some of the fast acting anti-inflammatory medications used in the treatment.

Disease Modifying Anti-Rheumatic Drugs (DMARDs) are the standard medical treatment for RA. Their ability is to slow down the progression of RA. These include- Methotrexate, leflunomide, hydroxychloroqune, minocycline and sulfasalazine. Unfortunately, all DMARDs tend to lose effectiveness over time and may also produce stomach and intestinal side effects.

Biological DMARDs – drugs made out of living cells are also used in the treatment. They are subsets of DMARDs. They target specific components of the immune system that contribute to the various attributes of rheumatoid arthritis. They include abatacept, adalimumab, anakinra, certolizumab pegol, etanercept, infliximab, golimumab and rituximab.


Some people with RA are benefitted by joint surgeries. It can help in relieved joint pains and correcting deformities and at times it modestly improves joint function.

Joint Replacement

Joint replacement (arthroplasty) is usually done for people over age 50 or those whose joint damage is rapidly progressing. The joint replacement can last for 20 years or more.


Its’ advisable for RA patients to maintain balance between rest and moderate exercise. Studies suggest that even little physical therapy can help the patients and that these benefits are sustained.

Natural Treatment

Natural Supplements

  • Boswellia Serate (Indian Frankincense) – contains anti-inflammatory and pain relieving properties.
  • Capsicum Fruitescens – reduces substance P, a pain transmitter. Research suggest that it helps in 50 percent reduction of joint pain. It’s available in the form of topical cream, gel etc.
  • Fish Oil Capsules (EPA & DHA) – Omega-3 blocks inflammatory cytokines and prostaglandins, and are converted into effective anti-inflammatory chemicals. EPA and DHA are very effective for treating RA and other inflammatory conditions. Studies prove that fish oil significantly decreases joint tenderness and stiffness in RA patients, helping in reduction or elimination of NSAIDs.
  • Gamma Linolenic Acid (GLA) – GLA is an Omega-6 fatty acid that the body converts into anti-inflammatory chemicals. Its intake shows significant improvement in joint pain, stiffness and grip strength. Studies show that a combination of fish oil and GLA reduces the need for conventional pain relievers.
  • Ginger – Ginger has the properties of anti-inflammatory components similar to ibuprofen and COX-2inhibitors, without any side effects. Its intake reduces osteoarthritis pain in the knee and other joints. It also reduces inflammatory reactions of RA.
  • Pine bark extract, rosehips, green-lipped mussel, devil’s claw, borage seed oil etc. also help in the treatment.
  • Change in Diet
February 8, 2017

Restless legs syndrome is a condition that causes an overwhelming urge to move your legs. It is also known as Willis-Ekbom disease. It is experienced by more women than men in the general population and can be a common problem for people who have Parkinson’s. Symptoms can start at any age, but it is more common as you get older.

Restless legs syndrome can be mild, moderate, severe or very severe based on the strength of the symptoms, how often the person may experience them and if they affect the ability to carry out daily tasks. Most people’s symptoms are not severe or frequent enough to need medical treatment. When it happens can vary from person to person. Some people experience it occasionally, while for others it happens every day. It happens most often when you are resting – for example, when you are sitting watching the TV or lying in bed.

People with RLS often have periodic limb movements, a closely related sleep disorder that occurs when muscles

involuntarily tighten, twitch or flex while you are still. Periodic limb movements in sleep occur in 80 percent to 90 percent of people who have RLS. RLS is found in 2 to 5% of people (both men and women). The risk of it goes up as you grow older, and it tends to be more serious in the elderly. But it can start at any age. It can be associated with pregnancy.

Restless Legs Syndrome affects approximately 10% of adults in the U.S. Researchers believe that RLS is commonly unrecognized or misdiagnosed as insomnia or other neurological, muscular or orthopedic condition. RLS also affects about 2% of children, according to a study of more than 10,000 families in the U.S. There is also evidence suggesting that children with attention deficit hyperactivity disorder (ADHD) and a family history of RLS are at risk for more severe ADHD.

Features of RLS

There are four primary features of RLS –

  • Uncomfortable sensation in the legs with a clear need or urge to move the legs
  • The symptoms are worse at night
  • The symptoms come on with rest
  • The symptoms are relieved with movement

Types of RLS

  • Early-onset RLS starts before the age of 45 years, producing symptoms that progress gradually. The daily occurrence of symptoms usually is not present until the age of 40 to 65 years.
  • Late-onset RLS advances more quickly and occurs more often. Symptoms may appear daily from the time that they begin, or they may progress rapidly over a period of about five years until they occur with regularity.
  • Primary RLS occurs independently of other disorders but may be exacerbated or triggered by other factors.
  • Secondary RLS is precipitated by other disorders and resolves when the other disorders are treated.


Genetic Factor – The simplest concept is when a specific gene is damaged, for example, hemophilia or sickle cell disease. In these diseases, the damaged gene results in an abnormal protein being made or in no protein at all being made.  When we talk about how genes are related to blood pressure, heart disease, Alzheimer’s disease, or RLS then the role of the gene is more difficult to understand because usually these common disorders do not result from one damaged gene but rather from interaction of several genes under certain environmental conditions. More than 50 percent of people with primary RLS report a pattern of the disorder in their family. First-degree relatives of a person with RLS are three times to six times more likely to have it.

Most of the people are born with normal hearts but over time, because of the interaction between environmental factors (aging, high cholesterol, smoking, increased blood pressure, diabetes, etc) and genes, some people will progress to having a bad heart.  RLS is also related to environmental factors and genes.  The single largest know environmental factors is low iron levels.  Low iron may occur before birth, during infancy, as a child, during pregnancy or later in adult life. The low iron may resolve long before one even develops RLS symptoms, but the low iron condition may set into motion set of conditions that eventually lead to getting RLS.

Underlying Health Condition – Restless legs syndrome can sometimes occur as a complication of another health condition, or it can be the result of another health-related factor. This is known as secondary restless legs syndrome.

  • Iron deficiency anaemia – low levels of iron in the blood can lead to a fall in dopamine, triggering restless legs syndrome
  • A long-term health condition – such as chronic kidney disease, diabetes, Parkinson’s disease, rheumatoid arthritis, an underactive thyroid gland, or fibromyalgia
  • Pregnancy – particularly from week 27 until birth; in most cases the symptoms disappear within four weeks of giving birth

Dopamine – Because of the marked improvement in RLS symptoms seen with drugs that stimulate the dopamine system and because of  the RLS-like symptoms produced with drug that block the dopamine system, the dopamine system has been implicated RLS.  CSF has also been used to evaluate dopamine system, and although this is a crude method for assessing the dopamine system in the brain, the data indicated possible increase in brain dopamine production.  Imaging studies using special radioactive chemicals have found reduced receptor and transporter function in the brain of more severely affected RLS patients.

Triggers – There are a number of triggers that don’t cause restless legs syndrome, but can make symptoms worse. These include medications such as –

  • Some antidepressants
  • Antipsychotics
  • Lithium – used in the treatment of bipolar disorder
  • Calcium channel blockers – used in the treatment of high blood pressure
  • Some antihistamines
  • Metoclopramide – used to relieve nausea

Other possible triggers include –

  • Excessive smoking, caffeine or alcohol
  • Being overweight or obese
  • Stress
  • Lack of exercise

Alcohol and sleep deprivation also may aggravate or trigger symptoms in some individuals. Reducing or completely eliminating these factors may relieve symptoms, but it is unclear if this can prevent RLS symptoms from occurring at all.


Not only are the signs and symptoms of restless legs syndrome different from person to person, but also they can be tricky to explain. Some describe the leg sensations as “creeping,” “prickling,” “burning,” “tingling,” or “tugging.” Others say it feels as if bugs are crawling up their legs, a fizzy soda is bubbling through their veins, or they have a “deep bone itch.”

The symptoms of RLS can range from mildly annoying to severely disabling. You may experience the symptoms only once in a while, such as when you’re under a lot of stress, or they may plague you every night.

Here are some signs and symptoms of RLS –

Leg discomfort and strong urge to move – Uncomfortable sensations deep within the legs, accompanied by a strong, often irresistible urge to move them. Many describe the sensations as tingling, jitteriness, a “creepy crawly” feeling, itching, or pulling.

Rest triggers the symptoms – Leg pain is normally trigged by activity and relieved by rest, but with restless legs syndrome, the reverse is true. Restless leg symptoms start or become worse when you’re sitting, relaxing, or trying to rest.

Symptoms get worse night – RLS typically flares up at night, especially when you’re lying down. In more severe cases, the symptoms may begin earlier in the day, but they become much more intense at bedtime.

Symptoms improve when you walk or move your legs – The uncomfortable sensations temporarily get better when you move, stretch, or massage your legs. The relief continues as long as you keep moving.

Nighttime leg twitching – Many people with restless legs syndrome also have periodic limb movement disorder (PLMD), a sleep disorder that involves repetitive cramping or jerking of the legs during sleep. These leg movements further disrupt your sleep.


Dopamine-Related Medications – Dopamine is a chemical that is produced by certain cells in the brain and this group of drugs functions to either increase the amount of dopamine made by the cell (levodopa) or increase the dopamine signal to other surrounding cells by mimicking dopamine in the brain. The dopamine-related drugs include levodopa, pramipexole, ropinirole and rotigotine.  These drugs are also used for Parkinson’s Disease. However, there is no indication that RLS is related to, or is a precursor of, Parkinson’s Disease. These medications are likely to be effective in reducing symptoms in 90% of patients with restless legs syndrome.

Excessive sleepiness, increased compulsive behavior and more commonly, paradoxical worsening of symptoms, referred to as “augmentation”, may occur with these medications after extended use.

Opiates – This category of medications includes codeine, hydrocodone, oxycodone, morphine, hydromorphone, methadone, buprenorphine and pentazocine. It is estimated that 85-90% of patients with RLS will respond very well to opiates.

Benzodiazepines Receptor Agonist (BRA) – This group of drugs is also known as sleeping pills and has valium-like effects.  The structure of the parent compound was designated as a “benzodiazepine”.  Later research identified the specific target of the benzodiazepine drugs and designated it as the “benzodiazepine receptor”.

Alpha-2 delta Drugs – These drugs have their affect by interacting with one of the calcium channel proteins, alpha-2 delta protein. Calcium channels allow the charged calcium ion to move into the nerve cell and are therefore important in activating, in deactivating and in stabilizing the electrical activity of the nerve cell. The alpha-2 delta drugs are also used to treat patients with nerve-damage related pain even in those without RLS.

Vein Treatment  – 98% of patients affected by RLS in a recent study found symptom relief after treating varicose veins in their legs with non-surgical sclerotherapy*.  Many physicians believe that it is the underlying vein problems that are causing the Restless Leg Syndrome, and by treating this with an outpatient procedure, patients can get relief.

Alternative Treatment

Iron Supplements – Iron supplements may reduce symptoms in people with restless legs syndrome who are also iron deficient. Patients should use them only when dietary measures have failed. Iron supplements do not appear to be useful for RLS patients with normal or above normal iron levels.

Magnesium mineral supplement – Magnesium therapy for periodic leg movements-related insomnia and restless legs syndrome: an open pilot study. Periodic limb movements during sleep (PLMS), with or without symptoms of a restless legs syndrome (RLS), may cause sleep disturbances. Anecdotal observations have shown that oral magnesium therapy may ameliorate symptoms in patients with moderate RLS.

5-HTP – If the iron levels are normal, then 5-HTP supplementation may significantly improve, or even eliminate, restless legs and myoclonus.

Folic Acid – If there is a family history of restless-legs syndrome (about one-third of all patients with this syndrome have a family history), high- dosage folic acid (35 to 60 mg daily) therapy can be helpful.

Vitamin E – Vitamin E supplements of 400 IU two or three times a day are extremely effective in alleviating RLS.

Chamomile – Studies show the herb chamomile has mild calmative effects (it has a calming effect on the whole body.

Ginkgo biloba – Studies show that the herb ginkgo biloba, which has been used in Chinese medicine for centuries, has beneficial effects on peripheral circulation and may help to improve symptoms.

Valerian – Studies show that the herb valerian is effective in inducing sleep as it has sedative effects that help to improve the quality of sleep. Valerian is often used in herbal preparations for insomnia.

Vitamin B1 (thiamin) – This vitamin assists the nervous tissue to perform correctly and reduces incidence of symptoms. Vitamin B1 (thiamin) may be more useful for reducing symptoms in combination with the rest of the B vitamins.

Vitamin B5 (pantothenic acid) – This vitamin helps the nervous system tissues perform properly and reduces incidence of symptoms. Vitamin B5 (pantothenic acid) may be more useful for reducing symptoms in combination with the rest of the B vitamins.

Vitamin B12 (cyanocobalamin) – A deficiency of vitamin B12 (cyanocobalamin) is known to cause secondary restless legs syndrome, so this vitamin is very important to help reduce symptoms.

Vitamin C – The antioxidant vitamin C helps to strengthen the capillary and other blood vessel walls, so it may help with those people that have peripheral neuropathy symptoms as the underlying reason for the restless legs syndrome.

Vitamin E – Studies show that the antioxidant vitamin E may help to reduce symptoms in people with peripheral neuropathy, as it helps to ensure there is proper circulation in the peripherals (legs/arms) and the blood in the veins and arteries is circulating properly.

Calcium – The mineral calcium is necessary to enable proper muscles contraction and to ensure the muscles work effectively, so it may assist with reduction of symptoms (in conjunction with other nutrients).

Potassium – The mineral potassium is also necessary for proper muscles contraction and ensuring the muscles work properly, so may assist with reduction of symptoms (especially in conjunction with the other nutrients).

Essential fatty acids – The omega 3 essential fatty acids are needed by the body to help reduce inflammation, especially in the muscles, tendons and nerves. The essential fatty acids may be especially useful in reducing severity of symptoms.

GABA – The amino acid GABA is also one of the neurotransmitters which helps the body to relax. GABA is also required to help make the important other neurotransmitter dopamine, which may not be functioning properly in people with restless legs syndrome.

Tryptophan – Studies show there is a link between low levels of the amino acid tryptophan and increased incidence of restless legs syndrome and this is most likely because tryptophan and vitamin B3 (niacin) are closely related and vitamin B3 (niacin) may be especially required to relieve restless legs syndrome symptoms.


Reference –


February 8, 2017

Osteoporosis is a disease in which bones become fragile and weak, leading to an increased risk of fractures (broken bones). People with osteoporosis can experience a fracture even after a slight bump, or a fall from standing height, in the course of daily activities.

Osteoporosis comes from ‘osteo’ meaning bone and the Greek word ‘por’ (passage) i.e. porous bone. Normal bone is composed of a mixture of calcium and other minerals such as magnesium and phosphate. It is also made up of collagen (protein), which forms the structural framework of bone. Osteoporosis occurs when there is a loss of mineral from bone mainly in the form of calcium as well as architectural loss of normal bone structure. The loss of mineral content of the bone is referred to as a loss of bone mineral density in the bone.

The 3 types of bone cells are osteoblasts, osteoclasts, and osteocytes. The osteocytes function as “mechanostats”, sensing the degree of micro-damage and triggering remodeling in areas of stress and strain, thus allowing continual renewal, repair, and replacement of bone. This process of remodeling maintains bone strength.

Osteoporosis has no signs or symptoms until a fracture occurs – this is why it is often called a ‘silent disease’. Fractures due to osteoporosis occur most commonly at sites such as the wrist, upper arm, pelvis, hip and spine, and can result in severe pain, significant disability and even death.

About 54 million Americans have osteoporosis and low bone mass, placing them at increased risk for osteoporosis. Studies suggest that approximately one in two women and up to one in four men age 50 and older will break a bone due to osteoporosis.


Genetic Factors – Bone health can be strongly inherited so consider your family history of osteoporosis. It is important to note if anyone in your family (particularly parents or siblings) has ever been diagnosed with osteoporosis, broken a bone from a minor fall or rapidly lost height. These can indicate low bone density.

Medical History – Certain conditions and medications can impact on your bone health. Corticosteroids – commonly used for asthma, rheumatoid arthritis and other inflammatory conditions Low hormone levels – in women: early menopause; in men: low testosterone Thyroid conditions – over active thyroid or parathyroid Conditions leading to malabsorption eg: coeliac disease, inflammatory bowel disease Some chronic diseases eg: rheumatoid arthritis, chronic liver or kidney disease Some medicines for breast cancer, prostate cancer, epilepsy and some antidepressants.

Calcium and Vitamin D Level – Low calcium intake – adults require 1,000 mg per day (preferably through diet) which increases to 1,300 mg per day for women over 50 and men over 70 Low vitamin D levels – a lack of sun exposure can mean you are not getting enough vitamin D which your body needs to absorb calcium.


Women are more at risk of developing osteoporosis than men because the hormone changes that occur in the menopause directly affect bone density.

The female hormone oestrogen is essential for healthy bones. After the menopause (when monthly periods stop), oestrogen levels fall. This can lead to a rapid decrease in bone density.

In most cases, the cause of osteoporosis in men is unknown. However, there’s a link to the male hormone testosterone, which helps keep the bones healthy.

Risk factors – Many hormones in the body can affect the process of bone turnover. If you have a condition of the hormone-producing glands, you may have a higher risk of developing osteoporosis.

  • Hormone-related conditions that can trigger osteoporosis include:
  • hyperthyroidism (overactive thyroid gland)
  • disorders of the adrenal glands, such as Cushing’s syndrome
  • reduced amounts of sex hormones (oestrogen and testosterone)
  • disorders of the pituitary gland
  • hyperparathyroidism (overactivity of the parathyroid glands)

Lifestyle choices – Some bad habits can increase your risk of osteoporosis. Examples include –

  • Sedentary lifestyle – People who spend a lot of time sitting have a higher risk of osteoporosis than do those who are more active. Any weight-bearing exercise and activities that promote balance and good posture are beneficial for your bones, but walking, running, jumping, dancing and weightlifting seem particularly helpful.
  • Excessive alcohol consumption. Regular consumption of more than two alcoholic drinks a day increases your risk of osteoporosis.
  • Tobacco use – The exact role tobacco plays in osteoporosis isn’t clearly understood, but it has been shown that tobacco use contributes to weak bones.


There are often no warning signs or symptoms until a minor fall or a sudden impact causes a bone fracture. Healthy bones should be able to withstand a fall from standing height, so a bone that breaks in these circumstances is known as a fragility fracture.

The most common injuries in people with osteoporosis are:

  • wrist fractures
  • hip fractures
  • fractures of the spinal bones (vertebrae)

Sometimes a cough or sneeze can cause a rib fracture or the partial collapse of one of the bones of the spine. In older people, a fractured bone can be serious and result in long-term disability. For example, a hip fracture may lead to long-term mobility problems. Although a fracture is the first sign of osteoporosis, some older people develop the characteristic stooping (bent forward). It happens when the bones in the spine have fractured, making it difficult to support the weight of the body.


Medications – Treatment recommendations are based on an estimate of your risk of breaking a bone in the next 10 years using information such as the bone density test. If the risk is not high, treatment might not include medication and might focus instead on lifestyle, safety and modifying risk factors for bone loss.

For both men and women at increased risk of fracture, the most widely prescribed osteoporosis medications are bisphosphonates. Examples include –

  • Alendronate (Fosamax)
  • Risedronate (Actonel, Atelvia)
  • Ibandronate (Boniva)
  • Zoledronic acid (Reclast)

Side effects include nausea, abdominal pain, difficulty swallowing, and the risk of an inflamed esophagus or esophageal ulcers. These are less likely to occur if the medicine is taken properly. Intravenous forms of bisphosphonates don’t cause stomach upset. Bisphosphonates have the potential to affect the jawbone. Osteonecrosis of the jaw is a rare condition that can occur after a tooth extraction in which a section of jawbone dies and deteriorates. You should have a recent dental examination before starting bisphosphonates.

Hormone-related therapy – Estrogen, especially when started soon after menopause, can help maintain bone density. However, estrogen therapy can increase a woman’s risk of blood clots, endometrial cancer, breast cancer and possibly heart disease. Therefore, estrogen is typically used for bone health only if menopausal symptoms also require treatment.

Alternative Treatment


  • Calcium is the most abundant mineral in the human body. It is well recognized for its importance in the development of bones and teeth and has many other functions as well. The ability of calcium supplements to “maintain good bone health and reduce the high risk of osteoporosis later in life” is one of the few health label claims allowed by the U.S. Food and Drug Administration.
  • Magnesium is the second most common mineral in the body, after calcium. Magnesium is important for many metabolic processes, including building bone, forming adenosine triphosphate, and absorbing calcium. Dietary sources of magnesium include nuts, whole grains, dark green vegetables, fish, meat, and legumes. Magnesium is often deficient in the standard American diet, due to low consumption of foods containing this nutrient, as well as soil depletion from commercial farming practices such as overcropping.
  • Vitamin D is essential for the formation and maintenance of bone tissue, due to its involvement in several complex mechanisms, including the regulation of calcium and phosphorous absorption. If vitamin D levels are low, parathyroid hormone (PTH) increases and triggers osteoclasts to release calcium into the blood via bone readsorption. If this process continues over time, it weakens bone and leads to osteoporosis. In addition, vitamin D stimulates intestinal epithelial cells to synthesize calcium-binding proteins that support the absorption of calcium in the blood.
  • Boron is ubiquitous throughout the human body, with the highest concentrations found in the bones and dental enamel. Although there is currently no RDA for it, boron appears to be indispensable for healthy bone function, possibly because of its effects on reducing the excretion and absorption of calcium, magnesium, and phosphorus.
  • The mineral strontium is a powerful agent in the treatment and prevention of osteoporosis. Strontium is a naturally occurring mineral present in water and food. Trace amounts of strontium are found in the human skeleton, where it is adsorbed at the matrix crystal surface of bones.
  • Research supports the positive effects of soy isoflavones on reducing the risk of developing osteoporosis. Diets high in soy may decrease bone reabsorption in postmenopausal women. Although ipriflavone, a semi-synthetic flavone comparable to genistein and daidzein found in soy foods, was ineffective in restoring bone density in rats, it modulated IGF-I (insulin growth factor I), which is linked to bone mineral density, and increased bone remodeling through several mechanisms.
  • Vitamin K is a fat-soluble vitamin known for its effect in blood clotting, which it accomplishes by regulating the coagulation cascade via its ability to bind calcium ions (Ca2+), among other mechanisms. Three known vitamin K–dependent proteins have been isolated in bone: MGP (matrix Gla protein), protein S, and osteocalcin. One of vitamin K’s roles in helping to maintain healthy bone mass is linked to its importance in the formation of osteocalcin by osteoblasts. The synthesis of osteocalcin requires both vitamin D and vitamin K.
  • Omega-3 fatty acids is proven way to improve cardiovascular health, Omega-3 fatty acids have also shown some benefit to those with rheumatoid arthritis, reducing morning stiffness and joint swelling
  • Traditional Chinese Medicine (TCM) and acupuncture: TCM has been proven over thousands of years to help treat many different physical ailments. Based on herbs (usually brewed into tea or soup), TCM can improve how your body uses calcium, which in turn helps bone health.





February 8, 2017

Ostoepenia is a condition characterized by a decreased density of bone, which leads to bone weakening and an increased risk of breaking the bone (fracture). “Osteo” means bone and “penia” indicates a state of being low in quantity. Therefore, the term osteopenia refers to a bone density which is somewhat less, but not excessively less, than a “standard” young person (someone in their mid to late 20s) of the same gender.

Osteopenia and osteoporosis are related conditions. The difference between osteopenia and osteoporosis is that in osteopenia the bone loss is not as severe as in osteoporosis. That means someone with osteopenia is more likely to fracture a bone than someone with a normal bone density but is less likely to fracture a bone than someone with osteoporosis. Osteopenia increases your risk of developing osteoporosis and is considered a precursor to osteoporosis.

Bone mineral density refers to the measure of the amount of mineral in bones, which determines the strength of the bones. As the mineral density decreases, the bones become thinner and more vulnerable to fractures. This happens when the balance between formation and loss of bone is lost. It indicates weakening of the bones which can eventually lead to osteoporosis. But this does not mean that every person diagnosed with osteopenia necessarily develops osteoporosis. It can lead to osteoporosis only if it is not treated at the right time.

Osteopenia is generally seen in women, though it does occur in men. The bones become thinner and weaker as one grows older. It is observed that after menopause, women are more prone to osteopenia. This is because the production of the hormone, estrogen, reduces after menopause. Estrogen is necessary for having strong and dense bones. There are no major symptoms of osteopenia. One may not realize she is suffering from it until the bones become too weak and tend to break. Though osteopenia can be treated with the help of medications, several side effects are seen in many cases. It is, therefore, advisable to maintain stronger bones with the help of diet or physical exercises and keep osteopenia away.


  • Genetic Factor – The risk of developing osteopenia is high (more than 50%) in patients with a family history of osteoporosis or low bone mass. Such people should consult a doctor when they reach 30 years of age and get their bone density tested.
  • Gender – Females are at a higher risk of suffering from bone loss or low bone density than males. It is mainly due to the fact that as a woman nears her menopausal years, hormonal changes take place in the body. This is the reason why early menopause and post-menopausal women are at high risk of bone loss.
  • Age and race – With age, bones begin to lose minerals along with bone structure and mass. This usually occurs as a person reaches peak bone density at the age of 30 years. Age apart; people belonging to Asian and Caucasian race are at a higher risk of developing osteopenia.
  • Diseases – In case a person has a history of anorexia nervosa (eating disorder) or are suffering from cholestasis (a liver condition) or chronic kidney disease, the chances that the bone density is lowered is high. This is because, they cause problems in absorption of vitamin D and other minerals necessary for maintaining bone health.
  • Medications – Certain medications like anticonvulsant, corticosteroids, chemotherapy and OTC pills like pain relievers and antacids chelate with important minerals calcium causing unavailability of the minerals to the body can cause osteopenia.
  • Malnutrition during pregnancy – It is during the last three months of pregnancy that there is transfer of high amounts of calcium and phosphorus to the fetus. Hence, lack of proper nutrition during these days by the mother increases the risk of poor bone health and low bone density in the child.
  • Faulty metabolism – In some cases, there might be problem in bone metabolism, which in turn affects the absorption and use of vitamins and minerals by the body. Although there might be many causes responsible for this, diagnosis of bone density is the only option to know whether you are suffering from bone loss or not.
  • Deficiency of Vitamin D – Lack of vitamin D in the body hinders with absorption of calcium and phosphorus from kidneys and intestines. If these bone minerals are not absorbed, over time there can be decreased bone density leading to osteopenia. 
  • Lifestyle factors:
    • Lack of exercise and sedentary lifestyle
    • Excess alcohol consumption
    • Excessive smoking
    • Excessive stress
    • Crash dieting and eating disorders
    • Excessive coffee, tea, soda, chocolate or sports and energy drinks
    • Young female athletes with eating disorders and amenorrhea. These women have lower body weight, lower fat percentage, and higher incidence of asthma. This increases the risk of osteopenia.
    • Teenage pregnancy


Osteopenia does not cause pain unless a bone is broken (fractured). Interestingly, fractures in patients with osteopenia do not always cause pain. Osteopenia or osteoporosis can be present for many years prior to diagnosis for these reasons. Many bone fractures due to osteopenia or osteoporosis, such as a hip fracture or vertebral fracture (fracture of a bone in the spine), are very painful. However, some fractures, especially vertebral fractures (fractures of the bony building blocks of the spine), can be painless and therefore osteopenia or osteoporosis may go undiagnosed for years.


Osteopenia should be prevented or treated in the early stage in order to avoid osteoporosis. The main objective is to make the bones resistant to fractures.


There are a lot drugs being used to treat osteopenia, some of them being bisphosphonates like alendronate, fosamax, actonel, reclast and boniva, calcitonin, oyster calcium, tamoxifen and fosteum. Bisphosphonates are used on a large scale. They make the bones denser by attaching themselves to the mineral surfaces of the bones. This increases the mineral density of bones. But over a period of years, the bones start to become brittle. The drugs also have various side effects, nasal irritation being the common one. Moreover, these drugs have to be taken for a long period of time, and one becomes dependent upon them. To avoid all this, natural treatment for osteopenia is the safest option. There are numerous ways to treat osteopenia naturally, like making changes in your diet and lifestyle, regular exercises and taking certain supplements.

In addition, several medications can help slow bone loss, reducing the risk of osteoporosis and fractures. These medications include:

  • Forteo (teriparatide), a synthetic form of a hormone that stimulates bone formation
  • Selective estrogen-receptor modulators such as Evista (raloxifene), which have positive estrogen-like effects on the bones
  • Calcitonin, which has been shown to increase bone mineral density

Exercise is important for having strong bones, because bone forms in response to stress. Weight-bearing exercises such as walking, hiking, and dancing are all good choices. Adding exercise with light weights or elastic bands can help the bones in the upper body.

Alternative Treatment




February 8, 2017

Osteoarthritis (OA) is the most common form of arthritis. It causes joint pain and stiffness. It usually develops gradually, over time. Several different joints can be affected, but osteoarthritis is most frequently seen in the hands, knees, hips, feet and spine.

Normal joints are hinges at the ends of bones usually covered by cartilage and lubricated inside a closed sack by synovial fluid.

Normally, joints have remarkably little friction and move easily. With degeneration of the joint, the cartilage becomes rough and worn out, causing the joint halves to rub against each other, creating inflammation with pain and the formation of bone spurs. The fluid lubricant may become thin and the joint lining swollen and inflamed.

Osteoarthritis is also known as degenerative joint disease and affects up to 30 million Americans, mostly women and usually those over 45 or 50 years of age. All races in the U.S. appear to be equally affected. This article focuses on osteoarthritis of the spine, particularly on facet joint arthritis.

OA affects people of all races and both sexes. Most often, it occurs in patients age 40 and above. However, it can occur sooner if you have other risk factors (things that raise the risk of getting OA).  Risk factors include –

  • Older age
  • Having family members with OA
  • Obesity
  • Previous traumatic Joint injury or repetitive use (overuse) of joints
  • Joint deformity such as unequal leg length, bowlegs or knocked knees


Genes – Various genetic traits can make a person more likely to develop OA. One possibility is a rare defect in the body’s production of collagen, the protein that makes up cartilage. This abnormality can cause osteoarthritis to occur as early as age 20. Other inherited traits may result in slight defects in the way the bones fit together so that cartilage wears away faster than usual. Researchers have found that a gene called FAAH, previously linked to increased pain sensitivity, is higher in people with knee OA than in people who don’t have the disease.

Weight – Being overweight puts additional pressure on hips and knees. Many years of carrying extra pounds can cause the cartilage that cushions joints to break down faster. Research has shown there is a link between being overweight and having an increased risk of osteoarthritis in the hands. These studies suggest that excess fat tissue produces inflammatory chemicals (cytokines) that can damage the joints.

Injury and overuse – Repetitive movements or injuries to joints (such as a fracture, surgery or ligament tears) can lead to osteoarthritis. Some athletes, for example, repeatedly damage joints, tendons and ligaments, which can speed cartilage breakdown. Certain careers that require standing for long periods of time, repetitive bending, heavy lifting or other movements can also make cartilage wear away more quickly. An imbalance or weakness of the muscles supporting a joint can also lead to altered movement and eventual cartilage breakdown in joints.

OthersSeveral other factors may contribute to osteoarthritis. These factors include bone and joint disorders like rheumatoid arthritis, certain metabolic disorders such as hemochromatosis, which causes the body to absorb too much iron, or acromegaly, which causes the body to make too much growth hormone.


The main symptoms of osteoarthritis are –

 Pain – The pain tends to be worse when you move your joint or at the end of the day. If you have severe osteoarthritis, you may feel pain more often.

Stiffness – Your joints may feel stiff after rest, but this usually wears off as you get moving. A grating or grinding sensation (crepitus) – Your joint may creak or crunch as you move.

Swelling – The swelling may be hard (caused by osteophytes) or soft (caused by synovial thickening and extra fluid), and the muscles around your joint may look thin or wasted.

Not being able to use your joint normally – Your joint may not move as freely or as far as normal. Sometimes it may give way because your muscles have weakened or your joint has become less stable. Exercises to strengthen your muscles can help to prevent this.


Pain and Anti-inflammatory Medications

Medicines for osteoarthritis are available as pills, syrups, creams or lotions, or they are injected into a joint. They include –

  • Analgesics – These are pain relievers and include acetaminophen, opioids (narcotics) and an atypical opioid called tramadol. They are available over-the-counter or by prescription.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) – These are the most commonly used drugs to ease inflammation and related pain. NSAIDs include aspirin, ibuprofen, naproxen and celecoxib. They are available over-the-counter or by prescription.
  • Corticosteroids – Corticosteroids are powerful anti-inflammatory medicines. They are taken by mouth or injected directly into a joint at a doctor’s office.
  • Hyaluronic acid – Hyaluronic acid occurs naturally in joint fluid, acting as a shock absorber and lubricant. However, the acid appears to break down in people with osteoarthritis. The injections are done in a doctor’s office.

Assistive Devices – Assistive devices can help with function and mobility. These include items, such as like scooters, canes, walkers, splints, shoe orthotics or helpful tools, such as jar openers, long-handled shoe horns or steering wheel grips. Many devices can be found at pharmacies and medical supply stores.

Surgery – Joint surgery can repair or replace severely damaged joints, especially hips or knees. A doctor will refer an eligible patient to an orthopaedic surgeon to perform the procedure.

Alternative Treatment

Glucosamine and chondroitin are the building blocks of cartilage. Cartilage is the substance that covers and protects joints. In people with OA, cartilage becomes damaged and degraded with use and time.

Omega 3 fatty acids EPA and DHA can be helpful for inflammatory arthritis including OS.

Vitamin E – Studies suggest that vitamin E can play a key role in treating OS by preventing damage to the cells of the bones and joints.

Selenium – Mild selenium deficiency is common in OS patients. It helps in slowing down the rapid progression of the disease.

SAM-e, pronounced “sammy”, is a naturally occurring compound produced from the amino acid methionine and adenosine triphosphate (ATP), a compound responsible for producing energy within the body. SAM-e is believed to improve joint mobility and relieve pain by raising levels of ATP and stimulating the production of cartilage within the joints. Getting sufficient folic acid in your diet (e.g. dark leafy green vegetables, fortified cereals) may help your body with natural SAM-e production.

Chondroitin sulfate, found naturally in cartilage, is believed to protect articular cartilage from deterioration caused by enzymes that destroy cartilage. It may also help to prevent the formation of microscopic blood clots leading to improvement of circulation to joint tissues.

Flax Seed Oil – Flax seed oil is an anti-inflammatory.

Avocado soybean unsaponifiables (ASUs) – A few preliminary studies suggest that this natural vegetable extract may help reduce the symptoms of OA and maybe even slow progression of the disease. More research is needed to know whether ASUs can actually stop joint damage.

Bromelain – This enzyme that comes from pineapples reduces inflammation. Bromelain increases the risk of bleeding, especially if you also take blood thinners, such as clopidogrel (Plavix), warfarin (Coumadin), or aspirin.

Turmeric – Turmeric is sometimes combined with bromelain, because it makes the effects of bromelain stronger. Turmeric can increase the risk of bleeding, especially for people who take blood thinning medications or NSAIDs.

Cat’s claw – It is useful for OA pain.

Devil’s claw – One study found that more than 50% of people with OA of the knee or hip or low back pain who took devil’s claw reported less pain and better mobility after 8 weeks. Devil’s claw may increase the risk of bleeding, especially if you also take blood thinners

Ginger – One study found that ginger extract blocked COX-2, a chemical in the body that causes pain. Ginger may increase the risk of bleeding, especially if you also take blood thinners such as clopidogrel (Plavix), warfarin (Coumadin), or aspirin.

Capsaicin – Capsaicin is the main component in hot chili peppers (also known as cayenne). Applied to the skin, it is believed to temporarily reduce amounts of “substance P,” a chemical that contributes to inflammation and pain in arthritis.

Acupuncture – Several controlled clinical trials suggest that the ancient Chinese practice of acupuncture works to treat OA pain. It may also help improve joint function. A few clinical studies have found that people with OA experience better pain relief and improvement in function from acupuncture than from NSAIDs, such as aspiroxicam.

Chiropractic – Although there is no evidence that chiropractic care can stop joint damage from OA, some studies indicate that spinal manipulation may:

  • Increase range of motion
  • Restore normal movement of the spine
  • Relax the muscles
  • Improve joint coordination
  • Reduce pain

Balneotherapy (Hydrotherapy or spa therapy)

Ice Massage, Transcutaneous Nerve Stimulation (TENS), and Electroacupuncture

Mechanical Aids (braces, splints)


Reference –



February 8, 2017

Myasthenia Gravis (MG) is a rare life-threatening auto immune neuromuscular junction disorder. The name Myasthenia Gravis is derives from Greek (myasthenia = muscle illness) and Latin (gravis = grave) words, together, meaning “grave muscular weakness”. MG is characterized by painless, fluctuating, fatigable weakness involving specific muscle group.

The prevalence of MG is estimated to be about 20/100,000 population in the United States. It occurs in all races, both genders and at any age, but the average age of onset in females is 28; in males, it’s 42. In about 10 percent of cases, MG begins in childhood (juvenile onset). In some cases, the foetus of a pregnant mother with MG may acquire immune antibodies. Congenital Myasthenia is a rare disorder where babies are born with a genetic defect in neuromuscular transmission similar to MG; however, it is not an auto-immune disorder. This is called Neonatal Myasthenia and is generally temporary, with the child’s symptoms often disappearing within few weeks after birth. Some children may develop MG indistinguishable from adults. MG is not directly inherited nor is it contagious. It does occasionally occur in more than one member of the same family.

Generally, the immune system releases antibodies to attack foreign invaders, such as bacteria. In autoimmune diseases, the antibodies mistakenly attack a person’s own tissues. In myasthenia gravis, they attack and damage muscle cells; in Lambert-Eaton myasthenic syndrome, they attack nerve cells that send messages to muscle.

MG can affect any voluntary muscle i.e. skeletal muscle muscles. Involuntary muscles such as the digestive system, heart and brain are not affected. MG tends to affect the muscles that control movement of the eyes and eyelids, causing ocular weakness, facial expression, chewing, talking, and swallowing are often, but not always, involved in the disorder.


  • Muscle Functions

Generally, the brain sends an electrical signal along the motor nerves to the muscle to make movements, during this process, a chemical transmitter – acetylcholine (ACh) is released from the nerve ending. It immediately crosses to the muscle where it

locks onto the ACh receptors (AChR), causing the muscle to contract. The spare ACh

is broken down by ACh esterase, allowing the muscle to relax.

However, in myasthenia gravis the immune system produces antibodies (proteins) that block or damage the muscle acetylcholine receptors, which prevent the muscles contracting. The disruption caused due to this, weakens the muscles.

These antibodies may also block the function of a protein called a muscle-specific receptor tyrosine kinase. This protein is involved in forming the nerve-muscular junction. When antibodies block the function of this protein, it may lead to myasthenia gravis.

  • Thymus Gland

Studies suggest that the thymus gland – part of the immune system situated in the upper chest beneath the breastbone, may trigger or maintain the production of the antibodies that block acetylcholine. Thymomas (tumour of the thymus) tend to be noncancerous and occur in 10% of individuals with MG. In 70% of individuals with MG, the thymus contains clusters of immune cells (hyperplasia) that indicate an active immune response.

The exact nature of the relationship between the thymus and MG is still uncertain. It is believed that the abnormal thymus gland may give incorrect instructions to developing immune cells, resulting in auto-immunity and consequently, defective transmission of nerve impulses to muscles.

  • Toxic Metals

Heavy metals are metallic elements with a high atomic weight and a density at least five times greater than that of water. Of the 20-plus heavy metals, four– lead (Pb), cadmium (Cd), mercury (Hg), and inorganic arsenic (As)–cause toxicity in humans, even at low levels. Present in toxic waste, they enter the body through the food chain and accumulate in both hard and soft tissue. Other heavy metals, such as nickel, can cause toxicity, but people are less likely to encounter them at toxic levels.

Underlying heavy metal toxicity may contribute to muscle insufficiencies. 

  • Auto Immune Attack

This factor is always present and is usually connected with the other causes, e.g. mercury and pesticide toxicity and Candida infection can keep the immune system in a state of imbalance, producing auto-immune reactions. 

  • Other

Symptoms among patient who already have the disease may worsen with some medications, such as beta blockers, calcium channel blockers, quinine, and some antibiotics. Many believe some people have a genetic propensity to developing the disease. The following are known to make symptoms worse:

  • Emotional/mental stress
  • Illness
  • Some medications
  • Tiredness
  • Very high temperatures
  • Muscle relaxants used during surgery
  • Aminoglycoside and Quinolone
  • Antibiotics like – cardiac anti-arrhythmics, local anesthetics, magnesium salts (including milk of magnesia)


The symptoms of myasthenia gravis can come on suddenly, but it may take some time before the condition is correctly diagnosed. MG symptoms tend to progress over time, usually reaching their worst within a few years after the onset of the disease.

The symptoms of myasthenia gravis include –

  • Eye Muscle – The muscles around the eyes are most commonly affected first, as these are constantly used and can quickly tire. This causes drooping of the eyelid, and double vision. In some people, the muscles around the eyes are the only ones affected (when the level of abnormal antibody is low). If symptoms only affect the muscles around the eyes for longer than two years then the condition is unlikely to progress to other muscles. This is known as ocular myasthenia and affects 1 in 6 people with myasthenia gravis.
  • Face and Throat Muscle – Muscles around the face and throat are also often affected. Difficulty in swallowing and slurred speech may be the first signs of myasthenia gravis.
    • Altered SpeakingSpeech may become very soft or nasal, depending on the affected muscles.
    • Limited Facial Expressions
    • Problems in Chewing – The muscles used for chewing may wear out halfway through a meal, particularly if you’ve been eating something hard to chew.
    • Difficulty in Swallowing
  • Neck and Limb muscles – MG can affect the muscles of the arms, legs and neck. This can cause mobility problems, such as a waddling gait, head drop and difficulty performing physical tasks such as lifting.
  • Other Symptoms
    • Breathing
    • Seeing
    • Swallowing
    • Chewing
    • Walking
    • Using your arms or hands
    • Holding up your head 


The following diagnostic tests will probably be carried out by the GP –

  • Blood Test – A blood test may reveal the presence of abnormal antibodies that disrupt the receptor sites where nerve impulses signal the muscles to move.
  • Ice Pack Test – If the patient is detected with a droopy eyelid, an ice pack test may be conducted. In this test, a bag filled with ice is placed on the patient’s eyelids for 2 minutes; once the bag is removed an analysis for any signs of improvement in the movement of eyelids is carried out.
  • Edrophonium test –This test is usually carried ,out only when other tests have not yet yielded a conclusive diagnosis. Edrophonium chloride (Tensilon, Reversol) or neostigmine (Prostigmin) is injected into a vein – the drug clocks the breakdown of acetylcholine by cholinesterase (cholinesterase inhibitors) and temporarily increases the levels of acetylcholine at the neuromuscular junction – put simply, edrophonium bocks an enzyme that breaks down acetylcholine, the chemical that transmits signals from the nerve ending to the muscle receptor sites. Some patients may experience a brief period in which muscle weakness is relieved, especially those with weakness in the eye muscles.
  • Repetitive nerve stimulation – In this test, electrodes are attached to the skin over the affected muscles. Small electrical pulses are sent through the electrodes to measure how well the nerves send a signal to the muscle. The electrical pulses will be applied several times to determine whether signals get worse when the muscle is tired.
  • Pulmonary function test (spirometry) – In this test, the aim is to determine whether the patient is breathing adequately. The forced vital capacity (the maximum amount of air a person can expel from the lungs after a maximum inspiration) may be periodically measured so as not to miss a gradual worsening of muscular weakness in the lungs. MG patients with severe symptoms are at risk of respiratory failure due to exhaustion of the respiratory muscles. Respiratory failure is when there is inadequate gas exchange by the respiratory system, with the result that arterial oxygen and/or carbon dioxide levels cannot be maintained within their normal ranges.
  • Muscle Biopsy – this is only done if the diagnosis is in doubt and a muscular condition is suspected. A needle or small incision is used to remove a small sample of muscle. The patient will receive a local anesthetic.
  • Single-fiber electromyography (EMG) – Electromyography (EMG) measures the electrical activity traveling between your brain and your muscle. It involves inserting a fine wire electrode through your skin and into a muscle. In a single-fiber EMG, doctors test a single muscle fiber.
  • Imaging Scans – Doctors at times prescribe CT scan or MRI test to check if there’s a tumor or other abnormality in the thymus.


  • Medications
    • Cholinesterase inhibitors – These inhibitors block the action of the chemical that normally makes the muscle relax after it has contracted. They improve communication between nerves and muscles. This medication is very effective for patients with mild MG symptoms. Some side effects may include nausea and/or stomach cramps.
    • Steroids or Immunosuppressant – These help in altering the body’s immune system and lower the production of antibodies that cause MG. This includes – prednisolone (a steroid drug) or azathioprine (an immunosuppressant drug)
  • Therapies
    • Plasmapheresis – In this therapy blood is removed from the body, the plasma (the abnormal antibodies that cause MG) is separated from the cells, the cells are then suspended in saline (or a plasma substitute or donor plasma), and the reconstituted solution is returned to the patient.
    • Intravenous immunoglobulin therapy – In this therapy, normal antibodies that alter the way the immune system acts are injected into the patient.
  • Removal of the thymus gland (thymectomy) – About 15 percent of the people with myasthenia gravis have a tumor in their thymus gland, a gland under the breastbone that is involved with the immune system. A thymectomy may be performed as an open surgery or as a minimally invasive surgery.

Alternative Treatment

Environmental Medicine is a branch of medicine whose domain is not limited by anatomical boundaries but, rather, is concerned with the whole person and the way that a person reacts to his/her total environment. It involves treating the cause of the disease. In MG, the treatment involves –

  • Herbs – Herbs like Liquorice and Kallawala (Polypodium leucotomos) can insignificantly turn off the auto-immune destructive reactions that maintain the disease. Also, colloidal silver (used to fight the infections) has some immune regulatory and healing effect. These herbs act as repairing agents for the immune system.
  • Thymus Treatment – Herbs like Echinacea, yarrow, thyme, barley grasslicorice, olive leafpau d’arco rosehips, wheatgrass help in keeping the thymus gland strong and enhances its immunity. Cruciferous vegetables like broccoli, cauli flower, cabbage etc. also appear to enhance thymus function, as do the essential oils of bergamot,clove, tea tree, oregano, thyme and eucalyptus, Nutrients like black current oil, organic germanium, vitamin A and beta carotene and zinc helps the thymus function.
  • Biodetoxification Program – The Center’s Bio-detoxification Program utilizes clinical procedures that safely reduce the body’s burden of toxic chemicals, including chemicals stored following occupational, accidental, and/or chronic airborne exposures.
  • Alka Vita Supplements – This has the tremendous advantage that it alkalises, therefore increases oxygenation, counteracts free radical attack and damage and therefore undermines the basis of disease. It is also directly ‘anti-septic’ against fungal infections, including Candida and possibly all harmful micro-organisms and parasites, although there is not enough information on this, we do know that all anaerobic infections (the harmful ones) are attacked by free electrons that Alka- vita supplies and are eventually destroyed or severely limited by an alkaline environment.
  • Colloidal Silver – Eliminates infections of various types, known and unknown that contribute to auto-immune disorders leading to the improper function of the immune function.
  • Vitamin Supplements -Different Vitamins are essential to aid the immune system and many biochemical processes including the utilisation of calcium and magnesium. Its deficiency is almost universal in northern climates and even more so since the introduction of sun screen. Its deficiency has been linked strongly to auto-immune diseases.
  • Omega 3 Fatty Acids –  For improving the body function.
  • Exercise – Helps to –
    • Increase flexibility
    • Improve range of motion of your joints
    • Boost circulation
    • Promote better posture
    • Relieve stress


References –




February 8, 2017

Mixed connective tissue disease (MCTD) is an autoimmune disease first described in 1972 and is considered an “overlap” of three diseases, systemic lupus erythematosus (lupus), scleroderma and polymyositis. People with MCTD experience symptoms of each of these three diseases.  In many cases, this mixed set of symptoms is eventually dominated by symptoms characteristic of one of the three illnesses, especially scleroderma or lupus.

Mixed connective tissue disease has features of three other connective tissue diseases –

  • Systemic lupus erythematosus (SLE) – An inflammatory disease that can affect many different organs. Symptoms include fever, fatigue, joint pains, weakness, and skin rashes on the face, neck, and upper body.
  • Scleroderma – Abnormal thickening and hardening of the skin, underlying tissue, and organs
  • Polymyositis – Muscle inflammation (swelling)

About 25% of patients with a connective tissue disease (such as dermatomyositis, rheumatoid arthritis, Sjogren’s syndrome, and the three disease listed above), develop another connective tissue disease over the course of several years. This is known as an “overlap syndrome.”

Mixed connective tissue disease occurs most often in women and is usually diagnosed in young adults in their 20s and 30s. Children have also been diagnosed with mixed connective tissue disease.

Mixed connective tissue disease is somewhat of a controversial term among arthritis specialists (rheumatologists). Some question whether mixed connective tissue disease is its own specific disease or whether it’s a precursor to another connective tissue disease.


The exact underlying cause of mixed connective tissue disease (MCTD) is currently unknown. It is an autoimmune disorder, which means the immune system mistakes normal, healthy cells for those that that body should “fight off.” There are ongoing studies exploring how immune system dysfunction may be involved in the development of this condition.

Risk Factors

Mixed connective tissue disease can occur in people of any age. However, it appears to be most common in women under the age of 30.


In the beginning stages, patients who have MCTD have symptoms similar to those of patients with other connective tissue disorders, including –

  • Fatigue
  • Muscle pain with no apparent cause
  • Joint pain
  • Low-grade fever
  • Raynaud phenomenon (reduced blood flow to the fingers, toes, ears, and nose). This causes sensitivity, numbness, and loss of color in these areas.

Less common early symptoms may include –

  • Severe polymyositis, often in the shoulders and upper arms
  • Acute (intense) arthritis
  • Aseptic meningitis (inflammation of the brain and spinal cord meninges, not caused by a bacteria or virus)
  • Myelitis (inflammation of the spinal cord)
  • Gangrene (death and decay) of fingers or toes
  • High fever
  • Abdominal pain
  • Neuropathy (nerve disorders) affecting the trigeminal nerve in the face
  • Hearing loss

The “classic” symptoms of MCTD are –

  • Raynaud phenomenon
  • swollen “sausage-like” fingers, sometimes temporary but at other times progressing into sclerodactyly (thin fingers with hardened skin and limited movement)
  • inflamed joints and muscles
  • pulmonary hypertension (high blood pressure in the blood vessels of the lungs)


Mixed connective tissue disease can lead to serious complications, including –

  • High blood pressure in the lungs (pulmonary hypertension) – This condition is the main cause of death in people with mixed connective tissue disease.
  • Interstitial lung disease – This large group of disorders can cause scarring in the lungs, which affects the ability to breathe.
  • Heart disease – Parts of the heart may become enlarged, or inflammation may occur around the heart. Heart disease is the cause of death in about 20 percent of people with mixed connective tissue disease.
  • Kidney damage – About one-fourth of people with mixed connective tissue disease develop kidney problems. Sometimes, that damage can lead to kidney failure.
  • Digestive tract damage – People may develop abdominal pain and problems with digesting food.
  • Anemia – About 75 percent of people with mixed connective tissue disease have iron deficiency anemia.
  • Tissue death (necrosis) – People with severe Raynaud’s phenomenon can develop gangrene in the fingers.
  • Hearing loss – Often unrecognized, hearing loss may occur in as many as half the people with mixed connective tissue disease.


Treatment for MCTD depends on which organs are involved and the severity of the disease. Some people need continuous treatment, while others need it only during periods of heightened disease activity, called flares.

Treatment may include corticosteroids to reduce inflammation and immunosuppressive drugs to suppress the immune system and its attack on healthy tissue. Other medications may be prescribed to treat or reduce the risk of certain complications of the disease.

Treatment considerations include the following –

  • Pulmonary hypertension is the most common cause of death in people with MCTD, and must be treated with antihypertensive medications.
  • People with a mild form of MCTD may not need treatment, or only low doses of nonsteroidal anti-inflammatory drugs, antimalarials, or low-dose corticosteroids (such as prednisone) to treat inflammation.
  • Higher doses of corticosteroids are often used to manage the signs and symptoms of moderate to severe MCTD. If major organs are affected, the patient may have to take immunosuppressants (to suppress the immune system).
  • MCTD patients are also at risk of developing heart disease, including an enlarged heart or pericarditis (inflammation around the heart). Patients may need regularly scheduled electrocardiograms to monitor the heart’s condition.

Alternative Treatment

Acupuncture – An acupuncture practitioner inserts tiny needles into the skin at precise points on the body. Studies of acupuncture have found it may help relieve many types of pain. Acupuncture is safe when done by a certified practitioner.

Fish oil supplements – Fish oil supplements have shown some promise in relieving signs and symptoms of other connective tissue diseases, such as lupus and rheumatoid arthritis. Fish oil supplements may help relieve joint pain and stiffness.

Hypnosis – During a hypnotherapy session, a therapist talks in a gentle voice that helps you relax. The therapist helps you reach a state of altered consciousness that lets people focus their mind on their goals or think positively about their challenges. Hypnosis may help relieve pain and stress.

Relaxation techniques – Relaxation techniques may help people take their mind off their signs and symptoms and help people relax. Relaxation techniques include activities such as progressive muscle relaxation and guided imagery. People can learn relaxation techniques from a therapist, or they can do them on their own. Relaxation techniques are generally safe.

Flaxseed – Flaxseed contains a fatty acid called alpha-linolenic acid, which may decrease inflammation in the body. Some studies have found that kidney function may improve in lupus patients who have kidney problems, such as like lupus nephritis.  Abdominal pain and bloating can be side effects of taking flaxseed.

DHEA – DHEA is a steroid molecule manufactured by the cholesterol-pregnenolone pathway, and is an intermediate to androstenediol and androstenedione, which have the potential to become either estrone or testosterone. Supplements containing this hormone have been shown to reduce the dose of steroids needed to stabilize symptoms in some people who have lupus

Herbal Medicine – Feverfew, goldenseal, and pau d’arco are just a few of the helpful herbs one can use, please consult the physician before adding any of these supplements as they may interfere with the other medications or have unwanted effects.

Chiropractic therapy – This therapy relies on the manipulation of the spine to improve the mobility of the joints and reduce pain. Chiropractic therapy practitioners have to go through training and licensing exams, and chiropractic care is often covered by insurance.

Vitamin A – Vitamin A is an antioxidant and is commonly found in whole milk, liver, and some fortified foods. Beta-carotene is a pro-vitamin found in carrots and many colorful vegetables that are then converted to vitamin A in the body.  Vitamin A protects against free radicals (harmful substances in your body) which can damage DNA and lead to cancer and other diseases, and has anti-inflammatory effects.

Vitamin D – People with lupus have shown some benefits from taking Vitamin D supplements   In recent testing, high doses of vitamin D were safe and appeared to temper some of the destructive immune system responses believed to cause lupus. Research is pointing to an immune-regulating role for vitamin D.

Vitamin E – This vitamin supplement comes in several different forms. The alpha-tocopherol type of Vitamin E may help prevent heart disease by slowing the release of inflammatory substances that damage the heart.* Alpha-tocopherol also might be effective for easing lung .inflammation related to allergies. However, because studies were conducted on animals, it’s not yet clear whether the results will translate to humans.

Evening primrose oil – Used to treat inflammation, evening primrose oil is associated with alleviating rheumatoid arthritis.


Reference –;wap2


February 8, 2017

Kyphosis is the term used to describe a type of abnormal curve in the spine in which there is too much forward curve in the spine. Kyphosis can have varying symptoms and degrees of severity, from minor changes in the shape of your spine to severe deformity, nerve problems, and chronic pain. The larger the abnormal curve, the more serious the problem.

The spine is divided into three sections: the cervical spine or neck, the thoracic spine or mid back, and the lumbar spine or low back. Each of these sections has a specific, normal curve to it. The cervical spine looks like a backward “C”, which is called a lordotic curve. The thoracic spine has a regular “C” shape with the opening of the “C” in the front of your body, which is called a kyphotic curve. The lumbar spine, like the cervical spine, also has a backward “C” shape or lordotic curve.

Kyphosis is most common in the thoracic spine, though it can also affect the cervical and lumbar spine. Kyphosis in the thoracic spine exaggerates the natural curve of the thoracic spine. Kyphosis in the cervical or lumbar spine is a condition in which the normal inward curve of the spine reverses. This causes an abnormal forward curve in the spine.

Types of Kyphosis

There are several types of kyphosis –

  • Postural Kyphosis – Postural kyphosis is the most common type of kyphosis. It is often attributed to slouching. It represents an exaggerated, but flexible, increase of the natural curve of the spine. Postural kyphosis usually becomes noticeable during adolescence. It is more common among girls than boys. It rarely causes pain.
  • Scheuermann’s Kyphosis – Scheuermann’s kyphosis is named after the Danish radiologist who first described the condition. As with postural kyphosis, Scheuermann’s kyphosis often becomes apparent during the teen years; however, patients with Scheuermann’s kyphosis have a significantly more severe deformity, particularly thin individuals. Scheuermann’s kyphosis usually affects the upper (thoracic) spine. It can also occur in the lower (lumbar) back area. If pain is present, it is usually felt at the apex of the curve.
  • Congenital Kyphosis – In some infants, the spinal column does not develop properly while the fetus is still in the womb. The bones may not form as they should. Several vertebrae may be fused together. Either of these abnormal situations may cause progressive kyphosis as the child grows.

Methods of treating kyphosis have evolved over time. Today there are numerous effective treatment options for correcting a severe kyphotic deformity.


The individual bones (vertebrae) that make up a healthy spine look like cylinders stacked in a column. Kyphosis occurs when the vertebrae in the upper back become more wedge-shaped. This deformity can be caused by a variety of problems, including –

Osteoporosis – This bone-thinning disorder can result in crushed vertebrae (compression fractures). Osteoporosis is most common in older adults, particularly women, and in people who have taken high doses of corticosteroids for long periods of time.

Disk degeneration – Soft, circular disks act as cushions between spinal vertebrae. With age, these disks dry out and shrink, which often worsens kyphosis.

Scheuermann’s disease – Also called Scheuermann’s kyphosis, this disease typically begins during the growth spurt that occurs before puberty. Boys are affected more often than are girls. The rounding of the back may worsen as the child finishes growing.

Birth defects – If a baby’s spinal column doesn’t develop properly in the womb, the spinal bones may not form properly, causing kyphosis.

Syndromes – Kyphosis in children can also be associated with certain syndromes, such as Marfan syndrome or Prader-Willi disease.

Cancer and cancer treatments – Cancer in the spine can weaken vertebrae and make them more prone to compression fractures, as can chemotherapy and radiation cancer treatments.

An increased curve in the upper spine also can be caused by slouching. Called postural kyphosis, this condition doesn’t involve any deformities in the spine. It’s most common in teenagers.

Risk Factors

Kyphosis is more common in girls than in boys. Although kyphosis can occur in any race or gender, there are some risk factors that could increase the odds of getting this disease. Adolescent girls who do not use proper posture techniques are at a higher risk of developing postural kyphosis. Boys who are between 10 and 15 have the greatest risk of getting Scheuermann’s kyphosis than their female counterparts. An adult is at a high risk of getting kyphosis if they have osteoporosis or other conditions which could result in spinal fractures. People who have connective tissue disorders such as Marfan syndrome are also at an increased risk of getting kyphosis during their lifetime.


If people have kyphosis, the easiest-to-recognize symptom is a rounded back. The extreme curve in the upper spine will cause them to hunch forward.

In addition to having a rounded back, people may have these other symptoms –

  • Mild to severe back pain
  • Back pain with movement
  • Fatigue
  • Tenderness and stiffness in the spine
  • Forward posture of the head
  • Chest pain or difficulty breathing (severe cases)
  • Difference in shoulder height
  • Tight hamstrings (muscles in the back of the thighs)


Kyphosis may cause the following complications –

  • Body image problems – Adolescents especially may develop a poor body image from having a rounded back or from wearing a brace to correct the condition.
  • Back pain – In some cases, the misalignment of the spine can lead to pain, which can become severe and disabling.
  • Decreased appetite – In severe cases, the curve may cause the abdomen to be compressed and lead to decreased appetite.



  • Pain relievers – If over-the-counter medicines — such as acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others) or naproxen (Aleve) — aren’t enough, stronger pain medications are available by prescription.
  • Osteoporosis drugs – In many older people, kyphosis is the first clue that they have osteoporosis. Bone-strengthening drugs may help prevent additional spinal fractures that would cause your kyphosis to worsen.

Bracing – For curves that progress, or in initially severe cases, a brace may be used to help straighten the spine and try to prevent further progression during growing years. Brace treatment for kyphosis is only used for patients who are still growing and is not an effective treatment for adult patients. Brace treatment for Scheuermann’s kyphosis in growing adolescents is similar to bracing for patients with scoliosis, however, the location and type of the brace may vary depending on the location of the kyphosis.

Exercises – Stretching exercises can improve spinal flexibility and relieve back pain. Exercises that strengthen the abdominal muscles may help improve posture.

Healthy lifestyle – Maintaining a healthy body weight and regular physical activity will help prevent back pain and relieve back symptoms from kyphosis.

Physical Therapy – Adolescents and adults with kyphosis may work with a physical therapist. A well-rounded rehabilitation program assists in calming pain and inflammation, improving mobility and strength, and helping with daily activities with greater ease and ability.

Alternative Treatment

Calcium + Vitamin D + Magnesium – The modern American diet is wreaking havoc on bone health. Many foods that are consumed on a daily basis lack nutrient density and block proper absorption of key vitamins. Gone are the days where large quantities of milk in one sitting are recommended for healthy bones. Science now recommends spreading out calcium intake throughout the day, and pairing certain food for optimal calcium absorption. For calcium to reach optimal absorption it should be paired with foods rich in Vitamin D and Magnesium.

Boron is ubiquitous throughout the human body, with the highest concentrations found in the bones and dental enamel. It helps in spinal health.

Vitamin K is a fat-soluble vitamin known for its effect in blood clotting, which it accomplishes by regulating the coagulation cascade via its ability to bind calcium ions (Ca2+), among other mechanisms. Three known vitamin K–dependent proteins have been isolated in bone: MGP (matrix Gla protein), protein S, and osteocalcin. One of vitamin K’s roles in helping to maintain healthy bone mass is linked to its importance in the formation of osteocalcin by osteoblasts. The synthesis of osteocalcin requires both vitamin D and vitamin K.

Omega-3 fatty acids is proven way to improve cardiovascular health, Omega-3 fatty acids have also shown some benefit to those with rheumatoid arthritis, reducing morning stiffness and joint swelling

Traditional Chinese Medicine (TCM) and acupuncture: TCM has been proven over thousands of years to help treat many different physical ailments. Based on herbs (usually brewed into tea or soup), TCM can improve how your body uses calcium, which in turn helps bone health.


Reference –


February 8, 2017

Knee pain is an extremely common complaint. In most cases, particularly for people over 50, osteoarthritis is to blame. However, people of every age can be affected due to many other possible causes including patellofemoral pain, muscle imbalances, structural pathology, or deformity and iliotibial band friction syndrome. Whatever the source of chronic knee pain, it usually involves a certain level of structural damage and limited function.

The knee is the largest and strongest joint in your body. It is made up of the lower end of the femur (thighbone), the upper end of the tibia (shinbone), and the patella (kneecap). The ends of the bones where they touch are covered with articular cartilage, a smooth slippery substance that protects the bones as you bend and straighten your knee.

Ligaments and tendons connect the thighbone to the bones of the lower leg. The four ligaments in the knee attach to the bones and act like strong ropes to hold the bones together.

Muscles are connected to bones by tendons. The quadriceps tendon connects the muscles in the front of the thigh to the kneecap. Stretching from your kneecap to your shinbone is the patellar tendon.

Knee pain may be the result of an injury, such as a ruptured ligament or torn cartilage. Medical conditions — including arthritis, gout and infections — also can cause knee pain. Many types of minor knee pain respond well to self-care measures. Physical therapy and knee braces also can help relieve knee pain. In some cases, however, the knee may require surgical repair.


Knee pain can have different causes. Being overweight puts people at greater risk for knee problems. Overusing the knee can trigger knee problems that cause pain. If patients have a history of arthritis, it could also cause knee pain.

Medical conditions

  • Arthritis — including rheumatoid arthritis, osteoarthritis, lupus, and gout
  • Baker’s cyst — a fluid-filled swelling behind the knee that may occur with swelling (inflammation) from other causes, like arthritis
  • Cancers that either spread to the bones or begin in the bones
  • Osgood-Schlatter disease
  • Infection in the bones of the knee
  • Infection in the knee joint

Injuries and overuse

  • Bursitis — inflammation from repeated pressure on the knee, such as kneeling for a long time, overuse, or injury
  • Dislocation of the kneecap
  • Fracture of the kneecap or other bones
  • Iliotibial band syndrome — injury to the thick band that runs from your hip to the outside of the knee
  • Pain in the front of the knee around the kneecap
  • Torn ligament — an anterior cruciate ligament (ACL) injury, or medial collateral ligament (MCL) injury may cause bleeding into your knee, swelling, or an unstable knee
  • Torn cartilage (a meniscus tear) – pain felt on the inside or outside of the knee joint
  • Strain or sprain – minor injuries to the ligaments caused by sudden or unnatural twisting

Risk Factors

  • Excess weight – Being overweight or obese increases stress on the knee joints, even during ordinary activities such as walking or going up and down stairs. It also puts people at increased risk of osteoarthritis by accelerating the breakdown of joint cartilage.
  • Biomechanical problems – Certain structural abnormalities — such as having one leg shorter than the other, misaligned knees and even flat feet — can make people more prone to knee problems.
  • Lack of muscle flexibility or strength – A lack of strength and flexibility are among the leading causes of knee injuries. Tight or weak muscles offer less support for the knee because they don’t absorb enough of the stress exerted on the joint.
  • Certain sports – Some sports put greater stress on the knees than do others. Alpine skiing with its rigid ski boots and potential for falls, basketball’s jumps and pivots, and the repeated pounding the knees take when people run or jog all increase the risk of knee injury.
  • Previous injury – Having a previous knee injury makes it more likely that some may injure the knee again.


Signs and symptoms that sometimes accompany knee pain include –

  • Swelling and stiffness
  • Redness and warmth to the touch
  • Weakness or instability
  • Popping or crunching noises
  • Inability to fully straighten the knee



  • Nonsteroidal anti-inflammatory drugs – There are more than a dozen different drugs in this category, some of which are available without a prescription.
  • Medications for Treatment of Knee Pain and Arthritis – Pain relievers, or analgesics, are an important part of treatment for many knee problems.
  • Analgesics – Analgesics are among the most commonly used drugs for many forms of arthritis.
  • Corticosteroids – These quick-acting drugs, similar to the hormone cortisone made by the body, are used to control inflammation.
  • Disease modifying anti-rheumatic drugs – Disease-modifying anti-rheumatic drugs (DMARDs) are drugs that work slowly to modify the course of autoimmune disease.
  • Gout medications – Some medications for gout are designed to reduce levels of uric acid in the blood to prevent future attacks of joint pain and inflammation.
  • Biologic response modifiers – The newest category of medications used for rheumatoid arthritis and a few other inflammatory forms of arthritis are the biologic agents.

Injections – In some cases, the injection of a corticosteroid drug into the knee joint may help reduce the symptoms of an arthritis flare and provide pain relief that lasts a few months. The injections aren’t effective in all cases. There is a small risk of infection.


  • Total joint replacement – The most common knee surgery is total knee replacement, a procedure in which the damaged knee joint is removed and replaced with prosthesis of metal, ceramic and/or plastic components.
  • Arthroscopy – Arthroscopy is a minimally invasive knee surgery performed by inserting a lighted scope and narrow instruments through small incisions in the skin over the knee.
  • Osteotomy – If the damage to the knee is mostly limited to one section, ther doctor may recommend a surgery called osteotomy.

Alternative Treatment

Capsaicin – Derived from hot chile peppers, topical capsaicin may be useful for some people in relieving pain. Capsaicin works by depleting substance P, a compound that conveys the pain sensation from the peripheral to the central nervous system.

Glucosamine sulfate – Glucosamine sulfate provides the joints with the building blocks they need to help repair the natural wear on cartilage caused by everyday activities. Specifically, glucosamine sulfate provides the raw material needed by the body to manufacture a mucopolysaccharide (called glycosaminoglycan) found in cartilage. Supplemental sources are derived from shellfish.

Chondroitin – Chondroitin protects the cartilage and attracts fluids that give the tissue its shock absorbing quality.

Evening primrose oil – A source of gamma-linolenic acid (GLA) which may help maintain healthy joints by modifying inflammation.

Herbs and spices – Ginger, holy basil, turmeric, green tea, rosemary, scutlellaria and huzhang all have naturally occurring anti-inflammatory compounds known as COX-2 inhibitors.

Omega-3 fatty acids – Containing primarily EPA and DHA, which have been shown in studies to help maintain bone health and flexibility.

SAM-e (S adenosylmethionine) – SAM-e helps to reduce inflammation and may increase the feel-good brain chemicals serotonin and dopamine.

Qigong – Qigong is an umbrella term for traditional Chinese-medicine exercises or techniques that integrate body, posture, mind and breathing to improve the flow of energy, or qi.

Acupuncture – Relieve arthritis; migraines; low-back, menstrual, or post-operative pain.

Boswellia – This herb is sourced from the frankincense tree. Its resin is used to thwart chemical reactions that cause inflammation, and thus pain. Ayurvedic scientists have used Boswellia for centuries to treat arthritic conditions, as well as inflammatory bowel disease.

Transcutaneous electrical nerve stimulation (TENS) –  A technique in which a weak electric current is administered through electrodes placed on the skin, TENS is believed to stop messages from pain receptors from reaching the brain. It has been shown to help with short-term pain control in some patients with knee or hip arthritis.

Knee braces – For osteoarthritis with associated knee instability, a knee brace can reduce pain, improve stability and reduce the risk of falling.

Heat and cold – Many people find the heat of a warm bath, heat pack or paraffin bath eases OA pain. Others find relief in cold packs. Still others prefer alternating the two.


Reference –,,20600989,00.html


February 8, 2017

Bursitis of the knee occurs when fluid fills up the knee, causing the kneecap to become reddened, painful and swollen. In the body, small sacks of fluid called bursae are found around joints to protect and stabilize these important areas. In the knee, there are 11 bursae that cover the kneecap to protect it from damage. When these burst, whether from trauma or overuse, the knee loses mobility and becomes painful to use when walking.

Types of Knee Bursitis

There are three most common types of knee bursitis –

  • Pre-patellar – The prepatellar bursa lies just above the knee cap between the skin and the knee cap. Prepatellar bursitis has historically been referred to as “housemaid’s knee”, which is derived from being a condition that was commonly associated with individuals whose work necessitated kneeling for extended periods of time. Prepatellar bursitis is common in professions such as carpet layers, gardeners, roofers and plumbers.
  • Infra-patellar – The infrapatellar bursa essentially consists of two bursae, one of which sits superficially between the patella tendon (below the kneecap) and the skin and the second referred to as the deep infrapatellar bursa is sandwiched between the patella tendon and tibia bone (shin). It can occur conjunctively with a condition called “Jumper’s Knee”, which involves repetitive strain and irritation to the patella tendon, often from jumping activities.
  • Anserine – The third most common knee bursitis, pes anserinus, occurs in the lower, inside part of the knee in close proximity to the upper aspect of the shin bone (tibia). It usually affects middle-aged women and overweight individuals.
  • Suprapatellar bursitis occurs above the kneecap. The suprapatellar bursa extends superiorly from beneath the patella under the quadriceps muscle. It is vulnerable to injury from both acute trauma and repeated microtrauma. Acute injuries are from direct trauma to the bursa via falls directly onto the knee, as well as from overuse injuries, including running on soft or uneven surfaces, or from jobs that require crawling on the knees, such as carpet laying.

Busra – A bursa is a thin sack filled with synovial fluid, the body’s own natural lubricating fluid. This slippery sack allows different tissues such as muscle, tendon, and skin slide over bony surfaces without catching. The bursa essentially reduces the friction between structures.

A bursa is normally very thin, but they can become inflamed and irritated. This is what is known as bursitis.

Bursa are of two types –

  • those naturally occurring in the body since birth
  • those that develop at places of repeated friction and pressure, called Adventitious bursae

Both the types are affected by similar conditions.


Usually the bursa becomes irritated or injured after overuse from repetitive motion or strenuous activity. A bacterial infection may also cause bursitis. Other health problems, such as gout or rheumatoid arthritis, can also cause bursitis.

There are a few causes of bursitis of the knee –

  • Overuse – The most common cause of this injury is overuse, which is how it got the nickname housemaid’s knee or clergyman’s knee. When a person puts excessive pressure on this already very thin and delicate area, it can cause the bursae to become inflamed. This in turn can lead to an infection.
  • Acute trauma – When a person receives acute trauma to his or her knee, bursitis can easily develop. The fluids released after a trauma can easily cause infection in this delicate region. When this occurs, the knee becomes inflamed, which can in turn trigger bursitis of the knee. First, blood will flow from the injured area to the spot of inflammation. Then, a cellular reaction will begin and leukocytes will flow to the area, causing an infection.
  • Disease – Several diseases, such as gout, CREST (calcinosis, Raynaud phenomenon, esophageal dysmotility, sclerodactyly and telangiectasia) syndrome, diabetes, sarcoidosis, mellitus, alcohol abuse and chronic obstructive pulmonary disease also can cause bursitis of the kneecap.

 Risk Factors

Knee bursitis is a common complaint, but the following factors may increase your risk of developing this painful disorder.

  • Excessive kneeling – People who work on their knees for long periods of time — carpet layers, plumbers and gardeners — are at increased risk of knee bursitis.
  • Participation in certain sports – Sports that result in direct blows or frequent falls on the knee — such as wrestling, football and volleyball — may increase the risk of knee bursitis. Runners may develop pain and inflammation in the anserine bursa, located on the inner side of the knee below the joint.
  • Obesity and osteoarthritis – Anserine bursitis, affecting the inner side of the knee below the joint, often occurs in obese women with osteoarthritis.


The symptoms of knee bursitis include –

  • Swelling over, above or below the kneecap.
  • Limited motion of the knee.
  • Redness and warmth at the site of the bursa.
  • Painful movement of the knee.

Knee bursitis swelling is within the bursa, not the knee joint. People often call any swelling of the knee joint “water on the knee,” but there is an important difference between fluid accumulation within the bursa and within the knee joint.

Symptoms of knee bursitis are usually aggravated by kneeling, crouching, repetitive bending or squatting and symptoms can be relieved when sitting still.


Physiotherapy – Many patients with knee bursitis start to feel better within a few weeks of the injury. The physiotherapy treatment will aim to –

  • Reduce pain and inflammation, this is achieved with the application of electrical modalities, ice, therapeutic taping and education regarding activity modification
  • Normalise the knee joint range of motion.
  • Strengthen the knee muscles: quadriceps and hamstrings.
  • Strengthen the lower limb: calves, hip and pelvis muscles.
  • Normalise the muscle lengths.
  • Improve the proprioception, agility and balance.
  • Improve the technique and function eg walking, running, squatting, hopping and landing.
  • Minimise the chance of re-aggravation.

Medication – Anti-inflammatories or NSAIDs are also used in combination with physiotherapy to help alleviate the pain and swelling. If the bursa becomes infected or if the symptoms persist for a prolonged period the doctor may recommend that the bursa be aspirated. Alternatively, the doctor may also recommend an injection of a glucocorticoid steroid that is mixed with a local anesthetic. If infection occurs, some may require antibiotics.

Surgery is rarely needed for pes anserine bursitis. The bursa may be removed if chronic infection cannot be cleared up with antibiotics.

Complementary and Alternative Treatment

Acupuncture can help reduce swelling and inflammation, and relieve pain.

Chiropractic – Although no well-designed scientific studies have looked at whether chiropractic treatment helps bursitis, chiropractors often treat persons with this condition. They report that some persons have less pain and increased range of motion.

Movement Therapy – Exercising the muscles around your joints will help reduce pressure on the joint and bursa. Gentle yoga may help bursitis by increasing flexibility and reducing muscle tension. Other movement therapies, such as Pilates and Tai Chi, may also help improve muscle and ligament strength and reduce the tension caused by repetitive motions.

Massage – People should not use massage if your bursitis is caused by an infection. Otherwise, massage, especially myofascial release therapy, may help to relax and may reduce the discomfort from a sore joint.


Glucosamine sulfate is a substance found in cartilage, the tissue that covers the ends of bones in a joint. Some evidence suggests it may help treat the pain of osteoarthritis, and it may also help reduce inflammation in bursitis. Glucosamine increases the risk of bleeding.

Omega-3 fatty acids such as fish oil or flaxseed oil – Although evidence is mixed on whether fish oil helps reduce inflammation, it seems to reduce the amount of inflammatory chemicals your body makes over time.

Vitamin C with flavonoids used to help repair connective tissue (such as cartilage).

Bromelain an enzyme that comes from pineapples, reduces inflammation. Bromelain may increase the risk of bleeding, so people who take blood thinners should not take bromelain without first talking to their doctor.

Turmeric is sometimes combined with bromelain because it makes the effects of bromelain stronger.

White willow acts similar to aspirin.


Reference –