Hi!Here are just a few things to know about me:
* I appreciate and LOVE my family and friends!
* I'm fun-loving and easy-going!
* I LOVE going to the beach! (Preferably in a warm climate!)
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* I LOVE to laugh! (laughter is great medicine and keeps us young at heart)
* I genuinely care about people!
* I am a DISNEY fanatic! (The Parks, the movies, and more!!) , ,
* I LOVE Country and Bluegrass music!
* I'm a Registered Nurse in the field of Rheumatology / Immunology!
* I DO what I love and LOVE what I do!
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View my page on LUPUS/FIBROMYALGIA BUTTERFLIES AMONG US
I live with MIXED CONNECTIVE TISSUE DISEASE (MCTD), which encompasses Systemic LUPUS, CREST Syndrome (Limited Scleroderma), Membranous Nephritis - A Class V Kidney Disease, Sjogrens Syndrome, Atypical Migraine Headaches, Fibromyalgia, MPS - Myofacial Pain Syndrome, gastroparesis, and more.
I have become accustomed and accepting, to dancing in the rain!...(barefoot...gotta dance in the rain barefoot!)
*** I can hardly believe that it is mid-November already!!!! Where did 2009 go? I cannot wait to spend Thanksgiving with my family !!!***
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Lupus is an autoimmune disease that can affect various parts of the body, including the skin, joints, heart, lungs, blood, kidneys and brain. Normally the body's immune system makes proteins called antibodies, to protect the body against viruses, bacteria, and other foreign materials. These foreign materials are called antigens.
In an autoimmune disorder like lupus, the immune system cannot tell the difference between foreign substances and its own cells and tissues. The immune system then makes antibodies directed against itself. These antibodies -- called "auto-antibodies" (auto means 'self') -- cause inflammation, pain and damage in various parts of the body.
Inflammation is considered the primary feature of lupus. Inflammation, which in Latin means "set on fire," is characterized by pain, heat, redness, swelling and loss of function, either on the inside or on the outside of the body (or both).
For most people, lupus is a mild disease affecting only a few organs. For others, it may cause serious and even life-threatening problems. Although epidemiological data on lupus is limited, studies suggest that more than 16,000 Americans develop lupus each year.
The Lupus Foundation of America (LFA) estimates between 1.5 - 2 million Americans have a form of lupus, but the actual number may be higher. More than 90 percent of people with lupus are women. Symptoms and diagnosis occur most often when women are in their child-bearing years, between the ages of 15 and 45.
In the United States, lupus is more common in African Americans, Latinos, Asians, and Native Americans than in Caucasians.
Symptoms:
Although lupus can affect any part of the body, most people experience symptoms in only a few organs. The most common symptoms of people with lupus are listed below. Occurrences of particular symptoms happening are listed as percentages. (The symptoms in bold print are some that I have/had experienced...)
* Achy joints / arthralgia (95 percent)
* Fever of more than 100 degrees F / 38 degrees C (90 percent)
* Arthritis / swollen joints (90 percent)
* Prolonged or extreme fatigue (81 percent)
* Skin Rashes (74 percent)
* Anemia (71 percent)
* Kidney Involvement (50 percent)
* Pain in the chest on deep breathing / pleurisy (45 percent)
* Butterfly-shaped rash across the cheeks and nose (42 percent)
(Me - during a brief flare in 2006)
* Sun or light sensitivity / photosensitivity (30 percent)
* Hair loss (27 percent)
* Abnormal blood clotting problems (20 percent)
* Raynaud's phenomenon / fingers turning white and/or blue in the cold (17 percent)
* Seizures (15 percent)
* Mouth or nose ulcers (12 percent)
If you have several of these symptoms, see your doctor right away.
Because many lupus symptoms mimic other illnesses, are sometimes vague and may come and go, lupus can be difficult to diagnose. Diagnosis is usually made by a careful review of a person's entire medical history coupled with an analysis of the results obtained in routine laboratory tests and some specialized tests related to immune status.
Currently, there is no single laboratory test that can determine whether a person has lupus or not. To assist the physician in the diagnosis of lupus, the American College of Rheumatology (ACR) in 1982 issued a list of 11 symptoms or signs that help distinguish lupus from other diseases. A person should have four or more of these symptoms to suspect lupus. The symptoms do not all have to occur at the same time. (The criteria in bold type are those that I met to receive my diagnosis...)
The Eleven Criteria Used for the Diagnosis of Lupus
1. Malar Rash - Rash over the cheeks
2. Discoid Rash - Red raised patches
3. Photosensitivity - Reaction to sunlight, resulting in the development of or increase in skin rash
4. Oral Ulcers - Ulcers in the nose or mouth, usually painless
5. Arthritis - Nonerosive arthritis involving two or more peripheral joints (arthritis in which the bones around the joints do not become destroyed)
6. Serositis - Pleuritis or pericarditis (inflammation of the lining of the lung or heart)
7. Renal Disorder - Excessive protein in the urine (greater than 0.5 gm/day or 3+ on test sticks) and/or cellular casts (abnormal elements the urine, derived from red and/or white cells and/or kidney tubule cells)
8. Neurologic Disorder - Seizures (convulsions) and/or psychosis in the absence of drugs or metabolic disturbances which are known to cause such effects
9. Hematologic Disorder - Hemolytic anemia or leukopenia (white blood count below 4,000 cells per cubic millimeter) or lymphopenia (less than 1,500 lymphocytes per cubic millimeter) or thrombocytopenia (less than 100,000 platelets per cubic millimeter). The leukopenia and lymphopenia must be detected on two or more occasions. The thrombocytopenia must be detected in the absence of drugs known to induce it.
10. Antinuclear Antibody - Positive test for antinuclear antibodies (ANA) in the absence of drugs known to induce it.
11. Immunologic Disorder - Positive anti-double stranded anti-DNA test, positive anti-Sm test, positive antiphospholipid antibody such as anticardiolipin, or false positive syphilis test (VDRL).
What is a "Flare"
In the simplest of terms, a lupus flare is when a person's lupus has been quiet or in remission, and then it becomes active again, either with new symptoms or a recurrence of old ones.
So what triggers an attack of lupus in someone? Scientists have noted some common features in many lupus patients. In some, exposure to the sun causes the sudden development of a rash, and then possibly other symptoms. In others, an infection ... perhaps a cold or a more serious infection ... does not get better, and then complications arise. These complications may be the first signs of lupus.
In still other cases, a drug taken for some illness produces the signaling symptoms. In some women, the first symptoms and signs develop during pregnancy. In others, they appear soon after delivery. Many people cannot remember or identify any specific factor. Obviously, many seemingly unrelated factors can trigger the onset of the disease.
Keeping A Flare At Bay
Doctors have identified healthy habits that can help you avoid triggering a lupus flare.
* Always take your medication as prescribed.
* Keep your doctor's appointments, even if you're feeling well.
* Avoid taking sulfa drugs (sulfonomides) that are used to treat infections such as bronchitis and urinary tract infections.
* Limit your exposure to sunlight; apply sunscreen before going outside during the day, and wear sun-protective clothing and a wide-brimmed hat.
* Reduce your risk of infections.
* Get plenty of rest.
* Do not smoke.
Treatments
For the vast majority of people with lupus, effective treatment can minimize symptoms, reduce inflammation, and maintain normal bodily functions.
Commonly prescribed medications include:
Non-steroidal Anti-inflammatory Drugs (NSAIDs): These medications are prescribed for a variety of rheumatic diseases, including lupus. Examples of such compounds include acetylsalicylic acid (e.g., aspirin), ibuprofen (Motrin), naproxen (Naprosyn), indomethacin (Indocin), nabumetone (Relafen), tolmetin (Tolectin), and a large number of others. These drugs are usually recommended for muscle and joint pain, and arthritis. Aspirin and NSAIDs may cause stomach upsets for some people. This effect can be minimized by taking them with meals, milk, antacids, or prostaglandins such as misoprostil (Cytotec). Newer NSAIDs contain a prostaglandin in the same capsule (Arthrotec). The other NSAIDs work in the same way as aspirin, but may be more potent, and patients often require fewer pills per day to have the same effect as aspirin. Many NSAIDs are now available in "over the counter" forms. Patients should be cautious about taking too much aspirin or NSAID since too many of these can reduce the blood flow to the kidney and cause problems.
Corticosteroids: Corticosteroids (steroids) are hormones that have anti-inflammatory and immunoregulatory properties. They are normally produced in small quantities by the adrenal gland. This hormone controls a variety of metabolic functions in the body. Synthetically produced corticosteroids are used to reduce inflammation and suppress activity of the immune system. The most commonly prescribed drug of this type is Prednisone.
Because steroids have a variety of side effects, the dose has to be regulated to maximize the beneficial anti-immune/anti-inflammatory effects and minimize the negative side effects. Side effects occur more frequently when steroids are taken over long periods of time at high doses (for example, 60 milligrams of Prednisone taken daily for periods of more than one month). Such side effects include weight gain, a round face, acne, easy bruising, "thinning" of the bones (osteoporosis), high blood pressure, cataracts, onset of diabetes, increased risk of infection, stomach ulcers, hyperactivity, and an increase of appetite.
Antimalarials: Chloroquine (Aralen) or hydroxychloroquine (Plaquenil), commonly used in the treatment of malaria, may also be very useful in some individuals with lupus. They are most often prescribed for skin and joint symptoms of lupus. It may take months before these drugs demonstrate a beneficial effect. Side effects are rare, and consist of occasional diarrhea or rashes. Some antimalarial drugs, such as quinine and chloroquine, can affect the eyes. Therefore, it is important to see an eye doctor (ophthalmologist) regularly. The manufacturer suggests an eye exam before starting the drug and one exam every six months thereafter. However, your physician might suggest a yearly exam is sufficient.
Immunomodulating Drugs: Azathioprine (Imuran) and cyclophosphamide (Cytoxan) are in a group of agents known as cytotoxic or immunosuppressive drugs. These drugs act in a similar manner to the corticosteroid drugs in that they suppress inflammation and tend to suppress the immune system. The side effects of these drugs include anemia, low white blood cell count, and increased risk of infection. Their use may also predispose an individual to developing cancer later in life.
Other agents like methotrexate and cyclosporin are used to control the symptoms of lupus. Both are immunomodulating drugs which have their own side effects. These drugs are still in the investigational phase for lupus. Some of these agents are used in conjunction with apheresis, a blood filtering treatment. Apheresis has been tried by itself in an effect to remove specific antibodies from the blood but the results have not been promising.
Newer agents are directed toward specific cells of the immune system. These include agents which block the production of specific antibodies like those against DNA, or agents which act to suppress the manufacture of antibodies through other mechanisms. Examples of this are intravenous immunoglobulin injections which are given on a regular basis to increase platelets (particles important to coagulation).
Anticoagulants: These drugs are employed to thin the blood, or in actuality to prevent blood from clotting rapidly. They range from aspirin at very low dose which prevents platelets from sticking, to heparin/coumadin which actually prevent the blood from clotting. The latter requires careful monitoring to insure that the patient is in the "therapeutic range" or that the blood is not excessively "thin". Generally, such therapy is life-long in people with lupus and follows an actual episode of clotting (embolus or thromboses).
People with lupus should learn to recognize early symptoms of disease activity. In that way they can help the physician know when a change in therapy is needed. Regular monitoring of the disease by laboratory tests can be valuable because noticeable symptoms may occur only after the disease has significantly flared. Changes in blood test results may indicate the disease is becoming active even before the patient develops symptoms of a flare. Generally, it seems that the earlier such flares are detected, the more easily they can be controlled. Also, early treatment may decrease the chance of permanent tissue or organ damage and reduce the time one must remain on high doses of drugs.
Prognosis
The idea that lupus is generally a fatal disease is a big misconception. In fact, the prognosis of lupus is much better today than ever before.
It is true that medical science has not yet developed a method for curing lupus. And some people do die from the disease. However, people with non-organ threatening aspects of lupus can look forward to a normal lifespan if they ...
* follow the instructions of their physician
* take their medication(s) as prescribed, and
know when to seek help for unexpected side effects of a medication or a new manifestation of their lupus.
Although some people with lupus have severe recurrent attacks and are frequently hospitalized, most people with lupus rarely require hospitalization. There are many lupus patients who never have to be hospitalized, especially if they are careful and follow their physician's instructions.
New research brings unexpected findings each year. The progress made in treatment and diagnosis during the last decade has been greater than that made over the past 100 years. It is therefore a sensible idea to maintain control of a disease that tomorrow may be curable.
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What is Sjögren’s syndrome?
Sjögren’s syndrome is a chronic disorder that causes insufficient moisture production in certain glands of the body.
Sjögren’s syndrome occurs when a person’s normally protective immune system attacks and destroys moisture-producing glands, including salivary (saliva-producing) glands and lacrimal (tear-producing) glands. The lungs, bowel and other organs are less often affected by Sjögren’s syndrome.
Sjögren’s syndrome is named after the Swedish eye doctor, Henrik Sjogren, who first described the condition.
Sjögren’s syndrome is characterized by dry eyes and mouth. In some patients, the parotid glands may become visibly enloarged.
What are some symptoms Sjögren’s syndrome may cause?
• Extremely dry eyes causing:
~ Feeling of grit or sand in the eyes
~ Burning
~ Redness
• Extremely dry mouth and throat causing:
~ Difficulty chewing and swallowing
~ Decreased sense of taste
~ Difficulty speaking
~ Increase in dental cavities
~ Dry cough or hoarseness
• Enlarged parotid glands (located at the angle of jaw) and sometimes infection of the parotid glands
• Excessive fatigue
• Aches, pains in muscles and joints
Less common features of Sjögren’s syndrome are:
• Irritation of the nerves in the arms, hands, legs or feet (neuropathy)
• Thyroid gland abnormalities
• Skin rashes
• Memory loss or confusion
• Feeling of numbness or tingling
• Gastrointestinal problems
• Inflammation of the lungs, kidneys, liver or pancreas
• Cancer of the lymphatic tissue (occurs in less than 1% of patients with the disease)
What causes Sjögren’s syndrome?
Normally, the immune system (the body’s defense system) protects the body from infection and foreign substances such as bacteria and viruses.
In autoimmune diseases, such as Sjögren’s syndrome, the immune system triggers an inflammatory response when there are no foreign substances to fight off. This inflammatory response causes the body’s white blood cells to attack and destroy certain moisture-producing glands.
The exact cause for the abnormal immune response in Sjögren’s syndrome is unknown. Some theories suggest that a virus or bacteria may alter the immune system, causing it to attack the glands. Certain people may have a genetic or inherited factor that makes them more likely to develop Sjögren’s syndrome.
What are the forms of the disease?
Sjögren’s syndrome occurs in two basic forms:
• Primary Sjögren’s syndrome – the disease by itself, not associated with any other illness
• Secondary Sjögren’s syndrome – disease that develops in the presence of another autoimmune disease such as rheumatoid arthritis, systemic lupus erythematosus or vasculitis
Who is affected by the disease?
More than one million people in the United States have Sjögren’s syndrome. Over 90% of people affected by Sjögren’s syndrome are women. The disease can affect people of any race or age.
How is primary Sjögren’s syndrome diagnosed?
The diagnosis of Sjögren’s syndrome is based on several factors, including:
• Presence of dry eyes and mouth
~ Dry eyes can be detected by an ophthalmologist (eye doctor) by measuring tear production or carefully examining the cornea (clear part of the eye).
• Certain laboratory tests also suggest that dry eyes and mouth are caused by autoimmune mechanisms
~ Examples include the presence of autoantibodies in the blood, known as anti-SSA or anti-SSB (also known as anti-Ro or anti-La).
• Biopsy of the inner lip (performed in some cases to prove the diagnosis of primary Sjögren’s syndrome). The biopsy may show inflammation damaging salivary glands.
How is secondary Sjögren’s syndrome diagnosed?
Secondary Sjögren’s syndrome is generally diagnosed when someone with an established autoimmune disease such as rheumatoid arthritis or systemic lupus erythematosus develops extreme dryness of the eyes and mouth. This diagnosis only rarely requires a lip biopsy.
Can other problems mimic Sjögren’s syndrome?
Sometimes, the use of certain medications mimic the symptoms of Sjögren’s syndrome. Medications such as tricyclic anti-depressants, antihistamines, radiation treatments to the head and neck and other autoimmune disorders can also cause severely dry eyes and mouth.
How is Sjögren’s syndrome treated?
There is no cure for Sjögren’s syndrome, but it can be treated and controlled. The goals of treatment are to decrease discomfort and reduce the harmful effects of dryness. The type of treatment prescribed will be tailored to each patient’s symptoms and needs.
GOOD ORAL HYGIENE
Good mouth care may not prevent a dry mouth, but it helps prevent infection. Toothpastes and oral gels are available for people with dry mouth symptoms. These products contain low doses of peroxide (high amounts could cause worse dryness). These products may also have antibacterial action to reduce the severity of dental cavities over a long period of time.
INCREASING EYE MOISTURE
Dry eyes are mainly treated with the use of artificial tears, and a wide variety of products are available. Artificial tears must be used regularly and more often in dry environmental conditions such as on airplanes, in air conditioned buildings and on windy days.
While artificial tears are helpful, they often do not last long enough. Thicker preparations are available that last longer. These are often used at bedtime because they sometimes cause blurry vision.
Surgery to slow the disappearance of tears is another treatment option when artificial tears are not sufficient.
MEDICATIONS
Medications that tend to deplete body fluids should be avoided.
Mild pain-relieving medications (analgesics) including acetaminophen (such as Tylenol) or nonsteroidal antiinflammatory drugs (NSAIDs – such as Motrin and Aleve) can reduce muscle or joint pain.
In some patients, the anti-rheumatic drug, hyroxychloroquine, has been beneficial in decreasing pain and salivary gland swelling.
For patients with generalized symptoms, particularly when the disease affects internal organs (including the gastrointestinal system, kidneys or nervous system), high doses of immunosuppressive medications may be necessary. These include medicines such as prednisone (a steroid) and rarely chemotherapy-type medications.
BALANCE OF REST AND EXERCISE
Guided exercise programs can help patients overcome fatigue, maintain flexibility and overcome joint and muscle pain.
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Although I take a medication daily called a Calcium Channel Blocker to help with circulation, my Raynaud's Disease flares regardless. It can happen when I am physically and/or emotionally stressed, when the air cools in the evenings, or when entering an air-conditioned place. It literally causes me to feel "cold to the core" and it can take hours for me to recover. Sometime I have to warm up heating pads to warm back up.
What Is Raynaud's Disease?
Raynaud's disease and Raynaud's phenomenon are rare disorders that affect blood vessels. These disorders are marked by brief episodes of vasospasm (narrowing of the blood vessels). Vasospasm causes decreased blood flow to the fingers and toes, and rarely to the nose, ears, nipples, and lips. The fingers are the most commonly affected area, but the toes also are affected in 40 percent of people with Raynaud's.
When this disorder occurs without any known cause, it is called Raynaud's disease, or primary Raynaud's. When the condition occurs along with a likely cause, it is known as Raynaud's phenomenon, or secondary Raynaud's. Primary Raynaud's is more common and tends to be less severe than secondary Raynaud's.
When you have primary or secondary Raynaud's, cold temperatures or stressful emotions can trigger attacks. During these attacks, there is a brief lack of blood flow to the affected body part(s), and the skin can temporarily become white then bluish. As blood flow returns to the area, the skin turns red. The affected areas can throb or feel numb and tingly. With severe Raynaud's, prolonged or repeated episodes can cause sores or tissue death (gangrene).
It is normal for the body to keep its vital inner organs warm by limiting blood flow to the arms, legs, fingers, and toes. The body naturally does this in response to a long period of cold. This response can cause frostbite. In people with Raynaud's, the response to cold is quicker and stronger. The response can be triggered by mild or short-lived changes in temperature, such as:
* Taking something out of the freezer
* Temperatures that dip below 60 degrees Fahrenheit
In people with Raynaud's, blood flow is more strongly reduced in response to cold temperatures than in people without the disorder. When Raynaud's is severe (which is uncommon), exposure to cold for as little as 20 minutes can cause major tissue damage.
The blood vessels of people with Raynaud's also , physically overreact to stressful emotions. It is normal during times of psychological stress for the body to release hormones that narrow its blood vessels. But for people with Raynaud's, this squeezing of blood vessels is stronger. This results in less blood reaching fingers, toes, and sometimes other extremities.
Outlook
For most people, primary Raynaud's is more of a bother than a serious illness and it can usually be managed with minor lifestyle changes. Secondary Raynaud's can be more difficult to manage, but several treatments may help prevent or relieve symptoms. Among the most important treatments for secondary Raynaud's is treating of the underlying condition, (as in MY case - Lupus.
Now you know why I have SO many pairs of mittens!!!
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Many of those already suffering from the pain of fibromyalgia also suffer from myofascial pain syndrome.
Myofascial pain syndrome is another form of chronic pain that can affect the entire body, particularly the face and jaw. Myofascial pain can add to the already annoying symptoms of fibromyalgia, and can contribute to disability and a poor quality of life if not diagnosed properly. If you think that you may be suffering from myofascial dysfunction, visit with your health care provider to discuss your treatment options.
What is Myofascial Pain Syndrome?
Myofascial syndrome is a pain disorder that affects the muscles and fascia throughout your body. Fascia is like a web that surrounds the bones, tissues, organs, and blood vessels throughout the body. Myofascial pain syndrome can attack and cause degeneration of certain areas of the fascia, resulting in chronic pain and a variety of other symptoms.
Pain usually originates in specific areas of the body, called myofascial trigger points (TrPs), which feel like tiny nodules under the skin. These trigger points commonly develop throughout the body, typically where the fascia comes into contact with a muscle.
Myofascial pain syndrome is a very common illness, and most people will develop at least one trigger point in their body at some point in their lives. The majority of these people will not develop severe symptoms and will be able to continue on with their normal routines. However, about 14% of the population will develop a chronic form of the syndrome, resulting in persistent pain and discomfort.
Myofascial pain disorder is very common in fibromyalgia sufferers. It was once thought that myofascial pain syndrome was actually a kind of fibromyalgia. However, this is now known not to be the case. It is possible to have both fibromyalgia and chronic myofascial syndrome, and therefore it is important to be diligent when analyzing your symptoms. If you notice myofascial syndrome symptoms, record them and report them to your doctor.
Signs and Symptoms of Myofascial Pain Syndrome
The most common sign of myofascial pain is the presence of palpable trigger points in your muscles. Trigger points are areas of extreme tenderness and sensitivity, and usually form in bands of muscle underneath your skin. They are similar to the tender points caused by fibromyalgia, only trigger points can be felt beneath the skin. When touched, trigger points will produce pain and twitching in the muscles. Often, pain is felt in an area distinct from the trigger point that is actually affected – this is called referred pain.
The pain of myofascial syndrome is typically a dull ache, but can also produce a throbbing, stabbing, or burning sensation. Pain is often located in the jaw area, though any part of the body can be affected. One-third of myofascial pain sufferers report localized pain, while two-thirds report having pain all over their bodies.
Myofascial pain can also produce a variety of other symptoms, many of which may appear unrelated. These include:
~ numbness in the extremities
~ popping or clicking of the joints
~ limited movement of joints, particularly the jaw
~ muscle weakness (manifested in dropping things)
~ migraine or headache
~ disturbed sleep
~ balance problems
~ tinnitus and ear pain
~ double vision or blurred vision
~ problems with memory ..
Aggravating Factors
Symptoms are often aggravated by specific factors. Stress and anxiety contribute to muscle tension and can irritate trigger points. Changes in the weather, including sudden coldness, high humidity, or extreme dryness can also exacerbate symptoms. Physical activity can also trigger symptoms.
Causes of Myofascial Pain Syndrome
There are numerous proposed causes of myofascial pain:
Muscle and Skeletal Problems:
The causes of myofascial pain dysfunction syndrome can be numerous and depend upon the individual. Generally, myofascial pain is caused by some sort of trauma to the muscles and skeleton in the body. Overworking of the muscles can cause damage to certain areas resulting in the development of a trigger point. Poor posture can also trigger myofascial pain in certain individuals. Skeletal abnormalities, such as having different sized feet, toes, or legs, can also contribute to the development of myofascial pains. Frequent exposure to cold weather may also increase the risk of developing chronic myofascial pain syndrome.
Chronic Fibromyalgia Pain:
People with fibromyalgia may get myofascial pain syndrome as a result of their fibromyalgia pain. Compensating for pain can often cause reduced movement or an unhealthy posture, leading to the formation of trigger points. The severe pain caused by fibromyalgia also causes muscle contractions around tender points, referred to as guarding. Eventually these muscle contractions cause trigger points to form in addition to the tender points of fibromyalgia.
Depression Associated with Fibromyalgia:
The depression associated with fibromyalgia may also cause myofascial pain to develop. At least 30% of fibromyalgia patients suffer from depression, which causes low levels of serotonin in the brain. Serotonin is a neurotransmitter responsible for regulating mood and pain in the body. Depression may interfere with the process of regulating pain, causing MPS.
Effects of MPS on Fibromyalgia
Having both myofascial pain syndrome and fibromyalgia can be quite trying at times. Symptoms of MPS and fibromyalgia are very similar, making it difficult for medical professionals to properly diagnose many people. Without proper diagnosis, a patient may not receive appropriate treatment, causing his or her symptoms to become even worse. In addition, myofascial pain can often contribute to the pain caused by fibromyalgia, making life much more difficult to enjoy.
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Mixed connective tissue disease is a term used by some doctors to describe a disorder characterized by features of systemic lupus erythematosus, systemic sclerosis, and polymyositis.
Raynaud's syndrome, joint pains, various skin abnormalities, weakness, and problems with internal organs can develop.
Characteristic abnormal antibodies are usually detectable in blood.
Treatment is similar to that of systemic lupus erythematosus, often with corticosteroids.
About 80% of people who have this disease are women. Mixed connective tissue disease affects people from ages 5 to 80. Its cause is unknown, but it seems to be an autoimmune disorder.
Symptoms
The typical symptoms are Raynaud's syndrome (in which the fingers suddenly become very pale and tingle or become numb or blue in response to cold or emotional upset—see Peripheral Arterial Disease: Raynaud's Syndrome), joint inflammation (arthritis), swollen hands, muscle weakness, difficulty in swallowing, heartburn, and shortness of breath. Raynaud's syndrome may precede other symptoms by many years. Regardless of how mixed connective tissue disease starts, it tends to worsen, and symptoms spread to several parts of the body.
The hands are frequently so swollen that the fingers look like sausages. A purplish butterfly-shaped rash on the cheeks and bridge of the nose, red patches on the knuckles, a violet discoloration of the eyelids, and red spider veins on the face and hands all may appear. Skin changes similar to those in systemic sclerosis also may occur. The hair may thin.
Almost everyone with mixed connective tissue disease has aching joints. About 75% develop the swelling and pain typical of joint inflammation (arthritis). Mixed connective tissue disease damages the muscle fibers, so the muscles may feel weak and sore, especially in the shoulders and hips. Tasks such as lifting the arms above the shoulders, climbing stairs, and getting out of a chair can become very difficult.
Fluid may collect in or around the lungs. In some people, abnormal lung function is the most serious problem, causing shortness of breath during exertion.
Occasionally, the heart is weakened, leading to heart failure (see Heart Failure). Symptoms of heart failure may include fluid retention, shortness of breath, and fatigue. The kidneys and nerves are affected in only 10% of people, and the damage is usually mild compared to the damage caused by lupus. Other symptoms may include fever, swollen lymph nodes, abdominal pain, and persistent hoarseness. Sjögren's syndrome may develop. Over time, most people develop symptoms that are more typical of lupus or systemic sclerosis.
Diagnosis
Doctors suspect mixed connective tissue disease when some symptoms from lupus, systemic sclerosis, polymyositis, or rheumatoid arthritis overlap.
Blood tests are performed to detect an antibody to ribonucleoprotein, (RNP Antibodies) which is present in almost all people who have mixed connective tissue disease. A high level of this antibody without the other antibodies present in lupus is characteristic of mixed connective tissue disease.
Prognosis
Despite treatment, mixed connective tissue disease worsens in about 13% of the people, causing potentially fatal complications in 6 to 12 years. The prognosis is worse for people who have mainly features of systemic sclerosis or polymyositis. Overall, 80% of people survive at least 10 years after the diagnosis is made. Symptom-free periods can last for many years with little or no continuing treatment with a corticosteroid.
Treatment
The treatment is similar to that of lupus. Corticosteroids are usually effective, especially when the disease is diagnosed early. Mild cases can be treated with aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs), hydroxychloroquine or similar drugs, or very low doses of corticosteroids. The more severe the disease, the higher the dose of corticosteroid needed. In severe cases, immunosuppressive drugs such as azathioprine, methotrexate
or cyclophosphamide may also be needed.
In general, the more advanced the disease and the greater the organ damage, the less effective the treatment. Systemic sclerosis-like damage to the skin and esophagus is least likely to respond to treatment.
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