Tammi L. Shlotzhauer, M.D. and James L. McGuire, M.D.

Course Outline

A trusted guide and an invaluable resource, Living with Rheumatoid Arthritis offers practical advice for the millions of people coping with this painful disease. Now thoroughly revised and expanded in a second edition, this book brings readers up to date with the latest methods of diagnosis and treatment.

Providing detailed information on medication, nutrition, and resources (online and off), this volume is a complete and comprehensive guide to the management of a difficult disease.

About the Authors

Tammi L. Shlotzhauer, M.D., is a clinical instructor of medicine at the University of Rochester Medical Center and a practicing rheumatologist at Rheumatology Associates of Rochester.

James L. McGuire, M.D., was a chairman of the department of medicine at Mount Auburn Hospital in Cambridge, Massachusetts.

Course Contents

1.The Joints and Rheumatoid Arthritis
1.1The Joints
1.1.1Rigid joints
1.1.2Slightly mobile joints
1.1.3Freely movable joints
1.1.4What are the parts of a synovial joint?
1.2The joints in RA
1.2.1What is inflammation?
1.2.2How is the inflammation of RA different from normal
1.2.4The stages of RA: How does inflammation affect the joints?
2.The Course and Prognosis of Rheumatoid Arthritis
2.1The course of RA
2.1.1How does RA usually start?
2.1.2What course of arthritis can I expect?
2.1.3Can a remission be brought on with medications?
2.2The Prognosis of RA
2.2.1Can arthritis be cured?
2.2.2Will other joints become involved with time?
2.2.3Will I become disabled?
2.2.4Does RA shorten a personís life?
3.Diagnosing Rheumatoid Arthritis: Why So Many Tests?
3.1Clinical History
3.2Physical Examination
3.3Differential Diagnosis
3.3.1What makes RA so difficult to diagnose?
3.4Diagnostic Tests
3.4.1What tests are used to diagnose or monitor activity of RA?
3.4.2What tests are used to rule out other types of arthritis?
3.5What tests are used to screen for complications of RA or medication side effects?
4.Outside the Joints: Other Symptoms of Rheumatoid Arthritis
4.1Blood and Blood Vessels
4.1.1How does RA affect the blood?
4.2What about blood vessels?
4.3Eyes and Mouth
4.6Chest and Lungs
4.7Vocal Cords
4.8The Heart
4.9The Bones
5.Coping Strategies
5.1Define and Assess the Problem
5.2Set Realistic Goals and Expectations
5.3Develop Methods for Problem Solving and Negotiating
5.3.1Eliminating the problem
5.3.2Circumventing the problem
5.3.3Working with the obstacle
5.3.4Modifying the goal
5.4Utilize All Available Resources
5.5Modify Negative Thoughts and Behaviors
5.6Be Willing to Reassess
5.7For More Information
6.Coping with Pain and Fatigue
6.1.1What is pain?
6.1.2Pain and your emotions
6.1.3What is the pain message in RA?
6.1.4Decreasing pain
6.2.1Why am I so tired?
6.2.2Controlling fatigue
6.3For More Information
7.Coping with Emotions- Yours and Everyone Elseís
7.2Managing anger
7.3.1Managing depression
7.4Anxiety, Fear, and Stress
7.4.1Relieving tension: Dealing with anxiety, fear, and stress
7.5Dealing with friends and Family
7.5.1Asking for help
7.5.2The special case of children
7.5.3Love and intimacy
7.5.4Friends and relatives
7.6For More Information
8.Protecting Your Joints
8.1Joint Protection Guidelines
8.2Protecting Specific Joints
8.2.1Hands and wrists
8.2.2Elbows and shoulders
8.2.3Hips and knees
8.2.4Ankles and feet
8.3For More Information
9.Exercise and Rheumatoid Arthritis
9.1Trends in therapeutic Advice
9.2Types of Exercise
9.2.1Range of motion
9.3Starting and Exercise Program
9.4Exercises That Are Right for You
9.4.1For people with very inflamed joints
9.4.2For people with moderately inflamed joints
9.4.3For people with controlled joints
9.5For More Information
10.Specific Exercises
10.1Range-of-Motion and Strengthening Exercises
10.1.1Neck range-of-motion exercises
10.1.2Neck muscle-strengthening exercises
10.1.3Shoulder range-of-motion exercises
10.1.4Elbow range-of-motion exercises
10.1.5Shoulder and elbow muscle-strengthening exercises
10.1.6Wrist and finger range-of-motion exercises
10.1.7Hip range-of-motion exercises
10.1.8Knee range-of-motion exercises
10.1.9Hip and knee muscle-strengthening exercises
10.2Endurance, or Aerobic, Exercises
10.2.1What is your target heart rate?
10.2.2Taking your pulse
10.2.3Beginning your aerobic exercise program
10.3For More Information
11.Medications Past, Present, Future
11.1The Past: The Conservative Approach
11.2The Present: More Aggressive Approaches to Therapy
11.3The Future
11.4Current Treatments: NSAIDs, DMARDs, BRMs, and Corticostroids
11.5For More Information
12.Aspirin, Nonsteroidal Anti-inflammatory Drugs (NSAIDs), and COX-2 Inhibitors
12.1.1Side effects of aspirin therapy
12.1.2Cautionary notes
12.2Traditional NSAIDs
12.2.1Side effects of traditional NSAIDs
12.2.2Cautionary notes
12.3New NSAIDs: COX-2 Inhibitors
12.3.1Side effects of COX-2 inhibitors
12.3.2Cautionary notes
12.4Stomach Medications Frequently Used with NSAIDs
13.Disease-Modifying Antirheumatic Drugs (DMARDs)
13.1Nonimmunosuppressant DMARDs
13.3For More Information
14.Biologic Response Modifiers (BRMs) and a Biologic Medical Device
14.1Understanding Cytokines and Inflammation
14.1.1Using the bodyís secrets to tame inflammation: Creating the Biologics
14.2Biologic Response Modifiers against TNF
14.3Biologic Response Modifiers against IL-1
14.4A Biologic Medical Device for Protein A Immunoadsorption
14.4.1Side effects of prosorba column therapy
14.5For More Information
15.1Oral Corticosteroids
15.1.1Side effects of oral corticosteroids
15.1.2Cautionary notes
15.2Corticosteroid Injections
15.2.1What to do after a joint injection
16.Osteoporosis Treatments
16.1Dietary and Life-Style Treatments
16.2Medicinal Treatments
16.3For More Information
17.Alternative and Complementary Therapies
17.4Breathing Techniques, Breath Therapy or Breathwork
17.5Chinese Medicine
17.5.2Tai Chi
17.5.4Chinese herbs
17.6Music and Sound Therapy
17.7Other Mind-Body Therapies
17.9Spa Therapy and Hydrotherapy
17.11Guidelines for Evaluating Unproven Treatments
17.12For More Information
18.Nutrition: Diets, Nutrients, and Food Supplements
18.1Nutrition and RA
18.2A Well-Balanced, Nutritious Diet
18.2.1The food guide pyramid
18.3Dietary Guidelines for Americans
18.4Special Diets
18.4.1Elimination Diets
18.4.3Vegetarian diets
18.4.4Gluten-free diet
18.4.5Fad diets
18.5A Word on Food Supplements
18.5.1Guidelines for evaluating food supplements
18.6Vitamins and Minerals
18.7Herbs and Plant-Based Medicine
18.8Other Supplements
18.9For More Information
19.Surgery for Rheumatoid Arthritis
19.1Surgeons Specializing in the Treatment of RA
19.2Types of Surgery
19.2.1Arthroscopic surgery
19.2.3Tendon reconstruction and transfers
19.2.4Joint fusion
19.2.5Osteotomy and bone resection
19.2.6Joint replacement
19.3Preparing for and Recovering from Surgery
19.3.1Before surgery
19.3.2During your recovery
19.4For More Information
20.Disability, Insurance, and Other Financial Matters
20.1Disability Benefits
20.1.1Commercial and employment disability programs
20.1.2State disability policies
20.1.3Social Security disability benefits
20.1.4Vocational rehabilitation benefits
20.2Health Insurance
20.2.1Private health insurance
20.2.2Government health insurance
20.3Veterans Administration (VA) Benefits
20.4Income Taxes
20.5For More Information
21.Other Issues
21.1Surfing the Net: Empowerment or Deception?
21.2Clinical Research
21.2.1What is clinical research?
21.2.2How do clinical studies operate?
21.2.3Should I participate in a clinical trial?
21.3Travel Tips
21.3.1Medical tips for travelers
21.3.2Driving tips
21.3.3When traveling by air
21.4Pregnancy and Childbirth
21.4.1Can I become pregnant?
21.4.2How will my pregnancy affect my RA?
21.4.3How will my RA affect my unborn child?
21.4.4Can I breastfeed my infant?
21.4.5Will my child have RA?
21.4.6Will I be able to care for my baby?
21.5Immunization for the Person with RA
21.5.1Should I get a yearly flu shot?
21.5.2Are there other vaccinations that I may want to get?
21.6RA in Children and Adolescents
21.7For More Information
Closing Thoughts

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