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METHODOLOGY TEXT BOOK 2009 2010.doc
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Rheumatoid arthritis and osteoporosis

from http://www.bbcnews.com

Rheumatoid arthritis (RA) (to be) _____ a chronic, inflammatory autoimmune disorder. RA (to cause) ________ the immune system to attack the joints. RA (to be) _____ a disabling and painful inflammatory condition. It can (to lead) ______ to substantial loss of mobility [mou’biliti] due to pain and joint destruction. The disease (to be) ______ also systemic. It often also (to affect) _______ many extra-articular tissues throughout the body including the skin, blood vessels, heart, lungs, and muscles. The symptoms (to be) ______ inflammation and soft-tissue swelling of many joints at the same time (polyarthritis), usually stiffness of all joints in the morning that (to last) ________ over 1 hour. Thus, the pain of rheumatoid arthritis (to be) ______ usually worse in the morning. Rheumatoid arthritis (to occur) ________ most frequently in the 20-40 age group, although can (to start) _________ at any age. Family history (to be) _____ an important risk factor. The disease (to affect) _________ females : males in a 3:1 ratio.

The American College of Rheumatology (to define) ___________ the following criteria for the diagnosis of rheumatoid arthritis.

  • Morning stiffness of >1 hour.

  • Arthritis and soft-tissue swelling of >3 of 14 joints/joint groups

  • Arthritis of hand joints

  • Symmetric arthritis

  • Subcutaneous nodules in specific places

  • Rheumatoid factor

  • Radiological changes suggestive of joint erosion

When RA (to suspect) _________________ clinically, immunological studies (to require) ______________, such as rheumatoid factor. Also, several other blood tests are usually done to allow for other causes of arthritis. The erythrocyte sedimentation rate (ESR), C-reactive protein, full blood count, renal function, liver enzymes and immunological test (to perform) ________. Pharmacological treatment of RA can (to divide) ______________ into disease-modifying antirheumatic drugs (DMARDs), anti-inflammatory agents and analgesics. DMARDs (to found) _______________________ to produce durable remissions. These drugs (to delay) __________ or (to halt) ________ disease progression. Other therapies (to be) _______ weight loss, occupational therapy, physiotherapy, joint injections, and special tools to improve hard movements (e.g. special tin-openers). Severely affected joints may (to require) _________ joint replacement surgery, such as knee replacement.

Osteoporosis

Osteoporosis mainly (to affect) _________ women after the age of the menopause, although men can (to have) _______ it too. It can (to occur) ________ in younger people if they (to have) _____________ other predisposing factors.

What (to cause) _________ it?

The condition (to occur) ________ because from around the age of 35 more bone cells (to lose) ___________ than (to replace) _______. This (to cause) _________ the bone density to decrease.

The first sign (to be) ______commonly when a minor bump or fall (to cause) ________ a bone fracture. These may (to result) ________ in pain, disability, loss of independence, and death. Osteoporosis may (to cause) ______________ people to 'shrink' as they (to get) _______ older. It (to cause) __________ the characteristic 'dowager's hump'.

Who (to affect) _______________?

About 3 million people in the UK (to have) _________ the condition, which (to be) ____ more common in women than men. Every year in the UK over 230,000 fractures (to occur) ________ because of osteoporosis. In the UK one in two women and one in five men over the age of 50 (to suffer) __________ a fracture.

After the menopause bone loss (to speed) __________ up making osteoporosis more likely. In women the risk (to increase) ____________ if they (to have) _________ an early menopause, (to have) __________ their ovaries removed before the menopause, or (to miss) _______ periods for six months or more as a result of over-exercising or over-dieting.

For men low levels of testosterone (to increase) ____________ the risk. For men and women long-term use of corticosteroid medication, maternal osteoporosis, smoking, heavy drinking, sedentary lifestyle, and low body weight all (to increase) _________ the risk.

Ways to prevent osteoporosis

You can (to help) _______ yourself by taking general measures such as the following:

  • Increasing the calcium in your diet.

  • Increasing weight-bearing exercise as this helps maintain bone density.

  • Reducing both alcohol intake and cigarette smoking.

Medication may (to include) ________________:

  • Calcium and vitamin D supplements.

  • A variety of hormone-type treatments including HRT, tibolone and SERMS.

  • Bisphosphonates (to be) _____ a group of drugs, which (to prevent) _________ bone breakdown and can (to be) ____ very effective in osteoporosis.

It(to) ____ better to prevent any condition than simply to manage it when it (to happen) _____________. Osteoporosis assessment and management (to be) ____ an important factor in maintaining the health of your bone structure as you (to enter) _______________ middle age.