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                                   ARTHRITIS 
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       Arthritis would probably be placed third on any list of backache 
       causes. Chronic back strain and disc disorders would earn first 
       and second place respectively, but arthritis affects some people 
       and for a variety of reasons, both mechanical and metabolic. 

       Osteoarthritis is the most common of the three arthritic 
       afflictions of the back. It is a reflection of the gradual 
       wearing out of the spinal column. Over time the joints of the 
       back wear. The process can be accelerated by faulty posture or 
       chronic strain, but the end result is the same. In one scenario 
       leading to osteoarthritis a disc can begin to bulge outwards due 
       to pressure or chronic strain. Eventually one of the connective 
       ligaments may be lifted free from the surface of two adjoining 
       the vertebral bodies. As time passes, this injured site fills 
       with "bone spur" growths which eventually join to fuse the two 
       vertebrae together. 
       
       Once natural fusion takes place, the discomfort is somewhat 
       lessened, but while the damaged space is filling with the new 
       bone spurs, grinding and pain is felt. Other types of 
       osteoarthritic growth can occur and this is only one example. 
       Since the lower lumbar region and upper cervical region of the 
       back have the greatest range of motion naturally, it is these 
       regions that frequently show the first signs of osteoarthritis. 
       Treatment may consist of one or a combination of the following: 
       bed rest, exercise therapies, pain killers and surgical spinal 
       fusion. 

       Rheumatoid arthritis is the second type of arthritis which can 
       afflict the back. It is not a mechanical problem like 
       osteoarthritis but a true disease and is much more serious. It 
       is not necessarily limited to the old, but can be found in all 
       age groups. Frequently it begins in the large joints of the body 
       and may spread to other joints. The spine may be affected in 
       later stages. The pain and inflammation of the joints may also 
       involve a gradual loss of bone mass, termed osteoporosis. 

       Ankylosing spondylitis or Marie-Strumpel disease is quite rare. 
       It has characteristics of some arthritic conditions. Gradually 
       the intervertebral joints of the spine are replaced by bone. 
       Eventually the entire spine may become rigid. The primary dorsal 
       curve of the back can become acute as leaving the victim with a 
       severely bent back. Surgery is the primary method of treatment 
       and can affect only modest restoration of function. 

       Gouty arthritis is the third arthritic condition which can 
       affect the back. It is seen infrequently in medical literature 
       today. It is a true metabolic disease involving uric acid 
       crystal buildup within the joints. The first joints to feel pain 
       are usually those of the foot and toes, although the spine can 
       also be affected. A blood test, X rays and appropriate 
       medications can usually identify and manage this type of 
       arthritic condition. It is most frequently seen in males. 

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                               SYSTEMIC DISEASES 
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       Systemic diseases, in simplest terms refer to diseases or 
       infections which are "system wide" or throughout your body. 
       Unlike localized back ailments such as chronic strain or a 
       slipped disc, these diseases can produce backaches and pains 
       from the perspective of their overall impact on the body. 

       Specific metabolic diseases, those that affect your metabolism 
       or endocrine balance, can cause back pain. The endocrine system 
       secretes hormones directly into the bloodstream. The pituitary 
       gland at the base of the brain, for example, secretes growth 
       hormone. Too much of this growth hormone and you end up becoming 
       either a giant or a dwarf. Three systemic endocrine imbalances 
       can affect the spine and bones of the back... 

       Hyperthyroidism is a disease of the thyroid gland located in the 
       neck. It controls the rate of bodily metabolic functions. 
       Hyperthyroidism refers to the "hyperactive" state of this gland 
       when it secretes too much hormone. When the rate of metabolism 
       is speeded excessively, calcium can be gradually removed from 
       the bones, frequently those of the spine. The individual 
       vertebrae begin to lose bone mass and density and can become 
       collapsed or misshapen. This obviously leads to back pain. 

       Hyperparathroidism refers to the small parathyroid glands which 
       are located in pairs on either side of the thyroid gland. When 
       these four glands become hyperactive a similar calcium depletion 
       can take place in the bones of the vertebrae, but in a non-
       uniform, irregular manner. Gradually gaps are created in the 
       vertebrae and other bones. A fibrous tissue fills in the gaps. 
       The bone becomes irregular and weakened. Surgery may be required 
       reduce back pain in severe cases. 

       The third primary metabolic disease which can affect the spine 
       is hyperadrenalism or Cushings Disease. In this instance 
       excessive cortisone is present in the bloodstream caused by 
       hyperactivity of the adrenal glands located near the kidneys. 
       Gradually osteoporosis or loss of bone mass begins. Frequently 
       in the bones of the spine. 

       Metabolic diseases can also affect the spine other than 
       endocrinological imbalances. 

       Paget's disease is also known as osteitis deformans. In this 
       situation the bone mass of the vertebral bodies begins to 
       rapidly grow and thicken. Usually this involves the bones of the 
       lower spine. The tiny holes through which nerve roots emerge, 
       the foramina, begin to narrow. Pressure is placed on spinal 
       nerves which become irritated by the compression. The disease is 
       confirmed by a blood test for enzyme alkaline phosphatase. The 
       cause of the disease is not fully understood. Surgery is 
       frequently the only remedy. 

       Diseases of the circulatory system can also affect back pain. If 
       a blood clot forms which partially blocks oxygen and nutrients 
       to muscles of the legs or buttocks severe pain can result which 
       mimics back pain. The pain is referred to the area of the back 
       and spine, but nonetheless originates from blockage of blood to 
       muscle groups in the leg. Thrombophlebitis, an inflammation of 
       the veins, can also cause backaches which can be referred to the 
       back and spinal region. Likewise arterial obstructions and 
       classic varicose veins can cause pain which is referred to the 
       back region. 

       On a mundane level, infections such as a common cold can also 
       cause backaches. A system wide viral infection lowers your 
       threshold of pain and tends to produce fatigue in joints and 
       muscles. Mild muscle spasm can result and as a consequence 
       backaches are not uncommon when you have a cold. A practical 
       solution is to encourage bed rest and keep those knees bent 
       which reduces strain in the lower lumbar region of the back. 

       This tutorial is merely a starting point! For further 
       information on back care and back pain, be sure to register this 
       software ($25.00) which brings by prompt postal delivery a 
       printed, illustrated guide to back pain written by a physician 
       plus two software disks. From the main menu select "Print 
       Registration Form." Or from the DOS prompt type the command  
       ORDER. Mail to Seattle Scientific Photography (Dept. BRN), PO 
       Box 1506, Mercer Island, WA 98040. If you cannot print the order 
       form, send $25.00 to the above address and a short letter 
       requesting these materials. End of chapter. 
       
