Questions and answers about arthritis pain.What Is Arthritis? What Is Pain? How Many Americans Have Arthritis Pain? What Causes Arthritis Pain? Why Is It So Variable? How Do Doctors Measure Arthritis Pain? What Will Happen When You First Visit a Doctor for Your Arthritis Pain? Who Can Treat Arthritis Pain? How Is Arthritis Pain Treated? What Alternative Therapies May Relieve Arthritis Pain? How Can You Cope With Arthritis Pain? What Research is Being Conducted On Arthritis Pain? Where Can You Find More Information on Arthritis Pain? Things You Can Do To Manage Arthritis Pain What Is Arthritis The word arthritis literally means joint inflammation, but is often used to refer to a group of more than 100 rheumatic diseases that can cause pain, stiffness, and swelling in the joints. These diseases may affect not only the joints but also other parts of the body, including important supporting structures such as muscles, bones, tendons, and ligaments, as well as some internal organs. This fact sheet focuses on pain caused by two of the most common forms of arthritis--osteoarthritis and rheumatoid arthritis rheumatoid arthritis Chronic, progressive autoimmune disease causing connective-tissue inflammation, mostly in synovial joints. It can occur at any age, is more common in women, and has an unpredictable course. . What Is Pain? Pain is the body's warning system, alerting you that something is wrong. The International Association for the Study of Pain The International Association for the Study of Pain (IASP) is an international professional organisation for doctors and other health professionals involved in the diagnosis, treatment and scientific study of pain, as well as education and training in the field of pain medicine. defines it as an unpleasant experience associated with actual or potential tissue damage to a person's body. Specialized nervous system cells (neurons) that transmit pain signals are found throughout the skin and other body tissues. These cells respond to things such as injury or tissue damage. For example, when a harmful agent such as a sharp knife comes in contact with your skin, chemical signals travel from neurons in the skin through nerves in the spinal cord spinal cord, the part of the nervous system occupying the hollow interior (vertebral canal) of the series of vertebrae that form the spinal column, technically known as the vertebral column. to your brain, where they are interpreted as pain. Most forms of arthritis are associated with pain that can be divided into two general categories: acute and chronic. Acute pain is temporary. It can last a few seconds or longer but wanes as healing occurs. Some examples of things that cause acute pain include burns, cuts, and fractures. Chronic pain, such as that seen in people with osteoarthritis osteoarthritis or osteoarthrosis or degenerative joint disease Most common joint disorder, afflicting over 80% of those who reach age 70. It does not involve excessive inflammation and may have no symptoms, especially at first. and rheumatoid arthritis, ranges from mild to severe and can last a lifetime. How Many Americans Suffer From Arthritis Pain? Chronic pain is a major health problem in the United States and is one of the most weakening effects of arthritis. More than 40 million Americans suffer from some form of arthritis, and many have chronic pain that limits daily activity. Osteoarthritis is by far the most common form of arthritis, affecting about 20 million Americans, while rheumatoid arthritis, which affects about 2.1 million Americans, is the most crippling form of the disease. What Causes Arthritis Pain? Why is It So Variable? The pain of arthritis may come from different sources. These may include inflammation of the synovial membrane synovial membrane n. The connective-tissue membrane that lines the cavity of a synovial joint and produces the synovial fluid. Also called synovium. (tissue that lines the joints), the tendons, or the ligaments; muscle strain; and fatigue. A combination of these factors contributes to the intensity of the pain. The pain of arthritis varies greatly from person to person, for reasons that doctors do not yet understand completely. Factors that contribute to the pain include swelling within the joint, the amount of heat or redness present, or damage that has occurred within the joint. In addition, activities affect pain differently so that some patients note pain in their joints after first getting out of bed in the morning whereas others develop pain after prolonged use of the joint. Each individual has a different threshold and tolerance for pain, often affected by both physical and emotional factors. These can include depression, anxiety, and even hypersensitivity hypersensitivity, heightened response in a body tissue to an antigen or foreign substance. The body normally responds to an antigen by producing specific antibodies against it. The antibodies impart immunity for any later exposure to that antigen. at the affected sites due to inflammation and tissue injury. This increased sensitivity appears to affect the amount of pain perceived by the individual. Social support networks can make an important contribution to pain management. How Do Doctors Measure Arthritis Pain? Pain is a private, unique experience that cannot be seen. The most common way to measure pain is for the doctor to ask you, the patient, about your difficulties. For example, the doctor may ask you to describe the level of pain you feel on a scale of 1 to 10. You may use words like aching, burning, stinging, or throbbing throb intr.v. throbbed, throb·bing, throbs 1. To beat rapidly or violently, as the heart; pound. 2. To vibrate, pulsate, or sound with a steady pronounced rhythm: . These words will give the doctor a clearer picture of the pain you are experiencing. Since doctors rely on your description of pain to help guide treatment, you may want to keep a pain diary pain diary Pain management A log kept by a Pt with chronic pain, indicating when the pain is greatest during the day, and medication needs for relieving pain. See Pain maangement. to record your pain sensations. You can begin a week or two before your visit to the doctor. On a daily basis, you can describe the situations that cause or alter the intensity of your pain, the sensations and severity of your pain, and your reactions to the pain. For example: "On Monday night, sharp pains in my knees produced by housework interfered with my sleep; on Tuesday morning, because of the pain, I had a hard time getting out bed. However, I coped with the pain by taking my medication and applying ice to my knees." The diary will give the doctor some insight into your pain and may play a critical role in the management of your disease. What Will Happen When You First Visit a Doctor for Your Arthritis Pain? The doctor will usually do the following: * Take your medical history and ask questions such as: How long have you been experiencing pain? How intense is the pain? How often does it occur? What causes it to get worse? What causes it to get better? * Review the medications you are using * Conduct a physical examination to determine causes of the pain and how this pain is affecting your ability to function * Take blood and/or urine samples and request necessary laboratory work * Ask you to get x rays taken or undergo other imaging procedures such as a CAT scan CAT scan (kăt) [computerized axial tomography], X-ray technique that allows relatively safe, painless, and rapid diagnosis in previously inaccessible areas of the body; also called CT scan. (computerized axial tomography computerized axial tomography: see CAT scan. computerized axial tomography (CAT) Diagnostic imaging method using a low-dose beam of X-rays that crosses the body in a single plane at many different angles. ) or MRI 1. (application) MRI - Magnetic Resonance Imaging. 2. MRI - Measurement Requirements and Interface. (magnetic resonance imaging magnetic resonance imaging (MRI), noninvasive diagnostic technique that uses nuclear magnetic resonance to produce cross-sectional images of organs and other internal body structures. ) to see how much joint damage has been done. Once the doctor has done these things and reviewed the results of any tests or procedures, he or she will discuss the findings with you and design a comprehensive management approach for the pain caused by your osteoarthritis or rheumatoid arthritis. Who Can Treat Arthritis Pain? A number of different specialists may be involved in the care of an arthritis patient--often a team approach is used. The team may include doctors who treat people with arthritis (rheumatologists), surgeons (orthopaedists), and physical and occupational therapists. Their goal is to treat all aspects of arthritis pain and help you learn to manage your pain. The physician, other health care professionals, and you, the patient, all play an active role in the management of arthritis pain. How Is Arthritis Pain Treated? There is no single treatment that applies to all people with arthritis, but rather the doctor will develop a management plan designed to minimize your specific pain and improve the function of your joints. A number of treatments can provide short-term pain relief. Short-Term Relief * Medications--Because people with osteoarthritis have very little inflammation, pain relievers such as acetaminophen acetaminophen (əsēt'əmĭn`əfĭn), an analgesic and fever-reducing medicine similar in effect to aspirin. It is an active ingredient in many over-the-counter medicines, including Tylenol and Midol. (Tylenol*) may be effective. Patients with rheumatoid arthritis generally have pain caused by inflammation and often benefit from aspirin or other nonsteroidal anti-inflammatory drugs Nonsteroidal Anti-Inflammatory Drugs Definition Nonsteroidal anti-inflammatory drugs are medicines that relieve pain, swelling, stiffness, and inflammation. (NSAIDs) such as ibuprofen ibuprofen (ī`by  prō'fən), nonsteroidal anti-inflammatory drug (NSAID) that reduces pain, fever, and inflammation. (Motrin or Advil).* Heat and cold--The decision to use either heat or cold for arthritis pain depends on the type of arthritis and should be discussed with your doctor or physical therapist. Moist heat, such as a warm bath or shower, or dry heat, such as a heating pad, placed on the painful area of the joint for about 15 minutes may relieve the pain. An ice pack (or a bag of frozen vegetables) wrapped in a towel and placed on the sore area for about 15 minutes may help to reduce swelling and stop the pain. If you have poor circulation, do not use cold packs. * Joint Protection--Using a splint splint, rigid or semiflexible device for the immobilization of displaced or fractured parts of the body. Most commonly employed for fractures of bones, a splint may be a first-aid measure that allows the patient to be moved without displacing the injured part, or it or a brace to allow joints to rest and protect them from injury can be helpful. Your physician or physical therapist can make recommendations. * Transcutaneous electrical nerve stimulation transcutaneous electrical nerve stimulation n. TENS. Transcutaneous electrical nerve stimulation (TENS) A method for relieving the muscle pain of TMJ by stimulating nerve endings that do not transmit pain. (TENS)--A small TENS device that directs mild electric pulses to nerve endings that lie beneath the skin in the painful area may relieve some arthritis pain. TENS seems to work by blocking pain messages to the brain and by modifying pain perception. * Massage--In this pain-relief approach, a massage therapist will lightly stroke and/or knead knead tr.v. knead·ed, knead·ing, kneads 1. To mix and work into a uniform mass, as by folding, pressing, and stretching with the hands: kneading dough. 2. the painful muscle. This may increase blood flow and bring warmth to a stressed area. However, arthritis-stressed joints are very sensitive so the therapist must be very familiar with the problems of the disease. Osteoarthritis and rheumatoid arthritis are chronic diseases that may last a lifetime. Learning how to manage your pain over the long term is an important factor in controlling the disease and maintaining a good quality of life. Following are some sources of long- term pain relief. Long-Term Relief * Medications Biological response modifiers--These new drugs used for the treatment of rheumatoid arthritis reduce inflammation in the joints by blocking the reaction of a substance called tumor necrosis factor tumor necrosis factor n. Abbr. TNF A protein that is produced in the presence of an endotoxin, especially by monocytes and macrophages, is able to attack and destroy tumor cells, and exacerbates chronic inflammatory diseases. , an immune system immune system Cells, cell products, organs, and structures of the body involved in the detection and destruction of foreign invaders, such as bacteria, viruses, and cancer cells. Immunity is based on the system's ability to launch a defense against such invaders. protein involved in immune response immune response n. An integrated bodily response to an antigen, especially one mediated by lymphocytes and involving recognition of antigens by specific antibodies or previously sensitized lymphocytes. system. These drugs include Enbrel and Remicade. Nonsteroidal anti-inflammatory drugs (NSAIDs)--These are a class of drugs including aspirin and ibuprofen that are used to reduce pain and inflammation and may be used for both short-term and long-term relief in people with osteoarthritis and rheumatoid arthritis. NSAIDs also include Celebrex and Vioxx, so-called COX-2 inhibitors Cox-2 Inhibitors Definition Cox-2 inhibitors are non-steroidal anti-inflammatory drugs (NSAIDs) which selectively inhibit cyclooxygenase-2. The cyclooxygenases are required for the creation of prostaglandins. that block and enzyme known to cause an inflammatory response. Disease-modifying anti-rheumatic drugs (DMARDs)--These are drugs used to treat people with rheumatoid arthritis who have not responded to NSAIDs. Some of these include the new drug Arava and methotrexate methotrexate, drug used in halting the growth of actively proliferating tissues. Introduced in the 1950s, it is used in the treatment of leukemia, psoriasis, and non-Hodgkin's lymphoma. , hydroxychloroquine, penicillamine penicillamine /pen·i·cil·la·mine/ (pen?i-sil´ah-men) a degradation product of penicillin that chelates certain heavy metals and also binds cystine and promotes its excretion; used in the treatment of Wilson's disease, cystinuria, , and gold injections. These drugs are thought to influence and correct abnormalities of the immune system responsible for a disease like rheumatoid arthritis. Treatment with these medications requires careful monitoring by the physician to avoid side effects Side effects Effects of a proposed project on other parts of the firm. . Corticosteroids--These are hormones that are very effective in treating arthritis but cause many side effects. Corticosteroids Corticosteroids Definition Corticosteroids are group of natural and synthetic analogues of the hormones secreted by the hypothalamic-anterior pituitary-adrenocortical (HPA) axis, more commonly referred to as the pituitary gland. can be taken by mouth or given by injection. Prednisone prednisone (prĕd`nĭsōn): see corticosteroid drug. is the corticosteroid corticosteroid /cor·ti·co·ster·oid/ (-ster´oid) any of the steroids elaborated by the adrenal cortex (excluding the sex hormones) or any synthetic equivalents; divided into two major groups, the glucocorticoids and most often given by mouth to reduce the inflammation of rheumatoid arthritis. In both rheumatoid arthritis and osteoarthritis, the doctor also may inject a corticosteroid into the affected joint to stop pain. Because frequent injections may cause damage to the cartilage, they should only be done once or twice a year. Other Products--Hyaluronic acid products like Hyalgan and Synvisc mimic a naturally occurring body substance that lubricates the knee joint and permits flexible joint movement without pain. A blood filtering device called the Prosorba Column Prosorba® column Therapeutics A blood-filtration device used during apheresis–eg, for treating ITP; it may improve severe rheumatoid arthritis in Pts who failed or are intolerant to disease-modifying antirheumatic drugs–DMARDs. See Apheresis. is used in some health care facilities for filtering out harmful antibodies in people with severe rheumatoid arthritis. * Weight reduction--Excess pounds put extra stress on weight-bearing joints such as the knees or hips. Studies have shown that overweight women who lost an average of 11 pounds substantially reduced the development of osteoarthritis in their knees. In addition, if osteoarthritis has already affected one knee, weight reduction will reduce the chance of it occurring in the other knee. * Exercise--Swimming, walking, low-impact aerobic exercise aerobic exercise, n sustained repetitive physical activity, such as walking, dancing, cycling, and swimming, that elevates the heart rate and increases oxygen consumption resulting in improved functioning of cardio-vascular and respiratory systems. , and range-of-motion exercises may reduce joint pain and stiffness. In addition, stretching exercises are helpful. A physical therapist can help plan an exercise program that will give you the most benefit. (The National Arthritis and Musculoskeletal musculoskeletal /mus·cu·lo·skel·e·tal/ (-skel´e-t'l) pertaining to or comprising the skeleton and muscles. mus·cu·lo·skel·e·tal adj. Relating to or involving the muscles and the skeleton. and Skin Diseases Information Clearinghouse has a separate fact sheet on arthritis and exercise. See the end of this booklet for contact information.) * Surgery--In select patients with arthritis, surgery may be necessary. The surgeon may perform an operation to remove the synovium (synovectomy), realign the joint (osteotomy osteotomy /os·te·ot·o·my/ (os?te-ot´ah-me) incision or transection of a bone. cuneiform osteotomy removal of a wedge of bone. ), or in advanced cases replace the damaged joint with an artificial one (arthroplasty). Total joint replacement has provided not only dramatic relief from pain but also improvement in motion for many people with arthritis. What Alternative Therapies May Relieve Arthritis Pain? Many people seek other ways of treating their disease, such as special diets or supplements. Although these methods may not be harmful in and of themselves, no research to date shows that they help. Some people have tried acupuncture, in which thin needles are inserted at specific points in the body. Others have tried glucosamine glucosamine /glu·co·sa·mine/ (gloo-ko´sah-men) an amino derivative of glucose, occurring in glycosaminoglycans and a variety of complex polysaccharides such as blood group substances. and chondroitin sulfate chondroitin sulfate /chon·dro·i·tin sul·fate/ (kon-dro´i-tin) 1. a glycosaminoglycan that predominates in connective tissue, particularly cartilage, bone, and blood vessels, and in the cornea. 2. , two natural substances found in and around cartilage cells, for osteoarthritis of the knee. Some alternative or complementary approaches may help you to cope or reduce some of the stress of living with a chronic illness. If the doctor feels the approach has value and will not harm you, it can be incorporated into your treatment plan. However, it is important not to neglect your regular health care or treatment of serious symptoms. How Can You Cope With Arthritis Pain? The long-term goal of pain management is to help you cope with a chronic, often disabling disease. You may be caught in a cycle of pain, depression, and stress. To break out of this cycle, you need to be an active participant with the doctor and other health care professionals in managing your pain. This may include physical therapy, cognitive-behavioral therapy Cognitive-Behavioral Therapy Definition Cognitive-behavioral therapy is an action-oriented form of psychosocial therapy that assumes that maladaptive, or faulty, thinking patterns cause maladaptive behavior and "negative" emotions. , occupational therapy, biofeedback biofeedback, method for learning to increase one's ability to control biological responses, such as blood pressure, muscle tension, and heart rate. Sophisticated instruments are often used to measure physiological responses and make them apparent to the patient, who , relaxation techniques (for example, deep breathing and meditation), and family counseling therapy. The Multipurpose Arthritis and Musculoskeletal Diseases Center at Stanford University, supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases The National Institute of Arthritis and Musculoskeletal and Skin Diseases, or NIAMS, is an institute of the National Institutes of Health, an agency of the United States Department of Health and Human Services. (NIAMS NIAMS National Institute of Arthritis, Musculoskeletal and Skin Diseases (USA) ), has developed an Arthritis Self-Help Course that teaches people with arthritis how to take a more active part in their arthritis care. The Arthritis Self-Help Course is taught by the Arthritis Foundation and consists of a 12- to 15-hour program that includes lectures on osteoarthritis and rheumatoid arthritis, exercise, pain management, nutrition, medication, doctor-patient relationships, and nontraditional treatment. You may want to contact some of the organizations listed at the end of this fact sheet for additional information on the Arthritis Self-Help Course and on coping with pain, as well as for information on support groups in your area. Things You Can Do To Manage Arthritis Pain * Eat a healthy diet * Get 8 to 10 hours of sleep at night. * Keep a daily diary of pain and mood changes to share with your physician. * Choose a caring physician. * Join a support group * Stay informed about new research on managing arthritis pain. What Research Is Being Conducted On Arthritis Pain? The NIAMS, part of the National Institutes of Health, is sponsoring research that will increase understanding of the specific ways to diagnose, treat, and possibly prevent arthritis pain. As a part of its commitment to pain research, the Institute joined with many other NIH "Not invented here." See digispeak. NIH - The United States National Institutes of Health. institutes and offices in 1998 in a special announcement to encourage more studies on pain. At the Specialized Center of Research in Osteoarthritis at Rush-Presbyterian-St Luke's Medical Center in Chicago, Illinois, researchers are studying the human knee and analyzing how injury in one joint may affect other joints. In addition, they are analyzing the effect of pain and analgesics Analgesics Definition Analgesics are medicines that relieve pain. Purpose Analgesics are those drugs that mainly provide pain relief. on gait (walking) and comparing pain and gait before and after surgical treatment of knee osteoarthritis. At the University of Maryland University of Maryland can refer to:
At Duke University in Durham, North Carolina Durham is a city in the U.S. state of North Carolina. It is the county seat of Durham CountyGR6 and is the fourth-largest city in the state by population. , NIAMS researchers have developed cognitive-behavioral therapy (CBT (Computer-Based Training) Using the computer for training and instruction. CBT programs are called "courseware" and provide interactive training sessions for all disciplines. ) involving both patients and their spouses. The goal of CBT for arthritis pain is to help patients cope more effectively with the long-term demands of a chronic and potentially disabling disease. Researchers are studying whether aerobic fitness aerobic fitness Clinical medicine A value obtained from exercise testing, which is expressed as either VO 2 peak–O2 consumption at peak exercise, or Wpeak , coping abilities, and spousal responses to pain behaviors diminish the patient's pain and disability. NIAMS-supported research on arthritis pain also includes projects in the Institute's Multipurpose Arthritis and Musculoskeletal Diseases Centers. At the University of California The University of California has a combined student body of more than 191,000 students, over 1,340,000 living alumni, and a combined systemwide and campus endowment of just over $7.3 billion (8th largest in the United States). in San Francisco, researchers are studying stress factors, including pain, that are associated with rheumatoid arthritis. Findings from this study will be used to develop patient education programs that will improve a person's ability to deal with rheumatoid arthritis and enhance their quality of life. At the Indiana University School of Medicine The Indiana University School of Medicine is the medical school of Indiana University, part of the Indiana University Purdue University at Indianapolis (IUPUI) campus located in Indianapolis, Indiana. Established in 1903, the school had an initial class of 25 students. in Indianapolis, health care professionals are looking at the causes of pain and joint disability in patients with osteoarthritis. The goal of the project is to improve doctor-patient communication about pain management and increase patient satisfaction. The list of pain studies continues. A NIAMS-funded project at Stanford University in California is evaluating the effects of a patient education program that uses a book and videotape to control chronic pain. At Indiana University in Indiannapolis, Institute-supported scientists are determining whether strength training can diminish the risk of sever pain from knee osteoarthritis. And a multicenter study funded by the National Center for Complementary and Alternative Medicine National Center for Complementary and Alternative Medicine, n.pr established in 1998 as a Center of the National Institutes of Health. Supports and conducts research on complementary and alternative med-icine and informs healthcare pro-fessionals about and NIAMS, and coordinated by the University of Utah The University of Utah (also The U or the U of U or the UU), located in Salt Lake City, is the flagship public research university in the state of Utah, and one of 10 institutions that make up the Utah System of Higher Education. School of Medicine, is investigating the effects of the dietary supplements glucosamine and chondroitin sulfate for knee osteoarthritis. Where Can You Find More information on Arthritis Pain? * National Institute of Arthritis and Muscuskeletal and Skin Diseases Information Clearinghouse (NAMSIC) National Institutes of Health 1 AMS Circle Bethesda, MD 20892-3675 301/495-4484 or 877/22-NIAMS (226-4267) (free of charge) TTY: 301/565-2966 Fax: 301/718-6366 www.nih.gov/niams/ The clearinghouse provides information about various forms of arthritis and rheumatic disease and bone, muscle, and skin diseases. It distributes patient and professional education materials and refers people to other sources of information. Additional information and updates can also be found on the NIAMS web site. * American Academy of Orthopaedic Surgeons P.O. Box 2058 Des Plains, IL 60017 Phone: 800/824-BONE (2663) (free of charge) www.aaos.org This academy publishes brochures on arthritis and other subjects. Single copies of a brochure are available free of charge by sending a self-addressed, stamped (business size) envelope to (name of brochure) at the address above. * American College of Rheumatology 1800 Century Place, Suite 250 Atlanta, GA 30345 Phone: 404/633-3777 Fax: 404/633-1870 www.rheumatology.org This association provides referrals to doctors and health professionals who work on arthritis, rheumatic diseases, and related conditions. It also provides educational materials and guidelines. * American Physical Therapy Association 1111 North Fairfax Street Alexandria, VA 22314-1488 Phone: 703/684-2782 or 800/999-2782, ext.3395 (free of charge) www.apta.org This association is a national professional organization representing physical therapists, allied personnel, and students. Its objectives are to improve research, public understanding, and education in the physical therapies. * Arthritis Foundation 1330 West Peachtree Street Atlanta, GA 30309 404/872-7100 or 800/283-7800 (free of charge) or call your local chapter, (listed in the telephone directory) www.arthritis.org This is the major voluntary organization devoted to arthritis. The foundation publishes a free brochure, Coping With Pain, and a monthly magazine for members that provides up-to-date information on all forms of arthritis. The foundation also can provide addresses and phone numbers for their local chapters and physician and clinic referrals. * American Chronic Pain Association P.O. Box 850 Rocklin, CA 95677 916/632-0922 www.theacpa.org The Association provides information on positive ways to deal with chronic pain, and can provide guidelines on selecting a pain management center. * American Pain Society 4700 West Lake Avenue Glenview, IL 60025-1485 847/375-4715 www.ampainsoc.org The Society provides general information to the public and maintains a directory of resources, including referrals to pain centers. * National Chronic Pain Outreach Association, Inc. 7979 Old Georgetown Road, Suite 100 Bethesda, MD 20814-2429 Phone: 301/652-4948 Fax: 301/907-0745 neurosurgery.mgh.harvard.edu/ncpainoa.htm The Association operates an information clearinghouse offering publications and cassette tapes for people with pain. They also publish a newsletter that includes information on pain management techniques, coping strategies, book reviews, and support groups. Acknowledgments The NIAMS gratefully acknowledges the assistance of Susana Serrate-Sztein, M.D., and Barbara Mittleman, M.D., of the NIAMS; John H. Klippel, M.D., Medical Director, Arthritis Foundation; Brian M. Berman, M.D., Director of the Complementary Medicine Program, University of Maryland, School of Medicine; and Laurence A. Bradley, Ph.D., Professor of Medicine/Rheumatology, University of Alabama at Birmingham UAB began in 1936 as the Birmingham Extension Center of the University of Alabama. Because of the rapid growth of the Birmingham area, it was decided that an extension program for students who had difficulties which prevented them from studying in Tuscaloosa was needed. in the preparation and review of this booklet. The mission of the National Arthritis and Musculoskeletal and Skin Diseases Information, a part of the National Institutes of Health (NIH), is to support research into the causes, treatment, and prevention of arthritis and muschloskeltal and skin diseases, the training of basic and clinical scientists to carry out this research, and the dissemination of information on the progree of research in these diseases. The National Institute of Musculoskeletal and Skin Diseases Information Clearinghouse is a public service sponsored by the NIAMS that provides health information and information sources. Additional information can be found on the NIAMS web site at www.nih.gov/niams. U.S. Department of Health and Human Services Noun 1. Department of Health and Human Services - the United States federal department that administers all federal programs dealing with health and welfare; created in 1979 Health and Human Services, HHS Public Health Service National Institutes of Health National Institutes of Arthritis and Musculoskeletal and Skin Diseases NIH Publication No. 01-4856 February 2001 |
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