As a result of inflammation, scar tissue forms in the space between the vertebrae, making the joints stiff. This tissue may turn to bone so that when the inflammation dies down, it leaves bony deposits on the rims of the vertebrae.
Bone grows from the sides of the affected vertebrae and may fuse together, producing a rigid spine. At the same time, the disks and ligaments harden, further restricting mobility. At this stage, the condition may be referred to as “bamboo spine.” If left untreated, this can cause severe deformity with the sufferer bending forward, hardly able to look up. In fact, the name “ankyl”, that is, “ankylosing” is formed from a Greek word meaning “bent” or “crooked” or “in the form of a loop.” Age is a factor in the development of the disease, but not the cause.
Although the disease affects more men than women (three times as often), it tends to be more severe in men. AS is often overlooked or missed in women, who tend to have more peripheral joint involvement.
Primary AS usually develops in young men between the ages of 16 and 30. Secondary AS develops in older age groups and is often associated with other inflammatory diseases. It also appears in about 5% of the children (mainly boys), but is rarely seen in African-Americans.
There is a strong genetic factor linked to a tissue type called HLA-B27 (positive in over 90% of patients with the disease), but not all who carry the gene develop the disease. Klebsiella infections are also thought to trigger or perpetuate the inflammatory responses. In women, AS tends to affect the peripheral joints of the appendicular skeleton rather than the axial skeleton, progress less rapidly, and cause less dramatic spinal changes.
AS starts with persistent back pain and early-morning stiffness that tend to lessen with movement during the day. Sometimes, the chest will hurt during inhalation. Tiredness and weight loss are also factors.
It often goes untreated in the early stages because it can easily be confused with mechanical back that often accompanies the lifting of a heavy object. Symptoms may also include chronic fatigue and weight loss. There may also be pain in the chest and ribs, making it difficult to breathe. Pain in the buttocks and the backs of the thighs, swollen ankles, and tender heel bones may result.
The condition requires immediate treatment to prevent the spine from locking. Patients are frequently taught to sleep on their stomachs to prevent the back from curving forward. A relatively rare complication is iritis or uveitis, characterized by red, painful eyes. If this happens, immediate treatment is a must.
Like rheumatoid arthritis, AS is a systemic, immune inflammatory disease; but there are differences between the two in the primary site of inflammation and the end result.
In RA, the primary site of inflammation is the synovial membrane, resulting in the destruction and instability of synovial joints. In AS, the primary site is the enthesis – the point where ligaments, tendons, and the joint capsule are inserted into bone. The end result is fibrosis, ossification, and fusion of the joint. Blood tests and x-rays are used to make a definitive diagnosis.
Treatment involves anti-inflammatories, exercise, and heat applications (hot baths, hot water bottles, electric blankets). However, no treatment reliably stops the progression of the disease, but aims only to delay further deformity.
Physiotherapists can assist in exercise planning so that, if spinal fusion takes place, the vertebrae will fuse straight rather than curved. It is advised that, when working at a desk, the position be changed frequently rather than holding the spine in one fixed position for long periods of time.
Swimming is an excellent nonweight-bearing exercise that improves mobility; but other forms of exercise should be encouraged as well, especially brisk walking or running.
Pathophysiology of ankylosing spondylitis
AS begins with inflammation of the fibrocartilage in cartilagionous joints. The fibrous tissue of the joint capsule, the cartilage that surrounds in intervertebral discs, entheses, and periosteum are infiltrated with inflammatory cells (chiefly macrophages) and lymphocytes which erode the bone and fibrocartilage. This causes repair work to begin, which ultimately is the signal for the disease process to start, producing disability.
Repair of cartilaginous structures initiates the proliferation of fibroblasts, which synthesize and secrete collagen. This process becomes organized into fibrous scar tissue. The scar tissue undergoes calcification and ossification and, in time, all the cartilaginous structures of the joint are replaced by ossified scar tissue, causing the joint to fuse or lose flexibility.
Repair of eroded bone begins with osteoblast activation and proliferation. Osteoblasts lay down new bone (callus), which is remodeled and replaced by compact, lamellar bone. Bone repair changes the contour of the bone’s surface because the new bone grows outward to form a new enthesis with the end of the eroded ligament.
The new enthesis, which forms on top of the old one, is called syndesmophyte. As calcification of the spinal ligaments progresses, the vertebral bodies lose their concave anterior contour and appear square. The spine assumes the classic ‘bamboo’ appearance of AS.
Physical therapy is important in the treatment of AS in order to maintain skeletal mobility and prevent the natural progression of contractures. This usually requires a continuous program performed several times a day to maintain chest expansion, full extension of the spine, and complete range of motion in the proximal joints.
Medications are given to suppress some of the pain and stiffness, but they do nothing to halt or reverse the progression of the disease. Dietary interventions, however, can go much further in this regard.
Bursitis and tendinitis are common forms of soft tissue, rheumatic afflictions, especially in athletes of every level. Both are usually caused by sudden overuse of a joint and begin with pain and tenderness that radiates into nearby limbs. Sometimes, they is accompanied by a fever. It is the shoulders, elbows, wrists, fingers, hips, back, knees, ankles, and feet that are often targeted through overenthusiastic use.
Bursa means “purse.” The small fluid-like sacs (bursae) that cushion various parts of the joints do look something like little purses. There are dozens of them in the body. For example, each knee has eight or more. The bursae act as cushions between soft tissue and bony prominences. These may become inflamed if the joint is subjected to abnormal pressure. The bursae can fill with more fluid than usual, triggering pain.
Tendinitis is often grouped with bursitis, but it is a very different problem. Tendinitis is characterized by the inflammation of a tendon, which is the tough, fibrous many-layered tissue that lies between the muscle and the bone, allowing the two to work together. Forcing swollen tendons to move can not only be painful, but can increase the risk of tendon rupture. Tendinitis usually strikes suddenly, but is generally restricted to one area. It can linger for days or weeks before disappearing.
Generally speaking, both bursitis and tendinitis occur after the age of 30 as a result of wear and tear, abnormal stress on the joints or tendons, or a sudden strain as lifting. They are not usually chronic conditions, and treatment occurs in phases, depending on the progressive severity of the condition. Phase I requires the removal of the aggravating factor and applying ice, massage, or mild medications as well as gentle stretching exercises or range-of-motion. Phase II adds such physical therapy as ultrasound or electric stimulation, plus supervised strengthening exercises and movement of of the surrounding structures. Phase III involves injections of NSAIDs or a cortisone-like drug. Phase IV requires surgery, which used as a last resort.
Fibromyalgia, also known as fibrositis, is a condition characterized by widespread, possibly incapacitating pain, stiffness and weakness of muscular areas of the lower back, hips, thighs, neck, shoulders, chest, or arms, and accompanied by muscle spasms in any of those areas.
Symptoms include aching and stiffness around the neck, shoulders, upper back, lower back, and hip areas. There may also also be pain in the chest and knees, sleep disturbance, irritable bowel syndrome, and migraines. Symptoms are quite similar to those of chronic fatigue syndrome, explaining why doctors have difficulty distinguishing between the two. Research has discovered that the diagnosis of fibromyalgia is based on pain or tenderness in at least eleven of eighteen specific points of the body.
Fibromyalgia literally means “muscle pain.” When it strikes, the connective tissue layers of the muscles, tendons, and bones become inflamed. Chronic pain sets in and is described as burning, radiating, gnawing, or aching. It may begin in one area of the body but then spreads to other areas.
However, the stiffness and tenderness centers in the ligaments, tendons, and muscles rather than in the joints, explaining why it is considered a soft-tissue syndrome rather than an arthritic disease. Women between the ages of 35 and 60 are most likely to be affected, with the highest incidence occurring just before menopause.
Fibromyalgia does not respond to aspirin or other NSAIDs, and even stronger analgesics may be ineffective. Muscle relaxants or local anesthetics are sometimes injected into painful areas for quick, but temporary, relief.
Treatment usually involves alleviating the chronic pain and sleep disturbances and the depression that often accompanies chronic disease. Water exercises, biofeedback, and relaxation techniques are also helpful, as are hot baths, relaxation exercises, and gentle massage. Swimming in warm water and exercises help to improve posture and tone the muscles. There are many alternative treatments available that work much better and are less harmful.
Goodpasture’s syndrome is a serious autoimmune disorder characterized by malaise, fatigue, and pallor associated with severe iron deficiency anemia. Pulmonary findings range from slight dyspnea (difficulty breathing) and cough with blood-tinged sputum to frank pulmonary hemorrhage. This bleeding may precede overt hemorrhage and renal disease by months or years, with the only signs being a little blood in the urine or peripheral edema.
There is a high incidence of of the tissue type HLA-DRw2, in these patients, suggesting a genetic predisposition. Confirmation requires the measurement of circulating anti-GBM antibodies. This will distinguish it from such other pulmonary-renal syndromes as Wegener’s granulomatosis, polyarteritis, and SLE. Treatment involves the use of immunosuppressive drugs. If there is renal failure, dialysis is ordered.
Lupus erythematosus is a chronic inflammatory disorder of the connective tissues. It appears in two forms: discoid lupus erythematosus (DLE), which affects only the skin, and systemic lupus erythematosus (SLE), which affects multiple organ systems, as well as the skin, and can be fatal. Like rheumatoid arthritis, SLE is an autoimmune disorder characterized by recurring remissions and exacerbations, especially during the spring and summer.
DLE is marked by chronic skin eruptions that appear as raised, red, scaling plaques, with follicular plugging and central atrophy. The raised edges and sunken centers give them a coin-like appearance. They can appear anywhere on the body. However, they most often errupt on the face, scalp, ears, neck, and arms or any part of the body that is exposed to sunlight.
Such lesions can heal quickly or, if left untreated, cause hyper/hypo-pigmentation, atrophy, and permanent scarring and disfigurement. Facial plaques sometimes assume the butterfly patter like SLE. Hair tends to be brittle or may fall out in patches. About one out of every twenty patients will later develop SLE.
Although the exact cause is unknown, there is some evidence to suggest an autoimmune defect since it is related to SLE. About 60% of those who develop the disorder are women in their late twenties or older. It is rarely seen in children.
DLE patients are advised to avoid prolonged exposure to the sun, fluorescent lighing, or reflected sunlight. They should wear protective clothing, use sunscreening agents, and avoid outdoor activity during periods of intense sunlight. The cause is thought to be an altered immune response to an unknown antigen and may be described as a subset to SLE with skin manifestations the only symptom.
On skin biopsies, there are lumpy deposits of immunoglobulins with IgM being the most common immunoglobulin. There are no deposits on normal skin. Standard drugs used for SLE is the method of choice, but further examination of dietary deficiencies and environmental causes should not be ruled out.
SLE, or simply lupus, is an autoimmune disorder which affects all the organs of the body. On average, it affects three or four people out of every 100,000, being more common in Afro-Caribbeans and some Asian populations than in Caucasians. Women, usually between the ages of 15 and 45, are affected nine times more than men. This figure rises to 15 times as often during the childbearing years. Some lupus patients have also been found to be lacking in a certain enzyme involved in healthy immune responses, thus making them more susceptible to the disease.
One significant feature of SLE patients is their ability to produce abnormal antibodies called antinuclear antibodies (ANA) that damage many such different tissue components as red blood cells, neutrophils, platelets, lymphocytes or almost any organ or tissue in the body.
There are certain predisposing factors that may make one person more susceptible to the disorder than another. Physical or mental stress, streptococcal or viral infections, exposure to sunlight or ultraviolet light, immunization, pregnancy, and abnormal estrogen metabolism may all affect the development of the disorder.
SLE may also be triggered or aggravated by certain drugs – procainamide (an antiarrythmic), hydralazine (an antihypertensive), anticonvulsants, penicillins, sulfa drugs, and oral contraceptives, for example.
Symptoms include fever, weight loss, skin rashes, joint pain, stiffness, muscle ache, loss of hair, and exhaustion, followed by kidney damage, and gastrointestinal disorders, as well as such psychological symptoms as depression. In 90% of the cases, joint involvement is similar to that of rheumatoid arthritis.
There may also be a sensitivity to ultraviolet light. Exposure to the sun will worsen the rash. As the disease progresses, inflammation of the linings of the heart, lungs, and kidneys can cause permanent damage. The blotchy red rash that can appear on the skin is like the condition itself – subsiding and then recurring. The classic butterfly rash that appears over the nose and cheeks occurs about 50% of the time. This rash resembles markings on wolves and gives the disease its name – lupus is Latin for “wolf.”
Conventional treatments include aspirin and NSAIDs for pain and inflammation, antimalarial drugs for active attacks or when an extensive rash is present, ointments for the rash, and corticosteroids in severe cases, especially if the kidneys are affected. Exercise, avoiding exposure to the sun, and rest during active stages are very important.
Patients are also advised to avoid such chemicals as those found in hair spray, paints, insecticides, and fertilizers that seem to trigger some acute attacks. Prognosis is not good if patients develop cardiovascular, renal, or neruologic complications or severe bacterial infections.
Paget’s disease, also known as osteitis deformans, is a bone disease characterized by bone pain and deformity. The disease causes the normal process of bone remodeling to speed up remarkably, producing new, bulkier, and softer bone. This bone is weaker and has a greater tendency to fracture than normal bone.
The disease most often strikes the bones of the pelvis, skull, spine, and long bones of the legs. The weakened bone structure of the disease leads to arthritis in nearby joints. Ringing in the ears and hearing loss may occur if the small bones of the ear have been targeted. The rapid bone formation gradually stops and the symptoms may appear and disappear, but any bone alteration or damage that has already occurred is permanent. There are usually no symptoms at onset, so early detection is done through routine blood tests.
When symptoms do arise, they are described as a deep bone pain, a feeling of warmth all over, or headaches if the skull is affected. Bones are chronically painful, especially at night and they appear to be getting larger with the skin that covers them, feeling unusually warm. Movement may be impaired.
The disease is more common in men than women, particularly in those over the age of 40, with more frequent cases being between the ages of 50 and 70. It may run in families, with most being Caucasians of northwestern European ancestry, although it does occasionally appear in African-Americans. It is extremely rare in Asia, the Middle East, Africa, and Scandinavia, however.
Although the cause is unknown, it is speculated that early viral infections (possibly the mumps virus) causes a dormant skeletal infection that erupts many years later as Paget’s Disease. In about 5% of the patients, the involved bone will undergo malignant changes.
Conventional treatment centers on relieving the pain, preventing bone deformity or fracture, and protecting hearing. The medication used for osteoporosis, Fosamax (alendronate) is also given to patients with Paget’s disease, but the side effects are sometimes more disturbing than the disease itself. The disease can be fatal, particularly when it is associated with bone sarcoma, giant cell tumors, or congestive heart failure (as the disease creates a continuous need for high cardiac output).
Polymyalgia rheumatica (PMR) is a condition usually occurring in people over the age of 50, happening twice as often in women as men. The condition is characterized by severe stiffness and aching in the muscles of the neck, shoulder, and hip areas, especially in the morning upon arising.
Other symptoms include inflammation of the arteries, which can cause blindness, fatigue, weight loss, low fever, and depression. The disease strikes suddenly and a full set of symptoms can appear in one day. These include pain in the jaw muscles when eating or talking, severe headaches, tenderness of the scalp or temples, hearing difficulties, a persistent sore throat, swallowing difficulties, and cough. In rare instances, the blood supply to the eye may be affected, leading to blindness in that eye. It is uncertain as to whether PMR involves the joints, muscles, or arteries. Its cause is unknown. Corticosteroids are the standard treatment – along with their side effects.
Polymyositis and dermatomyositis are two diseases commonly referred to a myositis. It is not known exactly what causes myositis, but it has many similarities to lupus and rheumatoid arthritis and is probably the result of hypersensitivity or autoimmune problems.
Both are characterized by inflammation of the connective tissues, with weakening and subsequent breakdown of the muscles (polymyositis) and skin (dermatomyositis). Other symptoms include fever, weight loss, and joint pain. Myositis appears gradually over a period of months and usually strikes between the ages of 30 and 60, affecting twice as many women as men.
Polymyositis produces inflammation of the muscle, especially in the arms and legs, that leads to the destruction of muscle fiber and the wasting of that muscle. If the shoulder is involved, the patient will have difficulty reaching up to comb his hair or take a dish out of the cupboard. If it is the hip that is involved, rising from of a chair or climbing stairs will become difficult. In its most severe form, the disease can weaken muscles in the neck and throat, changing the voice and making it difficult to swallow.
If chest muscles are involved, it may become hard to breathe. With dermatomyositis, a reddish patchy rash can appear on the face, knuckles, elbows, knees, ankles, or around the eyes. Sometimes the eyelids will become puffy and have a purplish colour. In the more advanced cases, rubbing a finger across the affected area can take off several layers of skin. Although myositis can be fatal, most patients respond well to treatment, including older people who also have cancer. Conventional treatment includes corticosteroids for muscle weakness, as well as physical therapy. Rest is also important especially in the acute stage.
Psoriatic arthritis (PA) is a rheumatoid-like joint disease associated with a skin disease called psoriasis. Psoriasis causes red, scaly patches on the skin that appear on the neck, knees, elbows, with the nails becoming pitted. PA can settles in the end joints of the fingers or toes, causing them to become so swollen that they are often referred to as “sausage digits.”
It is the joints in the extremeties that are most often affected and seen in about one in every fifty people. PA is an inflammation of joints in about one in ten of those who already have psoriasis or who tend to develop it in the future. Diagnosis cannot be made unless there is skin and nail involvement consistent with psoriasis. Although the disease is chronic, most people with PA feel well, with the exception of joint pain, but generally do not suffer from fatigue or bone weakening.
The condition affects all ages and genders, with men and women sharing equally in the development of the disease. Although the arthritis components of this syndrome may be clinically indistinguishable from rheumatoid arthritis, the rheumatoid nodules are absent, and the tests for the rheumatoid factor (RF) are negative. Evidence suggests that predisposition to the disease is hereditary, and 20%-50% of all patients are HLA-B27 tissue positive.
However, onset is often precipitated by streptococcal infection or trauma. Conventional treatment includes NSAIDs, exercises to improve joint mobility, and rest. In a small number of cases, methotrexate is prescribed and gold injections have sometimes proven effective. There are also a number of alternative treatments available that are safer and more effective .
Reiter’s syndrome is associated with polyarthritis, urethritis, balanitis, conjunctivitis, and mucocutanious lesions and appears to be related to infection, either venereal or enteric.
This disease, first described by Dr. Hans Reiter during WWI, usually affects young men from age 20 to 40. Although rare in women and children, it has been known to happen. Most patients test positive for the HLA-B27 antigen, suggesting a genetic predisposition. However, it often appears after bouts of infection involving Mycoplasma, Shigella, Salmonella, Yersinia, and Chlamydia infections. It is most common in those who are HIV positive and may precede or follow AIDS.
Arthritic symptoms usually follow genitourinary or enteric symptoms and often last for months. Asymmetric and extremely variable polyarticular arthritis occurs most often and tends to develop in weight-bearing joints of the legs and sometimes the lower back or sacroiliac joints. There may also be pain in these joints, especially in the back, hips, legs, and toes.
The affected joints are usually warm and swollen, but occasionally symptoms are mild with minimal swelling and pain. Muscle wasting is common near affected joints. Fingers and toes may swell and appear “sausage-like”. Not only can joints be affected but also the eyes, skin, and urinary tract. Because it is an “itis” disease, inflammation is involved and characterized by at least two of the following:
- urethritis (inflammation of the urethra);
- prostatitis (inflammation of the prostate);
- stomatitis (painless mouth ulcers);
- dermatitis (scaly skin rash, especially on the penis).
Many symptoms of RS include inflammation of the urethra, the urging of frequent urination, low-grade fever, redness of the eyes, an unpleasant discharge within two weeks after sexual intercourse, plus skin lesions around the fingernails, toenails, and the palms of the hands or soles of the feet. Conventional treatment includes NSAIDs and antibiotics with a strong recommendation for the use of condoms to prevent the spread of the disease.
Scleroderma means “thick skin” and so named because the disease is characterized by a hardening and thickening of the skin on the hands, arms, and face, as well as ulcers on the fingers, hair loss, and skin discoloration. It also affects the joints, blood vessels, and internal organs.
The tiny blood vessels and capillaries become inflamed first, prompting the body to over-produce collagen. The excess collagen is deposited in the skin and body organs where it hardens, causing the skin to thicken and the internal organs to malfunction. Although the joints themselves are not damaged by scleroderma, they may feel stiff because the skin has hardened. The fingers may become clawlike as excess cartilage is deposited. However, the joints themselves may remain healthy. The most severe complications of the disease are related to the deposition of collagen and consequent scarring of the internal organs. Scleroderma-induced damage to the esophogus, heart, lungs, kidneys, or intestinal tract can be fatal.
The disease affects women five times more often than men, targeting them between the ages of 30 and 60. However, it can strike either sex at any age. Like rheumatoid arthritis, scleroderma is believed to be an autoimmune disease triggered by an unknown factor.
The trigger may be environmental or chemical as similar diseases have been seen in workers exposed to silica dust or vinyl chloride, as well as in those taking the cancer drug bleomycin or the amino acid supplement L-tryptophan. Patients receiving bone marrow transplants sometimes develop a condition that closely resembles scleroderma.
Conventional medicine states that there is no cure and can only offer treatments to control symptoms including aspirin and NSAIDs for pain and inflammation, corticosteroids for muscle problems, antacids for heartburn, and medications to control high blood pressure and stimulate circulation.
Careful exercise helps to maintain overall fitness and keeps the skin and joints flexible. Protecting the skin from further damage is also an important part of the treatment plan.
Alternative treatments will involve ferreting out the root cause and eliminating it, then focusing on strengthening the overall condition of the body.
Sjögren’s Syndrome (SS) is a chronic arthritic autoimmune disorder characterized by dry eyes and a dry mouth. It is the most common autoimmune rheumatic disease after rheumatoid arthritis and often found in conjunction with rheumatoid arthritis, lupus (SLE), scleroderma, or polymyositis.
In some patients, the disorder is limited to the exocrine gland referred to as glandular SS. In others, it also involves such other organs as the lungs and kidneys and known as extraglandular SS. Although it can strike anyone at anytime, 90% of the sufferers are women over the age of twenty, with the average age of occurrence being around fifty.
Symptoms include such eye irritation as a “gritty” feeling or painful burning sensation, as well as redness, photosensitivity, eye fatigue, itching, and mucus discharge. There may also be a complaint of a “film” across the field of vision. The eyelids may stick together. Food becomes difficult to chew and swallow, because it sticks in the throat. The voice may be thin and reedy, and the teeth may start to degenerate.
Other effects may include generalized itching, fatigue, recurrent low-grade fever, and arthralgia or myalgia. Lymph node enlargement may be the first sign of a malignant lymphoma or pseudolymphoma.
These effects are caused mainly by diminished lacrimal and salivary gland secretion (sicca complex). About 50% of SS patients have confirmed rheumatoid arthritis and a history of slowly developing sicca complex. However, medical help is usually sought first for the rapidly progressing and severe oral and ocular dryness, which often is accompanied by periodic parotid gland enlargement (like mumps). What triggers this chain of events is not clear, but it is suspected to have genetic and environmental links. Viral or bacterial infections, or perhaps, pollen may also be triggers in a susceptible individual. Hormonal imbalances are also thought to be a possible link.
Oral dryness (xerostomia) leads to difficulty in swallowing and talking, abnormal taste and/or smell sensations, thirst, severe and rampant dental caries, and ulcers of the tongue, buccal mucosa, and lips – often occurring at the corners of the mouth. Other problems associated with SS are inflammation of the lungs, kidneys, liver, nerves, thyroid glands, and brain.
A mild form of arthritis usually accompanies the condition. Dryness of the respiratory tract leads to epistaxis (hemorrhaging from the nose), hoarseness, chronic nonproductive cough, recurrent otitis media (ear infection), and an increased incidence of respiratory infections. Tissue damage results from infiltration by lymphocytes or from the deposition of immune complexes. Lymphocytic infiltration may be classified as benign, malignant, or pseudolymphoma (nonmalignant but tumorlike aggregates of lymphoid tissue).
Conventional treatment is designed to relieve discomfort while controlling the dryness of the mouth and eyes. Lubricating eye drops, chewing gum, and room humidifiers are recommended, as well as aspirin and NSAIDs. Treatment is usually the same as for rheumatoid arthritis.
There are alternative measures that can be used but the basic rule is prevention or, by catching it early, reversing the disorder through good health and diet practices.
Temporal arteritis is an inflammatory disease of the large arteries in the head, neck, and sometimes elsewhere in the body. TA is an autoimmune disease that occurs when there is an accumulation of giant cells in the walls of medium-sized arteries, especially the temporal arteries – and thus its name.
Symptoms include pain, aching, and stiffness in the muscles of the upper arms, trunk, and legs, particularly in the morning, a headache that usually pounds away in one temple, tenderness, swelling, and redness following the path of the temporal artery on one side of the head, mild fever, and loss of appetite.
Because it affects the arteries, it prevents them from delivering an adequate blood supply to the connective tissues. The collagen is then adversely affected, which can result in an arthritic condition. TA is thought to be very similar to, if not a characteristic of, polymyalgia rheumatica. The average age of onset is 70, affecting twice as many women as men.