Mayo Clinic Health Letter, December 2012 Highlights

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Here are highlights from the December issue of Mayo Clinic Health Letter. You may cite this publication as often as you wish. Reprinting is allowed for a fee. Mayo Clinic Health Letter attribution is required. Include the following subscription information as your editorial policies permit: Visit HealthLetter.MayoClinic.com or call toll-free for subscription information, 800-333-9037, extension 9771.

Aggressive, Early Treatment for Rheumatoid Arthritis Reduces Risk of Disability

A generation ago, rheumatoid arthritis almost always led to disfigured joints and severe disability. Today, this disease still causes joint damage, discomfort and disability. But the risk of disability can be dramatically reduced when drugs that modify the immune system are started soon after the disease begins, according to the December issue of Mayo Clinic Health Letter.

Rheumatoid arthritis occurs when the immune system attacks joint linings (synovial membranes) that protect and lubricate the joints. The joint linings become inflamed and feel warm, painful and swollen. Muscle aches and fatigue may also occur. The onset can be sudden or subtle, involving swelling in only one or two joints.

When joint swelling occurs and lasts more than two weeks, it’s important to see a physician. Persistent inflammation can lead to changes that damage cartilage, bone, tendons and ligaments. Medications can slow or stop this destructive process.

Aggressive drug treatment for rheumatoid arthritis starts as soon as possible. With several choices for medication, doctors increase dosages of drugs used -- or add or take away drugs from the mix -- until remission or very low disease activity is achieved. The intensity of early treatment improves the odds of remission. The longer the active disease persists, the less likely it will respond to drug therapy.

Exercise will very likely be part of the treatment plan, too. Older adults with rheumatoid arthritis -- especially those newly diagnosed -- are at risk of muscle weakness caused by the disease. A physical therapist can design an exercise program to strengthen muscles, increase exercise capacity and avoid joint irritations. Without safe exercise, a decline to disability can occur quickly, sometimes within weeks.

It’s not entirely known what causes rheumatoid arthritis, but there’s a strong genetic component that makes certain people more susceptible to triggering factors, such as a viral infection. While it can occur at any age, the peak age of onset is 56.

Basic Remedies Relieve Hairy Tongue and Other Common Tongue Changes

Changes in the color or texture of the tongue -- even a tongue that appears hairy -- usually aren’t serious health concerns.

The December issue of Mayo Clinic Health Letter reviews some common and more unusual changes that can occur to the tongue and the papillae, the tiny raised red dots that cover the tongue. Common conditions include:

*Geographic tongue: With this condition, areas of papillae become white and more pronounced. The result is a “map” of red, white and pink patches on the tongue. Usually, there are no other symptoms, though some people may be sensitive to hot or spicy foods. This sensitivity can be improved with a topical steroid gel or soothing mouth rinse.

*Hairy tongue: Dead cell skins can accumulate between elongated papillae, usually at the middle and back of the tongue. These cells can resemble tan to black hair. Hairy tongue sometimes causes bad breath or a bad taste. Smokers and people with poor oral hygiene are more likely to experience hairy tongue. It can be treated with daily brushing of the tongue and the use of a tongue scraper.

*Fissured tongue: Natural grooves on the tongue may become more pronounced with age or with certain diseases such as psoriasis or Sjogren’s syndrome. The grooves aren’t a concern unless bacteria become trapped in them, causing inflammation. Gentle brushing of the grooves prevents bacterial buildup.

Less common tongue problems merit a trip to the physician for diagnosis and treatment. Some of these conditions include:

*Median rhomboid glossitis: A fungal infection can cause small areas of smooth and shiny tongue tissue, usually in the middle back of the tongue. Burning and itching may occur. Antifungal medications are used to treat this condition.

*Smooth tongue (glossitis): The papillae shrink or disappear, causing the tongue to appear smooth and shiny. Tenderness or sensitivity to spicy food may occur. Often, glossitis is caused by a deficiency of iron, folic acid or other vitamins. Treatment involves addressing the nutrition deficiency.

*Burning tongue: A burning sensation on the tongue occurs and worsens as the day progresses. Conditions such as Sjogren’s syndrome, diabetes, underactive thyroid, oral yeast infection or dry mouth can cause burning tongue. Burning tongue also can be related to medications that cause dry mouth. Treatment focuses on managing the underlying condition.

*Tongue cancer: This usually appears as a thickened white or red patch, nodule or sore on the side or underside of the tongue. Tobacco, alcohol use and aging are primary risk factors. Treatment involves surgery, radiation therapy and sometimes chemotherapy.

Painless Swollen Legs: Many Causes from Mild to Serious

Painless swollen legs are relatively common and usually easily managed. But, according to the December issue of Mayo Clinic Health Letter, this condition -- called peripheral edema -- is sometimes associated with a more serious underlying disease.

Edema is the result of excess fluid in the tissues. Normally, the blood vessels, lymph systems and tissues surrounding these vessels maintain a balance of fluid. When these forces are out of balance, the tiniest blood vessels (capillaries) may leak fluid that ends up in surrounding tissues, causing swelling.

Other edema symptoms may include skin that is stretched or shiny; skin that stays indented after being pressed for at least five seconds; and an increase in abdomen size. Edema can affect the lungs and cause shortness of breath that requires immediate medical care.

Mild peripheral edema, without serious symptoms such as shortness of breath or high blood pressure, is usually the result of not-so-worrisome causes including:

*Too much salt consumption the previous day

*Age -- older age increases susceptibility to swollen legs

*Being overweight

*Standing or sitting for extended periods of time

Edema can also signal serious health concerns such as weak or damaged leg veins, congestive heart failure, scarring of the liver, blood clots in the lower legs, chronic kidney damage and pelvic tumor.

A physical exam and diagnostic tests can help sort out the underlying cause of peripheral edema. Tests might include blood analysis, urinalysis, electrocardiogram or chest X-ray.

In addition to treating any underlying condition, a physician will likely suggest management techniques to help prevent fluid retention. Options include wearing special compression stockings, lying down with legs elevated for an hour or two a day, and water aerobics or walking in a swimming pool. For more severe cases, a fluid pill (diuretic) may be prescribed.

Mayo Clinic Health Letter is an eight-page monthly newsletter of reliable, accurate and practical information on today’s health and medical news. To subscribe, please call 1-800-333-9037 (toll-free), extension 9771, or visit HealthLetter.MayoClinic.com.