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Ankylosing Spondylitis, or AS, is a form of arthritis that primarily affects the spine, although other joints can become involved. It causes inflammation of the spinal joints that can lead to severe, chronic pain and discomfort. AS can also cause inflammation, pain and stiffness in other areas of the body such as the shoulders, hips, ribs, heels and small joints of the hands and feet. These changes may be mild or severe, and may lead to a stooped-over posture. Early diagnosis and treatment helps control pain and stiffness and may reduce or prevent significant deformity.

Ankylosing spondylitis affects about 0.1% to 0.5% of the adult population. Although it can occur at any age, spondylitis most often strikes men in their teens and 20s. It is less common and generally milder in women.Causes:

Although the cause of anklosing spondylitis is unknown, there is a strong genetic or family link. Most, but not all, people with spondylitis carry a gene called HLA-B27. Although people carrying this gene are more likely to develop spondylitis, it is also found in up to 10% of people who have no signs of the condition.Symptoms:

Early signs and symptoms may include pain and stiffness in your lower back and hips. These symptoms may come on so gradually that you don’t notice them at first. Over time, symptoms may worsen, improve or stop completely at irregular intervals. The areas most commonly affected are the joints between the base of your spine and pelvis, vertebrae in lower back, cartilage between your breastbone and ribs, hip and shoulder joints. Ankylosing spondylitis is a systemic disease, which means symptoms may not be limited to the joints. People with the condition may have fever, fatigue, and loss of appetite. Diagnosis:

Diagnosis of ankylosing spondylitis may be delayed if your symptoms are mild or if you mistakenly attribute some of your symptoms to more common back problems.

  • Medical history – The doctor will ask the patient about their pain, whether they have any other medical conditions and if any family members have back problems or arthritis.
  • Physical exam – The doctor will check if the patient has any pain along the spine and/or pelvis, sacroiliac joints, heels or chest. The patient may also be asked to move and bend in different directions to check the flexibility of the spine.
  • X-ray – X-rays allow your doctor to check for changes in your joints and bones, though the characteristic effects of ankylosing spondylitis may not be evident early in the disease.
  • Magnetic resonance imaging (MRI) – Using radio waves and a strong magnetic field, MRI scans are better at visualizing soft tissues such as cartilage.
  • Blood test – The main blood test used checks for the HLA-B27 gene. This gene is not always present in people with AS. Less than 8 percent of Americans that have the gene actually develop AS. If the gene is present in someone that has symptoms of AS, it may help support the diagnosis of AS. Certain blood tests can check for signs of inflammation, however inflammation can be caused by many different health problems.


There is no cure for AS, but there are treatments that can reduce discomfort and improve function. The goals of treatment are to reduce pain and stiffness, maintain good posture, prevent deformity, and preserve the ability to perform normal activities. Under ideal circumstances, a team approach to treat spondylitis is recommended. Members of the treatment team typically include the patient, doctor, physical therapist, and occupational therapist.

Doctors use a variety of approaches to treat AS that are often used in combinations. The most commonly used treatments are:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) — these medications are commonly used to relieve pain and inflammation. Some people seem to respond better to one NSAID than another. Examples of NSAIDs are aspirin, ibuprofen and naproxen.
  • Disease-modifying anti-rheumatic drugs (DMARDs) — these medications help control the disease process and help reduce inflammation. The most commonly used DMARD for AS is sulfasalazine.
  • Corticosteroids — Injections of corticosteroids directly into the affected joint can offer quick but only temporary pain relief. Injections may be given in the sacroiliac joint, hip joint or knee. They cannot be given in the spine.
  • Biologic agents — this class of medications helps relieve symptoms when NSAIDs or other treatments have not worked. They are given by infusion or injection.


Sometimes side effects can disrupt a person’s life and day-to-day activities. However, it is important that a person never change their dosage or stop taking their medication without talking to their doctor or pharmacist.

Common side effects for the different treatment options for AS include:

  • NSAIDs – Nausea, vomiting, heartburn, diarrhea and headache
  • DMARDs – Nausea, vomiting, diarrhea, weakness, liver damage and increased risk of developing an infection
  • Corticosteroids – Weight gain, increased appetite, anxiety, nervousness and increased risk of developing an infection. Steroids may also interfere with normal growth in children.
  • Biologic agents – Cough, nausea, vomiting, rash, weakness, abdominal pain and increased risk of infection

Resources and References:

Arthritis Foundation
American College of Rheumatology
Spondylitis Association of America (SAA)
Mayo Clinic


Cancer is the general name for a group of more than 100 diseases. Although there are many kinds of cancer, all cancers start because abnormal cells grow out of control. Untreated cancers can cause serious illness and death.


Cancer starts when cells in a part of the body start to grow out of control. Cancer cell growth is different from normal cell growth. Instead of dying, cancer cells continue to grow and form new, abnormal cells. Cells become cancer cells because of DNA damage. DNA is in every cell and it directs all the cell’s actions. In cancer cells, the damaged DNA is not repaired, and the cell doesn’t die like it should. Instead, the cell goes on making new cells that the body doesn’t need. These new cells all have the same abnormal DNA as the first cell does. People can inherit abnormal DNA, but most DNA damage is caused by mistakes that happen while the normal cell is reproducing or by something in the environment. Sometimes the cause of the DNA damage may be something obvious like cigarette smoking or sun exposure. But it’s rare to know exactly what caused any one person’s cancer.


Most people with cancer will lose weight as some point. When you lose weight for no known reason, it’s called an unexplained weight loss. An unexplained weight loss of 10 pounds or more may be the first sign of cancer. This happens most often with cancers of the pancreas, stomach, esophagus, or lung. 

Fever is very common with cancer, but it more often happens after cancer has spread from where it started. Almost all patients with cancer will have fever at some time, especially if the cancer or its treatment affects the immune system. Less often, fever may be an early sign of cancer, such as blood cancers like leukemia or lymphoma.

Fatigue is extreme tiredness that does not get better with rest. It may be an important symptom as cancer grows. It may happen early, though, in some cancers, like leukemia. Some colon or stomach cancers can cause blood loss that’s not obvious.

Pain may be an early symptom with some cancers like bone cancers or testicular cancer. A headache that does not go away or get better with treatment may be a symptom of a brain tumor. Back pain can be a symptom of cancer of the colon, rectum, or ovary. Most often, pain due to cancer means it has already spread (metastasized) from where it started.

Along with cancers of the skin, some other cancers can cause skin changes that can be seen. These signs and symptoms include:

  • Darker looking skin
  • Yellowish skin and eyes
  • Reddened skin
  • Itching
  • Excessive hair growth


  • Physical exam. Your doctor may feel areas of your body for lumps that may indicate a tumor. During a physical exam he or she may look for abnormalities, such as changes in skin color or enlargement of an organ that may indicate the presence of cancer.
  • Laboratory tests, such as urine and blood tests, may help your doctor identify abnormalities that can be caused by cancer. For instance, in people with leukemia, a common blood test called complete blood count (CBC) may reveal an unusual number of white blood cells.
  • Imaging tests. Imaging tests allow your doctor to examine your bones and internal organs in a noninvasive way. Imaging tests used in diagnosing cancer may include computerized tomography (CT) scan, bone scan, magnetic resonance imaging (MRI), ultrasound and X-ray, among others.
  • Biopsy. During a biopsy, your doctor collects a sample of cells for testing in the laboratory. In most cases, a biopsy is the only way to definitively diagnose cancer. 


  • Surgery. Surgery can be used to diagnose, treat, or even help prevent cancer in some cases. Most people with cancer will have some type of surgery. It often offers the greatest chance for cure, especially if the cancer has not spread to other parts of the body.
  • Chemotherapy. Chemotherapy (chemo) is the use of medicines or drugs to treat cancer. Chemo may be used to:
    • Keep the cancer from spreading.
    • Slow the cancer’s growth.
    • Kill cancer cells that may have spread to other parts of the body.
    • Relieve symptoms such as pain or blockages caused by cancer.
    • Cure cancer
  • Radiation Therapy. Radiation Therapy uses high-energy particles or waves to destroy or damage cancer cells. It is one of the most common treatments for cancer, either by itself or along with other forms of treatment.
  • Targeted Therapy. Targeted therapy is a newer type of cancer treatment that uses drugs or other substances to more precisely identify and attack cancer cells, usually while doing little damage to normal cells. Targeted therapy is a growing part of many cancer treatment regimens.
  • Immunotherapy. Immunotherapy is treatment that uses your body’s own immune system to help fight cancer.
  • Hyperthermia. The idea of using heat to treat cancer has been around for some time, but early attempts had mixed results. Today, newer tools allow more precise delivery of heat, and hyperthermia is being studied for use against many types of cancer.
  • Stem Cell Transplant (Peripheral Blood, Bone Marrow, and Cord Blood Transplants)
  • Photodynamic Therapy. Photodynamic therapy or PDT is a treatment that uses special drugs, called photosensitizing agents, along with light to kill cancer cells. The drugs only work after they have been activated or “turned on” by certain kinds of light.
  • Lasers in Cancer Treatment. Lasers, which are very powerful, precise beams of light, can be used instead of blades (scalpels) for very careful surgical work, including treating some cancers.
  • Blood Product Donation and Transfusion. Transfusions of blood and blood products temporarily replace parts of the blood when a person’s body can’t make its own or has lost them from bleeding.


Cancer and its treatment can cause several complications, including:

  • Pain. Pain can be caused by cancer of by cancer treatment. Medications and other approaches can effectively treat cancer-related pain.
  • Fatigue. Fatigue in people with cancer has many causes, but it can often be managed. Fatigue associated with chemotherapy or radiation therapy treatments is common, but it’s usually temporary. 
  • Difficulty breathing. Cancer or cancer treatment may cause a feeling of being short of breath. Treatments may bring relief.
  • Nausea. Certain cancers and cancer treatments can cause nausea. Medications and other treatments may help you prevent of cope with nausea.
  • Diarrhea or constipation. Cancer and cancer treatment can affect your bowels and cause diarrhea or constipation.
  • Weight loss. Cancer and cancer treatment may cause weight loss
  • Unusual immune system reactions to cancer. In some cases the body’s immune system may react to the presence of cancer by attacking healthy cells. Called paraneoplastic syndromes, these unusual reactions can lead to a variety of signs and symptoms, such as difficulty walking and seizures.
  • Cancer that spreads. As cancer advances, it may spread (metastasize) to other parts of the body. Where cancer spreads depends on the type of cancer.
  • Cancer that returns. Cancer survivors have a risk of cancer recurrence. Some cancers are more likely to recur than others.


Crohn’s disease is an inflammatory bowel disease (IBD). It causes inflammation of the lining of your digestive tract, which can lead to abdominal pain, severe diarrhea and even malnutrition. Inflammation caused by Crohn’s disease can involve different areas of the digestive tract in different people. The inflammation caused by Crohn’s disease often spreads deep into the layers of affected bowel tissue. Like ulcerative colitis, another common IBD, Crohn’s disease can be both painful and debilitating, and sometimes may lead to life-threatening complications. Causes:The exact cause of Crohn’s disease remains unknown. Researchers believe that a number of factors, such as heredity and a malfunctioning immune system play a role in the development of Crohn’s disease. It’s possible that a virus or bacterium may trigger Crohn’s disease. When your immune system tries to fight off the invading microorganism, an abnormal immune response causes the immune system to attack the cells in the digestive tract, too. Crohn’s is more common in people who have family members with the disease, leading experts to suspect that one or more genes may make people more susceptible to Crohn’s disease. However, most people with Crohn’s disease don’t have a family history of the disease. Symptoms:

The main symptoms of Crohn’s disease include:

  • Abdominal pain. The pain often is described as cramping and intermittent, and the abdomen may be sore when touched. Abdominal pain may turn to a dull, constant ache as the condition progresses.
  • Diarrhea. Some people may have diarrhea 10 to 20 times a day. Crohn’s disease may cause blood in stools, but not always.
  • Loss of appetite
  • Fever. In severe cases, fever or other symptoms that affect the entire body may develop. A high fever may mean that you have a complication involving infection, such as an abscess.
  • Weight loss. Ongoing symptoms, such as diarrhea, can lead to weight loss.
  • Too few red blood cells (anemia). Some people with Crohn’s disease develop anemia because of low iron levels caused by bloody stools or the intestinal inflammation itself.

People with Crohn’s disease may also have:

  • Sores in the mouth
  • Nutritional deficiencies
  • Bowel obstruction
  • Disease in or around the anus
  • Pockets of infection (abscesses)
  • Skin tags


Doctors will likely diagnose Crohn’s disease only after ruling out other possible causes for your signs and symptoms, including irritable bowel syndrome (IBS), diverticulitis and colon cancer.

To help confirm a diagnosis of Crohn’s disease, you may have one or more of the following tests and procedures:

  • Blood tests
  • Fecal occult blood test
  • Colonoscopy
  • Flexible sigmoidoscopy
  • Computerized tomography (CT)
  • Magnetic resonance imaging
  • Capsule endoscopy
  • Double balloon endoscopy
  • Small bowel imaging
  • Barium enema


Currently there is not a cure for Crohn’s disease and there is no one treatment that works for everyone. The goal of medical treatment is to reduce the inflammation that triggers your signs and symptoms and to improve long-term prognosis by limiting complications. In the best cases, this may lead not only to symptom relief but also to long-term remission. Treatment for Crohn’s disease usually involves drug therapy or, in certain cases, surgery. Medications used to treat Crohn’s disease:

  • Anti-inflammatory
    • Sulfasalazine (Azulfidine)
    • Mesalamine (Asacol, Rowasa)
    • Corticosteroids 
  • Immune System Suppressors
    • Azathioprine (Imuran)
    • Mercaptopurine (Purinethol)
    • Infliximab (Remicade)
    • Adalimumab (Humira)
    • Certolizumab Pegol (Cimzia)
    • Methotrexate (Rheumatrex)
    • Cyclosporine (Gengraf, Neoral, Sandimmune)
    • Natalizumab (Tysabri)
  • Antibiotics
    • Metronidazole (Flagyl)
    • Ciprofloxacin (Cipro)
  • Other Medications
    • Anti-diarrheals
    • Laxatives
    • Pain relievers
    • Iron supplement
    • Nutritional supplements
    • Vitamin B-12 Shots
    • Calcium and vitamin D supplements


  • Bowel obstruction
  • Ulcers
  • Fistulas
  • Anal fissure
  • Malnutrition
  • Colon cancer
  • Arthritis
  • Kidney stones
  • Gallstones
  • Osteoporosis

Side Effects:

Treatment can cause side effects, but it is important that a person never change their dosage or stop taking their medication without talking to their doctor or pharmacist.

Common side effects for the different treatment options for Crohn’s disease include:

  • Anti-inflammatory drugs – Nausea, vomiting, heartburn, diarrhea and headache
  • Steroids – Weight gain, increased appetite, anxiety, nervousness and increased risk of developing an infection
  • Immune system suppressors – Nausea, vomiting, diarrhea and increased risk of developing an infection
  • Antibiotics – Nausea, vomiting, headache, constipation, diarrhea and dizziness
  • Biologic therapy – Cough, nausea, vomiting, rash, weakness, upper respiratory tract infections, urinary tract infections and back pain

Resources and References:

Mayo Clinic


It affects mostly males, as it is an X chromosome linked condition. Hemophilia affects 1 in 5,000 male births in the U.S. and approximately 400 babies are born with hemophilia each year. 400,000 people worldwide are living with hemophilia and about 20,000 are living with it in the United States alone. All races and economic groups are affected equally. People with hemophilia who have access to factor replacement therapy have a normal life expectancy.

Types of Hemophilia

Bleeding disorders are treated differently depending on what protein is missing in the blood. Hemophilia is one of the most common bleeding disorders and is classified as follows:

  • Hemophilia A – Also called classic hemophilia, it is 4 times more common than hemophilia B, and it occurs when factor VIII levels are deficient.
  • Hemophilia B – Also called Christmas disease, it occurs when factor IX levels are deficient.
  • Hemophilia C – It occurs when factor XI levels are deficient
  • Acquired hemophilia – A person can develop hemophilia as a result of illness, medications, or pregnancy. Acquired hemophilia is extremely rare and usually resolves itself with proper diagnosis and treatment.


When you’re cut or bleeding internally, your body normally pools blood cells together to form a clot to stop the bleeding. This process is called coagulation. Coagulation involves blood particles called platelets and plasma proteins that encourage clotting (clotting factors). The cause of hemophilia is a deficiency of one of these clotting factors. Which type of hemophilia you have depends on which clotting factor is deficient: 

  • Hemophilia A. The most common type, hemophilia A is caused by lack of enough clotting factor 8 (VIII).
  • Hemophilia B. This second most common type is caused by lack of enough clotting factor 9 (IX).
  • Hemophilia C. This type is caused by a lack of clotting factor 11 (XI), and symptoms are often mild with this type of hemophilia.

Hemophilia inheritance:

  • Everyone has two sex chromosomes, one from each parent. Females inherit an X chromosome from their mother and an X chromosome from their father. Males inherit an X chromosome from their mother and a Y chromosome from their father. 
  • The gene that causes hemophilia A or B is located on the X chromosome, so it can’t be passed from father to son. Hemophilia A or B almost always occurs in boys and is passed from mother to son through one of the mother’s genes. Most women who have the defective gene are simply carriers and exhibit no signs or symptoms of hemophilia. It’s also possible for hemophilia A or B to occur through spontaneous gene mutation.
  • The gene that causes hemophilia C can be passed on to children by either parent. Hemophilia C can occur in both boys and girls.


A person with hemophilia can bleed inside or outside of the body. People with hemophilia do not bleed more than people without hemophilia, they just bleed longer. The most common types of bleeds are into the joints and muscles.

Other symptoms include:

  • Nose bleeds
  • Prolonged bleeding from minor cuts
  • Bleeding that stops and resumes after stopping for only a short time
  • Blood in the urine
  • Blood in the stool
  • Large bruises
  • Hematomas
  • Easy bruising (unexplained bruising)
  • Excessive bleeding with dental work or tooth extraction
  • Heavy periods and/or periods lasting more than 7 days


For people with a family history of hemophilia, it’s possible to test the fetus during pregnancy to determine if it is affected by the disease. However, such testing poses some risk to the fetus. Discuss the benefits and risks of testing with your doctor.

Analysis of a blood sample from either a child or an adult can show a deficiency of a clotting factor. Sometimes mild hemophilia isn’t diagnosed until after a person has undergone surgery and excessive bleeding results.Treatment:

While there’s no cure for hemophilia, most people with the disease can lead fairly normal lives. 

Hemophilia treatment varies depending on the severity of the condition: 

  • Mild hemophilia A. Treatment may involve slow injection of the hormone desmopressin (DDAVP) into a vein to stimulate a release of more clotting factor to stop bleeding. Occasionally, desmopressin is given as a nasal medication.
  • Moderate to severe hemophilia A or hemophilia B. Bleeding may stop only after an infusion of clotting factor derived from donated human blood or from genetically engineered products called recombinant clotting factors. Repeated infusions may be needed if internal bleeding is serious.
  • Hemophilia C. The clotting factor missing in this type of hemophilia (factor XI) is available only in Europe. In the U.S., plasma infusions are needed to stop bleeding episodes.

Regular preventive infusions of a clotting factor may help prevent bleeding. This approach may reduce time spent in the hospital and away from home, work or school and limit side effects such as damage to joints. Your doctor or child’s doctor can train you to perform infusions of desmopressin or the clotting factor at home, work or school. 

Another class of drugs called antifibrinolytics is sometimes prescribed along with clotting factor replacement therapy. These medications help prevent clots from breaking down. 

If internal bleeding has damaged joints, physical therapy can help them function better. Therapy can preserve their mobility and help prevent frozen or badly deformed joints. In cases where repeated bouts of internal bleeding has damaged or destroyed joints, an artificial joint may be needed. 

For Minor Cuts:

If you or your child experiences a small cut or scrape, using pressure and a bandage will generally take care of the bleeding. For small areas of bleeding beneath the skin, use an ice pack. Ice pops can be used to slow down minor bleeding in the mouth.Complications:

Complications may occur from the condition or from the treatment for the condition: 

  • Deep internal bleeding. Hemophilia may cause deep muscle bleeding that leads to swelling of a limb. The swelling may press on nerves and lead to numbness or pain. This may result in a reluctance to use that limb.
  • Damage to joints. Internal bleeding may also put pressure on and damage joints. Pain sometimes may be severe, and you may be reluctant to use a limb or move a joint. If bleeding occurs frequently and you don’t receive adequate treatment, the irritation may lead to destruction of the joint or the development of arthritis.
  • Infection. People with hemophilia are more likely to receive blood transfusions and are at greater risk of receiving contaminated blood products. Until the mid-1980s, it was more likely for people with hemophilia to become infected with the human immunodeficiency virus (HIV) or with hepatitis through contaminated blood products. Since then, blood products are much safer because of steps taken to screen the supply of donated blood. The risk of infection through blood products also has decreased substantially since the introduction of genetically engineered clotting products called recombinant factors, which are free of infection. However, it’s still possible for people who rely on blood products to contract diseases. If you have hemophilia, consider receiving immunization against hepatitis A and B.
  • Adverse reaction to clotting factor treatment. In some people with hemophilia, the immune system sees these clotting factor treatments as foreign. When this happens, the immune system develops proteins that inactivate the clotting factors used to treat bleeding. Researchers are investigating treatments to dampen the immune system’s response and allow continuing treatment with clotting factors.

Resources and References:

Hemophilia Federation of America


Infertility is defined as the inability for a couple to become pregnant after a year of regular, unprotected intercourse. The male partner, the female partner, or both, may have a fertility problem. In women over 35 years old, an evaluation and possible treatment is needed after 6 months of unprotected intercourse.

A person who is infertile has a reduced ability to have a child. It usually doesn’t mean a person is sterile — that is, physically unable ever to have a child. Up to 15% of all couples are infertile, but only 1% to 2% are sterile. Half of couples who seek help can eventually bear a child, either on their own or with medical assistance.

Men and women are equally likely to have a fertility problem. In about one in five infertile couples, both partners contribute to fertility problems, and in about 15% of couples, no cause is found after all tests have been done. This is called “unexplained infertility.”

For many couples, infertility is a crisis. Fertility problems often come with feelings of guilt or inadequacy. But a diagnosis of infertility is not necessarily a verdict of sterility.Causes:

One-third of cases are due to infertility involving only the male and one-third of cases of infertility are involving only the female. The remaining cases of infertility involve both the mail and female or the cause is unknown.

Causes of infertility in women may include:

  • Ovulation disorders
    • Polycystic ovary syndrome (PCOS)
    • Excessive exercise
    • Eating disorders
    • Injury
    • Tumor
  • Uterine or cervical abnormalities
    • Uterine or cervical abnormalities
    • Problem with opening of the cervix
    • Abnormalities in shape or cavity of the uterus
    • Benign tumors in the uterine wall (Uterine fibroids)
  • Fallopian tube damage or blockage
    • Pelvic inflammatory disease
    • Sexually transmitted infection
  • Endometriosis
  • Primary ovarian insufficiency
    • Early menopause (<40 years of age)
  • Pelvic adhesions
    • Scar tissue
  • Thyroid problems
    • Cancer and its treatment
    • Certain medications

Causes of infertility in women may include:

  • Abnormal sperm production or function
    • Undescended testicles
    • Genetic defects
    • Enlarged veins in the testes (varicocele)
  • Problems with the delivery of sperm
    • Premature ejaculation
    • Cystic fibrosis
    • Testicular blockage
    • Organ injury
  • Overexposure to certain environmental factors
    • Pesticides
    • Radiation
    • Anabolic steroids
    • Cystic fibrosis
    • Marijuana
    • Frequent heat exposure (saunas or hot tubs)
    • Smoking
  • Damage from cancer or cancer treatment
    • Radiation
    • Chemotherapy


Most couples achieve pregnancy within the first six months of trying. Overall, after 12 months of unprotected intercourse, approximately 90 percent of couples will become pregnant. The majority of the remaining couples will eventually conceive, with or without treatment.

The main sign of infertility is the inability for a couple to get pregnant. There may be no other obvious symptoms.

In some cases, an infertile woman may have abnormal menstrual periods. An infertile man may have some signs of hormonal problems, such as changes in hair growth or sexual function.

When to see a doctor

In general, don’t be too concerned about infertility unless you and your partner have been trying regularly to conceive for at least one year.

Talk with your doctor earlier, however, if you’re a woman and: 

  • You’re age 34 or older and have been trying to conceive for six months or longer
  • You menstruate irregularly or not at all
  • Your periods are very painful
  • You have been diagnosed with endometriosis or pelvic inflammatory disease (PID)
  • You’ve had more than one miscarriage

If you’re a man, talk with your doctor if you have: 

  • Low sperm count
  • A history of testicular, prostate or sexual problems


Both partners will undergo physical examination to determine if there are any physical disorders contributing infertility.

Gender specific testing

For a man to be fertile, the testicles must produce enough healthy sperm, and the sperm must be ejaculated effectively into the woman’s vagina and be able to travel to the egg. Specific tests for male infertility attempt to determine whether any of these processes are impaired: 

  • Semen analysis
  • Hormone testing
  • Transrectal and scrotal ultrasound
  • Genetic testing

For a woman to be fertile, her ovaries must release healthy eggs. Her reproductive tract must allow an egg to pass into her fallopian tubes and allow the sperm to join the egg for fertilization. The fertilized egg must travel on to the uterus and implant in the lining. Specific tests for female infertility attempt to determine whether any of these processes are impaired.

  • Ovulation testing
  • Hysterosalpingography
  • Ovarian reserve testing
  • Other hormone testing
  • Imaging tests


Treatment depends on the cause of infertility. It may involve:

  • Education and counseling
  • Fertility treatments such as intrauterine insemination (IUI) and in vitro fertilization (IVF)
  • Medicines to treat infections and clotting disorders
  • Medicines that help the woman grow and release eggs from the ovaries 

It is important to recognize and discuss the emotional impact that infertility has on you and your partner, and to seek medical advice from your health care provider.

You can increase your chances of becoming pregnant each month by having sex at least every 3 days before and during ovulation. It is especially important to do so before ovulation occurs. Sperm can live inside a woman’s body for at least 3 days. However, a woman’s egg can only be fertilized by the sperm for a few hours after it is released. 

Ovulation occurs about 2 weeks before the next menstrual cycle (period) starts. If a woman gets her period every 28 days, the couple should have sex at least every 3 days between the 10th and 18th day after the period starts.Complications:

Common medicines used to treat infertility include clomiphene citrate, human menopausal gonadotropin (hMG), follicle-stimulating hormone (FSH), or gonadotropin-releasing hormone (Gn-RH) analog. Treatment can cause side effects but it is important that a person never changes their dosage or stops taking their medication without talking to their doctor or pharmacist. 

Common side effects for the different medication options for infertility include: 

  • Human menopausal gonadotropin (hMG) — Injection site pain, lower-abdomen tenderness, fluid retention, headache, emotional irritability, breast discomfort and fatigue
  • Follicle-stimulating hormone (FSH)— Injection site pain, abdominal pain, weight gain, breast discomfort, emotional irritability, nausea, vomiting and diarrhea
  • Gonadotropin-releasing hormone(Gn-RH) — An irregular menstrual period (or no menstrual period at all); hot flashes; vaginal burning, itching or dryness; decreased sexual interest and increased acne or oily skin or hair.

Resources and References:

PubMed Health
Mayo Clinic


Arthritis is a complex family of musculoskeletal disorders consisting of more than 100 different diseases or conditions that destroy joints, bones, muscles, cartilage and other connective tissues, hampering or halting physical movement. Juvenile arthritis (JA) is an umbrella term used to describe the many autoimmune and inflammatory conditions that can develop in children ages 16 and younger.

Arthritis typically affects joints — the word “arthritis” literally means joint inflammation: arth (joint) and itis (inflammation) — but JA can involve the eyes, skin and gastrointestinal tract as well.

In addition, there are several different types of juvenile arthritis. As JA’s prevalence rises, researchers and doctors alike are working to develop a more sophisticated understanding of the differences between the different forms.

The most common type of JA is juvenile idiopathic arthritis (JIA). To receive a diagnosis, a child should be younger than 16 and have initial swelling in one or more joints for at least six weeks.Causes:

No known cause has been pinpointed for most forms of juvenile arthritis, nor is there evidence to suggest that toxins, foods or allergies cause children to develop the disease. Some research points toward a genetic predisposition, which means the combination of genes a child receives from family members may cause the onset of arthritis when triggered by other factors.Symptoms:

The most common symptom of all types of juvenile arthritis is persistent joint swelling, pain, and stiffness that is typically worse in the morning or after a nap. The pain may limit movement of the affected joint, although many children, especially younger ones, will not complain of pain. JA commonly affects the knees and the joints in the hands and feet. One of the earliest signs of JA may be limping in the morning because of an affected knee. Besides joint symptoms, children with systemic JA have a high fever and a skin rash. The rash and fever may appear and disappear very quickly. Systemic arthritis also may cause the lymph nodes located in the neck and other parts of the body to swell. In some cases (fewer than half), internal organs including the heart and (very rarely) the lungs, may be involved. 

Eye inflammation is a potentially severe complication that commonly occurs in children with oligoarthritis but can also be seen in other types of JA. All children with JA need to have regular eye exams, including a special exam called a slit lamp exam. Eye diseases such as iritis or uveitis can be present at the beginning of arthritis but often develop some time after a child first develops JA. Very commonly, JA-associated eye inflammation does not cause any symptoms and is found only by performing eye exams.

Typically, there are periods when the symptoms of JA are better or disappear (remissions) and times when symptoms “flare,” or get worse. JA is different in each child; some may have just one or two flares and never have symptoms again, while others experience many flares or even have symptoms that never go away.

Some children with JA have growth problems. Depending on the severity of the disease and the joints involved, bone growth at the affected joints may be too fast or too slow, causing one leg or arm to be longer than the other. Overall growth also may be slowed. Doctors are exploring the use of growth hormone to treat this problem. JA may also cause joints to grow unevenly.Diagnosis:

The most important step in properly treating your child’s JA is getting an accurate diagnosis. The diagnostic process can be long and detailed, but be patient. Your child’s pediatrician will likely recommend that you visit a pediatric rheumatologist who will then take a complete health history to determine the length of time and type of symptoms present.

There is no single blood test that confirms juvenile arthritis. In fact, blood testing will reveal relatively little in terms of your child’s diagnosis. In children, the key to diagnosis is a careful physical exam, along with taking a medical history.

Along with the physical exam itself, your child’s doctors will take a number of other diagnostic steps – such as laboratory work and x-rays and other imaging tests – in part to rule out other potential causes of symptoms. Blood work, for example, can rule out the possibility of an underlying infection.Treatment:

Unfortunately, there is no cure for juvenile arthritis. The goal of treatment for JA is to relieve inflammation, control pain and improve your child’s quality of life. Most treatment plans involve a combination of medication, physical activity, eye care and healthy eating.

Every treatment plan is unique and requires that your child’s health care team, which might include a pediatric rheumatologist, dentist, ophthalmologist, nurse practitioner and physical therapist, among others.

Medications used to treat JA can be divided into two groups: those that help relieve pain and inflammation (nonsteroidal anti-inflammatory drugs, or NSAIDs, corticosteroids and analgesics) and those that can alter the course of the disease, put it into remission and prevent joint damage, a category known as disease-modifying anti-rheumatic drugs (DMARDs) and a newer subset known as biologic response modifiers (biologics).

Each child responds to his or her treatment plan differently, so there’s no set course of attack for JA. Your child’s doctor might try several different medications and/or dosages until your child responds positively to treatment. Some medications affect the immune system or have other side effects, making careful and frequent monitoring very important.Complications:

Having arthritis will affect your entire family, but you can maintain a sense of calm and normalcy. Stick to as many of your child’s daily routines and comforting habits as possible. Having arthritis should be part of your child’s life — not the central focus of his life.

Coping with a chronic illness diagnosis is difficult for anyone, but especially for children who are not emotionally or physically equipped to handle the situation. Expect and prepare for your child to sometimes feel sad or angry that he or she has arthritis. It’s important to address, rather than ignore these emotions. Help your child maintain the attitude that “arthritis is part of who I am, not the only thing I am.”

Arthritis is truly a family diagnosis. Parents experience many emotions – from sadness to guilt to anger that their child has arthritis. It’s tempting to keep a low profile and avoid participating in too many activities when your child is first diagnosed, but everyone will benefit by keeping relationships and schedules as consistent as possible. Parents should be sure to spend time with their other children and make time for one another – and themselves.

Siblings of children with arthritis will feel a full spectrum of emotion from guilt that they’re healthy, to resentment, anger, loneliness and a need for attention. One key to minimizing sibling tensions is to keep everyone equally involved in and informed about your child’s diagnosis and treatment. If your child who doesn’t have arthritis exhibits signs of clinginess, anxiety or dangerous behaviors, seek help from a counselor who can help ease this transition for your family.

Resources and References:

Arthritis Foundation
National Institute of Arthritis and Musculoskeletal and Skin Diseases


Multiple sclerosis (MS) is a disease in which the immune system, which normally protects your body, instead attacks the covering (myelin sheath) surrounding the nerves in your brain and spinal cord. These nerves send information from your brain and spinal cord to other nerves in your body, and myelin helps make this transmission efficient.

People with MS can typically experience one of four disease courses, each of which might be mild, moderate, or severe.

  • Relapsing-Remitting MS. People with this type of MS experience clearly defined attacks of worsening neurologic function. These attacks – which are also called relapses, flare-ups, or exacerbations – are followed by partial or complete recovery periods, during which no disease progression occurs. Approximately 85% of people are initially diagnosed with relapsing-remitting MS.
  • Primary-Progressive MS. This disease course is characterized by slowly worsening neurologic function from the beginning – with no distinct relapses or remissions. The rate of progression may vary over time, with occasional plateaus and temporary minor improvements. Approximately 10% of people are diagnosed with primary-progressive MS.
  • Secondary-Progressive MS. Following an initial period of relapsing-remitting MS, many people develop a secondary-progressive disease course in which the disease worsens more steadily, with or without occasional flare-ups, minor recoveries (remissions), or plateaus. Before the disease-modifying medications became available, approximately 50% of people with relapsing-remitting MS developed this form of the disease within 10 years.
  • Progressive-Relapsing MS. In this relatively rare course of MS (5%), people experience steadily worsening disease from the beginning, but with clear attacks of worsening neurologic function along the way. They may or may not experience some recovery following these relapses, but the disease continues to progress without remissions.


MS is caused by damage to the myelin sheath, the protective covering that surrounds nerve cells. When this nerve covering is damaged, nerve signals slow down or stop. The nerve damage is caused by inflammation. Inflammation occurs when the body’s own immune cells attack the nervous system. This can occur along any area of the brain, optic nerve, and spinal cord.

It is unknown what exactly causes this to happen. The most common thought is that virus or gene defects, or both, are to blame. Environmentally factors may play a role also. You are slightly more likely to get this condition if you have a family history of MS or live in a part of the world where MS is more common.

Some studies have suggested that many viruses such as Epstein-Barr (mononucleosis), varicella zoster, and the hepatitis vaccine may be the cause of MS. To date, however, this belief has not been proven.Symptoms:

In MS, damage to the myelin in the central nervous system, and to the nerve fibers themselves, interferes with the transmission of nerve signals between the brain and spinal cord and other parts of the body. This disruption of nerve signals produces the primary symptoms of MS, which vary depending on where the damage has occurred.


Most common symptoms include:

  • Fatigue
  • Numbness
  • Walking, balance & coordination problems
  • Bladder dysfunction
  • Bowel dysfunction
  • Vision problems
  • Dizziness and Vertigo
  • Sexual dysfunction
  • Emotional changes
  • Pain
  • Depression
  • Spasticity

Less common symptoms include:

  • Speech disorders
  • Swallowing problems
  • Headache
  • Hearing loss
  • Seizures
  • Tremor
  • Respiration/breathing problems
  • Itching


At this time, there are no symptoms, physical findings or laboratory tests that can, by themselves, determine if a person has MS. The doctor uses several strategies to determine if a person meets the long-established criteria for a diagnosis of MS and to rule out other possible causes of whatever symptoms the person is experiencing.

These strategies include:

  • Medical history
  • Neurologic exam
  • Magnetic resonance imaging (MRI)
  • Evoked potentials (EP)
  • Spinal fluid analysis

In order to make a diagnosis of MS, the physician must:

  • Find evidence of damage in at least two separate areas of the central nervous system (CNS), which includes the brain, spinal cord and optic nerves AND
  • Find evidence that the damage occurred at least one month apart AND
  • Rule out all other possible diagnoses


Multiple sclerosis (MS) has no cure. Treatment usually focuses on strategies to treat MS attacks, manage symptoms and reduce the progress of the disease. Some people have such mild symptoms that no treatment is necessary.

Strategies to treat attacks:

  • Corticosteroids. Corticosteroids are mainly used to reduce the inflammation that spikes during a relapse. Examples include oral prednisone and intravenous methylprednisolone (Solu-Medrol). Side effects may include mood swings, seizures, weight gain and an increased risk of infections.
  • Plasma exchange (plasmapheresis). This procedure removes some blood from your body and mechanically separates your blood cells from your plasma, the liquid part of your blood. Doctors then mix your blood cells with a replacement solution and return the blood to your body.


  • Depression
  • Difficulty swallowing
  • Less and less ability to care for self
  • Need to indwelling catheter
  • Osteoporosis or thinning of the bones
  • Pressure sores
  • Urinary tract infections

Resources and References:

Mayo Clinic
PubMed Health
National MS Society


Osteoarthritis is a joint disease that mostly affects cartilage. Cartilage is the slippery tissue that covers the ends of bones in a joint. Healthy cartilage allows bones to glide over each other. It also helps absorb shock of movement. In osteoarthritis, the top layer of cartilage breaks down and wears away. This allows bones under the cartilage to rub together. The rubbing causes pain, swelling, and loss of motion of the joint. Over time, the joint may lose its normal shape. Also, bone spurs may grow on the edges of the joint. Bits of bone or cartilage can break off and float inside the joint space, which causes more pain and damage.

People with osteoarthritis often have joint pain and reduced motion. Unlike some other forms of arthritis, osteoarthritis affects only joints and not internal organs. Rheumatoid arthritis — the second most common form of arthritis — affects other parts of the body besides the joints. Osteoarthritis is the most common type of arthritis.Causes:

Osteoarthritis usually happens gradually over time. Some risk factors that might lead to it include:

  • Being overweight
  • Getting older
  • Joint injury
  • Joints that are not properly formed
  • A genetic defect in joint cartilage
  • Stresses on the joints from certain jobs and playing sports.


Osteoarthritis symptoms often develop slowly and worsen over time. Signs and symptoms of osteoarthritis include:

  • Pain. Your joint may hurt during or after movement.
  • Tenderness. Your joint may feel tender when you apply light pressure to it.
  • Stiffness. Joint stiffness may be most noticeable when you wake up in the morning or after a period of inactivity.
  • Loss of flexibility. You may not be able to move your joint through its full range of motion.
  • Grating sensation. You may hear or feel a grating sensation when you use the joint.
  • Bone spurs. These extra bits of bone, which feel like hard lumps, may form around the affected joint.

When to see a doctor

If you have swelling or stiffness in your joints that lasts for more than a few weeks, make an appointment with your doctor.Diagnosis:

During the physical exam, your doctor will closely examine your affected joint, checking for tenderness, swelling or redness. He or she will also check the joint’s range of motion. Your doctor may also recommend imaging and lab tests.

Imaging tests

  • X-rays. Cartilage doesn’t show up on X-ray images, but the loss of cartilage is revealed by a narrowing of the space between the bones in your joint. An X-ray may also show bone spurs around a joint. Many people have X-ray evidence of osteoarthritis before they experience any symptoms.
  • Magnetic resonance imaging (MRI). MRI uses radio waves and a strong magnetic field to produce detailed images of bone and soft tissues, including bone cartilage. This can be helpful in determining what exactly is causing your pain.

Lab tests

  • Blood tests. Blood tests may help rule out other causes of joint pain, such as rheumatoid arthritis.
  • Joint fluid analysis. Your doctor may use a needle to draw fluid out of the affected joint. Examining and testing the fluid from your joint can determine if there’s inflammation and if your pain is caused by gout or an infection. 


There’s no known cure for osteoarthritis, but treatments can help to reduce pain and maintain joint movement.


  • Acetaminophen. Acetaminophen (Tylenol, others) can relieve pain, but doesn’t reduce inflammation. It has been shown to be effective for people with osteoarthritis who have mild to moderate pain. Taking more than the recommended dosage of acetaminophen can cause liver damage.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs reduce inflammation and relieve pain. Over-the-counter NSAIDs include ibuprofen (Advil, Motrin, others) and naproxen (Aleve, others). Stronger NSAIDs are available by prescription. NSAIDs can cause stomach upset, ringing in your ears, cardiovascular problems, bleeding problems, and liver and kidney damage. Older people are at highest risk of complications.
  • Narcotics. These types of prescription medication typically contain ingredients similar to codeine and may provide relief from more severe osteoarthritis pain. These stronger medications carry a risk of dependence, though that risk is thought to be small in people who have severe pain. Side effects may include nausea, constipation and sleepiness.


  • Work with a physical therapist. Ask your doctor for a referral to a physical therapist. The physical therapist can work with you to create an individualized exercise regimen that will strengthen the muscles around your joint, increase the range of motion in your joint and reduce your pain.
  • Find ways to avoid stressing your joints. Find ways to go about your day without stressing your joints. An occupational therapist can help you discover ways to do everyday tasks or do your job without putting extra stress on your already painful joint. For instance, a toothbrush with a large grip could make brushing your teeth easier if you have finger osteoarthritis. A bench in your shower could help relieve the pain of standing if you have knee osteoarthritis.
  • Try braces or shoe inserts. Consider trying splints, braces, shoe inserts or other medical devices that can help reduce your pain. These devices can immobilize or support your joint to help you keep pressure off it.
  • Take a chronic pain class. The Arthritis Foundation and some medical centers have classes for people with osteoarthritis or chronic pain. Ask your doctor about classes in your area or check with the Arthritis Foundation. These classes teach skills that help you manage your osteoarthritis pain. And you’ll meet other people with osteoarthritis and learn their tips and tricks for reducing and coping with joint pain.

Surgical and other procedures

  • Cortisone shots. Injections of corticosteroid medications may relieve pain in your joint. During this procedure your doctor numbs the area around your joint, and then inserts a needle into the space within your joint and injects medication. The number of cortisone shots you can receive each year is limited, because the medication can cause joint damage.
  • Lubrication injections. Injections of hyaluronic acid derivatives (Hyalgan, Synvisc) may offer pain relief by providing some cushioning in your knee. These treatments are made of rooster combs and are similar to a component normally found in your joint fluid.
  • Realigning bones. During a surgical procedure called an osteotomy, the surgeon cuts across the bone either above or below the knee to realign the leg. Osteotomy can reduce knee pain by shifting your body weight away from the worn-out part of your knee.
  • Joint replacement. In joint replacement surgery (arthroplasty), your surgeon removes your damaged joint surfaces and replaces them with plastic and metal devices called prostheses. The hip and knee joints are the most commonly replaced joints. Surgical risks include infections and blood clots. Artificial joints can wear out or come loose and may need to eventually be replaced.


Every person with OA is different. Pain and stiffness may prevent one person from performing simple daily activities, while others are able to maintain an active lifestyle that includes sports and other activities.

Your movement may become very limited over time. Doing everyday activities, such as personal hygiene, household chores, or cooking may become a challenge. Treatment usually improves function.

Complications Include:

  • Reactions to drugs used for treatment
  • Decreased ability to perform everyday activities, such as personal hygiene, household chores, or cooking
  • Decreased ability to walk

Resources and References:

PubMed Health
Mayo Clinic
Medicine Net


Bronchiectasis is a chronic condition of the lungs which typically occurs following years of respiratory complications or other conditions affecting the lungs. Bronchi act as a passageway for the air you breathe in to reach the lungs. Various lung conditions over time can cause inflammation, increased mucus secretions, and infections that cause permanent widening of the bronchi and damage to the lung tissue. So much damage can occur that the lungs aren’t able to get rid of the increased mucus, and this in turn increases the risk of lung infections. As a result, bronchiectasis is essentially a cycle of lung damage, inflammation, and infections.

People at higher risk of developing bronchiectasis include those with compromised immune systems, lung infections such as pneumonia, chronic obstructive pulmonary disease (COPD), cystic fibrosis (CF) and other lung diseases. Bronchiectasis is diagnosed using various lung function tests and sampling/analyzing mucus. It can also be diagnosed with a CT scan or chest X-ray.

Related Symptoms and Health Concerns

Symptoms of bronchiectasis can be non-specific and include:

  • Chronic productive cough
  • Frequent lower respiratory tract infections
  • Fatigue
  • Shortness of breath or wheezing
  • Weight loss
  • Chest pain/tightness


Bronchiectasis cannot be cured, but it can be managed. Treatment is highly variable between patients because the disease looks different in each person. Management may include various components, such as:

  • Clearing the airways of mucus. Pulmonary rehabilitation is one of the most common ways this is accomplished, but other methods may be used. Nebulized hypertonic saline, mannitol, or mucolytic agents are also commonly used to help break up the mucus and make it easier to clear out.  
  • Oral antibiotics, such as azithromycin.
  • Inhaled steroids and rescue inhalers.
  • Inhaled antibiotics, such as Cayston (nebulized aztreonam), Arikayce (nebulized amikacin), or Tobi (nebulized tobramycin). These drugs are available in specialty pharmacies.

Treatment Goals

The goals of treating bronchiectasis include:

  • Improving mucus clearance with lung exercises
  • Suppress and prevent bacterial colonization
  • Reduce airway inflammation
  • Improve physical function and quality of life
  • Maintaining optimal therapy adherence
  • Preventing, minimizing, and managing side effects of therapy

Strategies to Achieve Treatment Goals

  • Adherence to therapy
  • Monitoring and follow-up with physician
  • Reducing the risk of additional lung damage through smoking cessation
  • Immunization against flu and pneumonia
  • Appropriate management of other underlying diseases such as COPD, high blood pressure, anxiety, etc.

Additional Resources


  1. Imam J, Duarte A. Non-CF bronchiectasis: Orphan disease no longer. Respiratory Medicine. 2020(166):3-12. doi: 10.1016/j.rmed.2020.105940.
  2. Chalmers JD, Aliberti S, Blasi F. Management of bronchiectasis in adults. Eur Respir J. 2015(45):1446-1462. doi: 10.1183/09031936.00119114.

Download Condition Resource

Disease State Overview

Cystic Fibrosis (CF) is a rare, genetic disorder that is passed from parents to children. It is caused by inheriting two defective (or abnormal) copies of the gene cystic fibrosis transmembrane conductance regulator (CFTR) protein. This mutation makes mucus and other secretions much thicker and difficult to clear. As a result, there is a build-up of mucus and thick fluids, which creates blockage and obstructs vital organs. CF is a multi-systemic disease that affects the respiratory tract, pancreas, digestive system, and liver. Doctors can screen for and diagnose CF at birth with a positive newborn screening test. Diagnosis is further confirmed with a pilocarpine-induced sweat test and genetic testing. More than 30,000 people in the U.S. are living with cystic fibrosis and around 1,000 people are diagnosed with CF each year. 

Related Symptoms and Health Concerns

People experience different CF symptoms because CF affects multiple organs:

  • Lungs: chronic inflammation and obstruction, lung infections, and trouble breathing. Common symptoms include coughing up thick mucus, wheezing, difficulty breathing, frequent lung infections, and airway inflammation.
  • Pancreas: low enzyme and vitamin levels needed for absorbing nutrients. Damage can lead to CF-related diabetes.
  • Liver: blocked bile ducts, which can cause damage to the liver.
  • GI tract: constipation or obstruction in the intestines. Symptoms include abdominal pain, constipation, malnutrition, or inadequate weight gain.
  • Miscellaneous: fertility problems, urinary incontinence, and increased risk of GI-related cancers.


CF is treatable, but it does not have a cure. CF is more manageable with newer drugs coming to market.

  • Air clearance: Loosens mucus build up in the lungs.
  • Inhaled medications: Thins mucus and opens airways.
  • Oral medications:
    • Pancreatic enzymes to increase absorption of necessary nutrients.
    • CFTR modulators that target and improve function of defective protein.
    • Anti-inflammatory to reduce inflammation.
    • Antibiotics to help treat or prevent infection and inflammation.
    • Nutritional supplements with high dose fat-soluble vitamins.

Treatment Goals

The primary goal of cystic fibrosis treatment is to reduce symptom severity, slow disease progression, and increase survival by…

  • Maintaining lung function
  • Preventing and treating lung infections
  • Loosening and removing inflammation-causing mucus from the lungs
  • Preventing and treating of blockages in the intestines
  • Promoting adequate nutrition to maintain growth and appropriate BMI
  • Encouraging adequate hydration
  • Improving or maintaining quality of life
  • Increasing survival and life expectancy
  • Maintaining optimal therapy adherence
  • Preventing, minimizing, and managing side effects

Strategies to Achieve Treatment Goals

  • Adhere to drug therapy
  • Improve diet and nutrition to maintain growth and appropriate BMI
  • Prevent, minimize, and manage side effects
  • Prevent and treat lung infections
  • Minimize disruption to daily life due to CF symptoms and treatment burden

Additional Resources


  1. Lahiri, Thomas, et al. “Clinical Practice Guidelines From the Cystic Fibrosis Foundation for Preschoolers With Cystic Fibrosis.” American Academy of Pediatrics, American Academy of Pediatrics, 23 Mar. 2016,
  2. Mogayzel, Peter J, et al. “Cystic Fibrosis Pulmonary Guidelines Chronic Medications for Maintenance of Lung Health.” American Journal of Respiratory and Critical Care Medicine, 3 Jan. 2013,

Download Condition Resource

Disease State Overview

Nontuberculous Mycobacteria (NTM) are different types of bacteria found everywhere in the environment, including in soil and tap water, that can cause or worsen respiratory disease. The most common species of NTM are Mycobacterium avium complex, also known as MAC. Because NTM exist everywhere in our environment, healthy people may inhale NTM but not actually get infected. It can, however, affect those with immunodeficiencies and other health conditions. People at higher risk of getting NTM include those with chronic lung diseases, such as cystic fibrosis (CF), bronchiectasis, and chronic obstructive pulmonary disease (COPD), along with individuals above the age of 65. People with deficient immune systems can also be affected due to not being able to fight off the bacteria. NTM is not contagious. NTM is diagnosed by performing multiple sputum tests to determine if NTM are present and, if present, what strain. Other tests that may be performed include chest X-rays or CT scans. Additionally, symptoms are assessed to determine the severity of the disease. Onset of an NTM infection is often very slow and incubation periods can last from months to years, making diagnosis and tracing the source of the infection almost impossible in many cases.

Related Symptoms and Health Concerns

The bacteria make their way to the lung tissue and can cause serious lung infection. Symptoms of NTM may include…

  • Cough: with or without sputum. NTM may cause you to cough up blood; if this occurs, contact your doctor or seek emergency help immediately.
  • Fever or night sweats
  • Loss of appetite and weight loss
  • Fatigue/weakness
  • Shortness of breath
  • Wheezing
  • Chest pain with breathing


Treatment for NTM depends on the type of bacteria that is causing the disease as well as the severity of the disease. Treatments consist of three or more antibiotics (oral, intramuscular, IV, or inhaled) to fight off the specific bacteria. The purpose of multiple antibiotics together is that each class works slightly differently. Selecting a regimen with drugs from different classes helps them to essentially work as a team to attack the bacteria. Antibiotic therapy may last up to two years depending on your response to the regimen. Specialty medications may be used to treat NTM, such as Arikayce which is inhaled amikacin.

Treatment Goals

The primary goal of NTM therapy is to convert positive sputum cultures to negative and maintain negative cultures for at least 12 months before discontinuing therapy. Other goals of therapy include…

  • Maintaining lung function
  • Preventing and treating secondary lung infections
  • Improving or maintaining quality of life
  • Maintaining optimal therapy adherence
  • Preventing, minimizing, and managing side effects of therapy

Strategies to Achieve Treatment Goals

  • Adherence to therapy
  • Monitoring and follow-up with physician
  • Vision and hearing tests
  • Stay up to date on vaccinations
  • Avoid smoking or other lung irritants
  • Airway clearance exercises
  • Reduce NTM exposure by wearing a mask or increasing temperature of hot water heater to get rid of NTM in tap water

Additional Resources


  1. Daley, Charles, et al. Treatment of Nontuberculous Mycobacterial Pulmonary Disease: An Official ATS/ERS/ESCMID/IDSA Clinical Practice Guideline. Infectious Disease Society of America. 2020;71:1-36.
  2. Ratnatunga CN, et al. The Rise of Non-Tuberculosis Mycobacterial Lung Disease. Front. Immunol. 2020;11:303. doi: 10.3389/fimmu.2020.00303.

Download Condition Resource


Rheumatoid arthritis, or RA, is a form of inflammatory arthritis and an autoimmune disease. For reasons no one fully understands, in rheumatoid arthritis, the immune system — which is designed to protect our health by attacking foreign cells such as viruses and bacteria — instead attacks the body’s own tissues, specifically the synovium, a thin membrane that lines the joints. As a result of the attack, fluid builds up in the joints, causing pain in the joints and inflammation that’s systemic — meaning it can occur throughout the body. Rheumatoid arthritis is a chronic disease, meaning it can’t be cured. Most people with RA experience intermittent bouts of intense disease activity, called flares. In some people the disease is continuously active and gets worse over time. Others enjoy long periods of remission – no disease activity or symptoms at all. Evidence shows that early diagnosis and aggressive treatment to put the disease into remission is the best means of avoiding joint destruction, organ damage and disability.Causes:

The cause of rheumatoid arthritis is unknown. Even though infectious agents such as viruses, bacteria, and fungi have long been suspected, none has been proven as the cause. The cause of rheumatoid arthritis is a very active area of worldwide research. It is believed that the tendency to develop rheumatoid arthritis may be genetically inherited (hereditary). Certain genes have been identified that increase the risk for rheumatoid arthritis. It is also suspected that certain infections or factors in the environment might trigger the activation of the immune system in susceptible individuals. This misdirected immune system then attacks the body’s own tissues. This leads to inflammation in the joints and sometimes in various organs of the body, such as the lungs or eyes.Symptoms:

RA usually affects joints on both sides of the body equally. Wrists, fingers, knees, feet, and ankles are the most commonly affected.

The disease often begins slowly, usually with only minor joint pain, stiffness, and fatigue. 

Joint symptoms may include:

  • Morning stiffness, which lasts more than 1 hour, is common. Joints may feel warm, tender, and stiff when not used for an hour.
  • Joint pain is often felt on the same joint on both sides of the body.
  • Over time, joints may lose their range of motion and may become deformed. 

Other symptoms include:

  • Chest pain when taking a breath (pleurisy)
  • Dry eyes and mouth (Sjogren syndrome)
  • Eye burning, itching, and discharge
  • Nodules under the skin (usually a sign of more severe disease)
  • Numbness, tingling, or burning in the hands and feet
  • Sleep difficulties


Unlike diabetes or kidney disease, rheumatoid arthritis (RA) cannot be diagnosed with a simple blood test. Instead, the diagnosis often takes time and is based largely on what the doctor hears from you (the medical history) and observes in you (the physical exam).

During the medical history, your doctor will ask questions about specific joints as well as how you feel in general. Because findings from the medical history play a major role in the diagnosis, it’s important to give your doctor clear and accurate answers to questions, such as the following:

  • Do you have pain in many joints? People with rheumatoid arthritis often have pain in several joints at once as opposed to just one.
  • Do the same joints on both side of your body hurt at the same time? Symmetric pain is often as sign of rheumatoid arthritis. For example, if one wrist or knee is inflamed or painful, the other wrist or knee will likely be as well.
  • When is the pain most severe? People with rheumatoid arthritis often feel worst when they first wake up, and then later in the day when fatigue sets in.
  • Have you had periods of feeling weak and uncomfortable all over? Many people with rheumatoid arthritis notice generalized problems, such as muscle aches, fatigue, stiffness, weight loss and flu-like symptoms.


There is no known cure for rheumatoid arthritis. To date, the goal of treatment in rheumatoid arthritis is to reduce joint inflammation and pain, maximize joint function, and prevent joint destruction and deformity. Early medical intervention has been shown to be important in improving outcomes. Aggressive management can improve function, stop damage to joints as monitored on X-rays, and prevent work disability. Optimal treatment for the disease involves a combination of medications, rest, joint-strengthening exercises, joint protection, and patient (and family) education. Treatment is customized according to many factors such as disease activity, types of joints involved, general health, age, and patient occupation. Treatment is most successful when there is close cooperation between the doctor, patient, and family members.Complications:

Rheumatoid arthritis can affect nearly every part of the body. Complications may include:

  • Damage to the lung tissue (rheumatoid lung)
  • Increased risk of hardening of the arteries
  • Spinal injury when the neck bones become damaged
  • Inflammation of the blood vessels (rheumatoid vasculitis), which can lead to skin, nerve, heart, and brain problems
  • Swelling and inflammation of the outer lining of the heart (pericarditis) and of the heart muscle (myocarditis), which can lead to congestive heart failure

The treatments for RA can also cause serious side effects. Talk to your doctor about the possible side effects of treatment and what to do if they occur.

Resources and References:

Arthritis Foundation
Pub Med Health
Medicine Net

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