ACR 20, 50, 70—This is one of the most recent ways of measuring patient outcome in rheumatoid arthritis studies. The numbers 20, 50 and 70 refer to 20%, 50% and 70% improvement in the number of tender joints and swollen joints on exam. In addition, there are five other measurements and three out of the five also have to be improved by the same percentage. These include (1) the patient’s pain assessment using a visual analogue scale of pain, (2) the patient’s functional status as measured by a questionnaire, (3) an overall assessment by the patient of how they feel they are doing on a particular drug, (4) an overall physician assessment of the patient’s disease activity, and finally (5) two measures of inflammation (a sedimentation rate or C-reactive protein). It is now important to be able to state at the end of a study what number of patients improved by 20% versus 50% versus 70% in utilizing these different criteria. The term ACR stands for American College of Rheumatology which is the main organization of rheumatologists in the United States and which has supported these criteria. This serves to standardize results in studies done by different investigators so that the improvement with medications can be measured by the same parameters.

Acute - Of recent onset, short-lived.

Adhesive Capsulits - the medical terminology for what is called "frozen shoulder", a condition where there is shoulder pain associated with a marked loss of the ability to raise up your arm. May be secondary to underlying disease of the shoulder joint or the surrounding supportive tissues but also may be the result of other medical conditions such as diabetes mellitus, a prior heart attack, a pinched nerve in the neck, or other conditions. Treatment may include local injection, oral medications, and physical therapy. When physical therapy is utilized it often requires longer term treatment of up to several months to restore normal range of motion.

Alopecia - Hair loss.

Alopecia Areata - Hair loss which may lead to patches of baldness as occasionally seen in systemic lupus erythematosus.

Anemia - A decreased amount of hemoglobin in the red blood cells or decreased number of red blood cells which leads to a decreased ability to carry oxygen to the tissues.

Ankylosing - A joining together or fusing process between joints.

Ankylosing Spondylitis—A form of inflammatory arthritis, which may involve the spine as well as peripheral joints. It has been associated with the gene HLA-B27.

Anserine Bursitis - Refers to a type of inflammation which occurs over the inside portion of the knee below the knee joint where the tendons from the inner thigh insert on the bone.

Anti-DNA Antibodies - Very specific double stranded DNA antibodies that are found primarily in systemic lupus erythematosus and often correlate with disease flare-ups.

Anti-Malarial Drug - A type of disease modifying medication used particularly in rheumatoid arthritis and lupus. By far the most commonly used drug of this type is Plaquenil (hydroxychloroquine).

Anti-Neutrophil Cytoplasmic Antibodies (ANCA) - Antibodies that may be found in various forms of vasculitis and in Wegener's granulomatosis.

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Anti-Nuclear Antibody—An antibody directed towards the nucleus of a cell (most commonly a human epithelial cell placed on a slide). These antibodies may be seen in connective tissue diseases such as systemic lupus erythematosus, but also are found in other rheumatic disorders such as rheumatoid arthritis, polymyositis and Sjogren’s syndrome among others. A positive anti-nuclear antibody may even be induced by various medications or seen in association with autoimmune thyroid disease or certain liver disorders.

Anti-Phospholipid Antibody - An antibody which may be associated with an increased tendency to excessively clot and thus may contribute to deep vein thrombosis (clotting) in the legs, premature delivery of a fetus, and early strokes. These antibodies may be seen in association with systemic lupus erythematosus or may occur on their own in a condition called Anti-Phospholipid Antibody Syndrome.

Arthralgias - Aching sensation in the joints themselves.

Arthritis - A disorder of a joint where two bones meet which may be manifested on physical examination by swelling, redness, warmth or tenderness in the joint or may be demonstrated on x-rays by loss of the joint space, formation of spurs, erosions or cysts in the bone.

Arthrocentesis - Refers to the procedure where a needle is inserted in the joint for purposes of either draining fluid for diagnostic reasons, or injecting medications or other materials into the joint.

Arthroplasty - A term used for the implantation of a prosthesis in a joint.

Arthroscopy - Orthopedic procedure involving inserting a scope through the skin into a joint for diagnostic and/or therapeutic purposes.

Aseptic - Without any living organisms such as bacteria. Aseptic necrosis of the hip is a loss of the blood supply to the head of the femur, but no living organisms are involved in causing this process.

AUC - Area under the curve (a statistical term used in rheumatologic studies to better evaluate responses to treatment).

Autoimmune - Refers to the production of antibodies directed at one's own cells or tissues, a dysregulation of the immune response.

Avascular Necrosis - Refers to the loss of circulation to a portion of the bone such as in the head of the hip which leads to death of this bony tissue. This may eventually lead to a crumbling of the bone and even a subsequent loss of joint space. With avascular necrosis of the hip there frequently are x-ray changes with a flattening out of the head of the femur that is typical of this condition.

Baker's cyst - synonymous with popliteal cyst ( see popliteal cyst)

Biologic Agents—A new category of targeted therapy. Substances are synthesized which can interfere with the basic biologic and pathologic mechanisms of the disease process. These agents may interrupt the natural cascade of events, which occur in a particular disease. They may work in part by binding to various biologic messengers that are produced in disease states, or may block receptor sites where these messengers need to attach to induce further disease.

Biologic Response Modifiers (BRMs) - see biologic agents

Bone Densitometry - Refers to a technique for measurement of the density of bones to determine whether an individual has osteoporosis or not. DEXA stands for Dual Energy X-Ray Absorptiometry, which is the most commonly used technique to make this measurement.

Bouchard's Nodes - Refers to bony enlargement of the middle joints of the fingers as seen in osteoarthritis.

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Bursitis - Refers to the inflammation of the bursal sacs, which are lubricating sacs adjacent to joint areas. These may simply be irritated or may actually be inflamed to the point of producing fluid within the sac with resultant enlargement. When this occurs, fluid may even need to be drained from the bursa, and corticosteroids injected in order for this to resolve.

Butterfly Rash (Malar Rash) - Refers to a rash across the cheeks and even across the bridge of the nose which resembles the appearance of a butterfly on the face. This may be seen in systemic lupus erythematosus. Rashes on the cheeks need to be distinguished from another condition called rosacea. The patient may need to see a dermatologist to help diagnose these disorders.

Calcium Pyrophosphate Deposition Disease - Refers to a condition where calcium is deposited in the cartilage of the joints. This is often seen in the elderly or may be seen in association with an endocrinologic disorder called hyperparathyroidism. The presence of calcium crystals in the joint may incite an inflammatory type reaction called pseudogout, and the presence of these crystals may accelerate the rate of degenerative arthritic changes in the joint.

Carpal Tunnel Syndrome - Refers to changes involving the median nerve in the wrists which causes numbness usually in the thumb, index and long finger of the hand. It may occur secondary to repetitive abuse of the wrist such as in certain occupations or may sometimes be seen with rheumatic conditions which involve swelling in and around the wrist, such as is seen in rheumatoid arthritis.

Cervical Spine - Refers to the very top portion of the spine from the base of the skull down to the upper back area. It consists of seven vertebrae (C1 thru C7).

Cervical Spondylosis - Refers to degenerative arthritic changes (osteoarthritis) involving the joints in the neck area.

Charcot Joint - A condition involving joint space narrowing and even bony destruction which is seen in a situation where the sensory nerves are significantly affected. This may be seen in diabetic patients who have nerve involvement with subsequent changes in the feet and ankles due to the fact that they cannot properly sense the pressure they are putting on the feet and ankles when they walk.

Chondrocalcinosis - Refers to the deposition of calcium pyrophosphate crystals in the cartilage with the potential for acute attacks called pseudogout attacks.

Chondrocyte - Refers to the only cell found in the cartilage which produces the components that serve as building blocks of the cartilage.

Chronic Fatigue Syndrome - Refers to a state of constant and severe exhaustion which is often seen in association with fibromyalgia syndrome. Whether there is a separate entity with a yet undiscovered cause still is controversial.

Chronic Tophaceous Gout - Refers to long standing deposits of urate material in patients with an excessively high level of uric acid. Depositions of chalky (whitish material) may occur throughout the body and may even extrude from the skin on occasion.

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Circulating Immune Complexes - Combinations of antigen and antibody which attach to one another and may circulate in the bloodstream and then deposit in organs in the body causing subsequent changes in the tissues.

Collagen - This refers to the connective tissues in the body which help act as supporting tissues for other structures.

Complement - Refers to proteins which are very important in cellular function and immunity. They are involved in the inflammatory process. Specifically, reductions of C3 and C4 complements are often associated with active systemic lupus erythematosus. Some patients may have inherited deficiencies of one of the components of complement which may predispose them to disease states.

Congenital - At birth. Thus a congenital abnormality is one that is present at birth.

Connective Tissue Diseases - Refers to multiple rheumatic conditions which seem to primarily affect the connective tissues of the body. These include diseases such as systemic lupus erythematosus, scleroderma (systemic sclerosis), polymyositis, or dermatomyositis.

Corticosteroids - Refers to a hormonal substance, which is found naturally in the body, but may be given by tablet or injection to help control inflammation. Currently it is the most potent of agents available to control the acute inflammatory process.

Costochondritis - Refers to inflammation in the rib attachments to the sternum in the front part of the chest wall. This often occurs as a result of repetitive abuse or trauma.

COX-1 - see cyclooxgenase-1 listed below

COX-2 - see cyclooxygenase-2 listed below

COX-1 and COX-2 inhibition - see Original Feature Article on this subject on our website.

Cranial Arteritis - Refers to the inflammation of the arteries in the head area as seen in a condition called giant cell arteritis.

C-Reactive Protein (CRP) - This is a test done on the blood. When it is positive, it indicates the possible presence of acute inflammation in the body. This appears to be more sensitive and an earlier indicator of inflammation than a sedimentation rate, but both are helpful in determining the presence of inflammation in the body.

CREST Syndrome - Refers to a combination of conditions including deposits of calcium in the superficial tissues (calcinosis), Raynaud's phenomenon with spasm of the blood vessels in the digits, esophageal abnormalities, sclerodactyly which involves the tightening down of the skin particularly seen in the hands with loss of skin folds, and telangiectasias which are the formation of spider-like clusters of blood vessels on the skin often seen on the face and hands. CREST syndrome is considered a specific variant of scleroderma.

Cryoglobulinemia - Refers to the depositing of complexes of immunoglobulins that occur most commonly in cold temperatures. This may result in deposits in the distal portions of the hands or feet, and even in various organs which may lead to other abnormal conditions and organ damage.

Crystal Induced Arthritis - Refers to the inflammatory reaction that occurs most commonly with uric acid crystals or calcium crystals when they gain access to the joint. The crystals incite a release of inflammatory substances which may cause significant pain, redness, heat and swelling in the joint.

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Cyclooxygenase - Refers to a particular enzyme involved in the formation of prostaglandins in the body. These may be important in the natural physiology in a particular organ or cell, or may be involved in the formation of prostaglandins that induces inflammation in a joint, in which case it may be detrimental.

Cyclooxygenase-1 - (COX-1) is normally present in the body for physiologic reasons. It is also called "constitutive" cyclooxygenase. COX-1 is produced physiologically in the stomach and is protective for the lining of the stomach.

Cyclooxygenase-2 - (COX-2) Refers to the “inducible” form of cyclooxygenase that arises with joint inflammation and is involved in diseases of the joints. Cyclooxygenase-2 (COX-2) is therefore produced in the joint when “induced” by inflammation.

Cytokines - Refers to biologic messenger or signalling type proteins that enable cells to influence one another. Cytokines are important as part of the immune system in the body. In disease states, however, cytokines may send messages that may lead to further joint inflammation and damage.

Diffuse Idiopathic Skeletal Hyperostosis - see D.I.S.H.

D.I.S.H. - Diffuse Idiopathic Skeletal Hyperostosis; a condition where bony spurs form at the sites of attachments of ligaments and tendons. In the spine this produces an appearance that resembles "dripping candle-wax" between the vertebrae.

DMARDS (Disease Modifying Antirheumatic Drugs) - Refers to specialized medications used to control the underlying disease condition such as those used in rheumatoid arthritis.

Dysphagia - Refers to difficulty in swallowing.

Edema - swelling secondary to the accumulation of excessive fluids in the tissues; most commonly seen in the lower extremities; may leave a depression in the skin when pressed with the patient's or physician's thumb ( "pitting" ). Often seen as an early manifestation of too much salt in the circulation or with congestive heart failure (CHF).

Epidural Steroid Injection - This is an injection usually combining a form of cortisone and an anesthetic and put in the space outside of the spinal cord area. This is done to alleviate pain radiating into the leg from nerve irritation.

Episcleritis - Inflammatory condition of the eye which may be seen in association with rheumatoid arthritis.

Erythema Nodosum - Is a condition involving painful and often red nodules just below the surface of the skin and usually seen over the leg area.

Erythrocyte Sedimentation Rate - A blood test to measure inflammation in the body. This is often significantly elevated in inflammatory conditions such as rheumatoid arthritis and particularly elevated in polymyalgia rheumatica or giant cell arteritis.

Fetal - Referring to the fetus.

Fetus - Referring to a baby as it develops in the uterus.

Fibromyalgia - A term used to describe diffuse or widespread pains involving primarily the muscles. There may be multiple tender points found on examination of these various muscle groups.

Frozen Shoulder - see adhesive capsulitis

Giant Cell Arteritis - An inflammation of the blood vessels which may involve the temporal artery on the side of the head, as well as other arteries in the head area. It is often seen in association with polymyalgia rheumatica.

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Glomerulonephritis - Refers to inflammation of the filtering portion of the kidney and is the most common involvement seen in systemic lupus erythematosus when the kidney is inflamed.

Gout - A condition which may be acute or chronic and which results from an excessive level of uric acid in the circulation. This results in deposits in joint areas and even in other tissues if left untreated. The release of uric acid crystals into the joint incites a significant inflammatory reaction called acute gouty arthritis.

Heberden's Nodes - Refers to bony enlargement of the distal-most joint in the hands as seen in osteoarthritis.

HLA-B27 - A particular gene which is inherited and has a high association with inflammation of the spine and peripheral joints as seen in ankylosing spondylitis, psoriatic arthritis, inflammatory bowel disease with arthritis, or Reiter's syndrome.

Hyaluronic Acid - Is a substance in the synovial fluid which is responsible for the viscosity of joint fluid. It is important in the lubrication process as well as in the protection of the joint and allows for smoother motion of the joint.

Hylans - A cross-linked form of hyaluronic acid with molecular weight of over 6 million which may be injected into osteoarthritic joints (Synvisc).

IL-1 - (see Interleukin-1)

IL-1Ra - a natural inhibitor in the body which balances or counteracts the effects of IL-1 and is called Interleukin-1 receptor antagonist

IL-1ra - A synthetic protein designed to counteract IL-1 (called Interleukin-1 receptor antagonist), which is currently given by daily subcutaneous injections (the small "r" denotes that it is the synthetic form of the receptor antagonist, the large "R" in IL-1Ra indicates that it is referring to the naturally found receptor antagonist in the body)

Infection - A disease process caused by foreign organisms, most commonly bacteria, viruses or fungi.

Inflammation - A process in the body tissues where all of the bodies' immune defenses including white blood cells and macrophages are drawn into one or more areas in response to tissue injury. The result of this activity may eventually lead to repair and resolution of the disease process or may even contribute to further tissue injury if not eventually treated and controlled. It is important to note that inflammation is not the same as infection and in fact in the majority of situations inflammation occurs in the absence of any live microorganisms.

Infusion - A technique of administering fluids other than blood after inserting an intravenous line in the patient’s vein.

Interleukin-1 (IL-1) - A protein (also called a cytokine) that facilitates communication between cells. (see our Original Feature Article on IL-1)

Lumbar Spine - The equivalent of the low back which starts where the thoracic spine ends and goes down to the tailbone area. There are usually five lumbar vertebrae (L1 thru L5)

Lyme Disease - Is a condition which occurs after a tick bite with resultant infection from bacteria contained by the tick and found mainly in certain areas of the United States. If untreated, this may lead to arthritic symptoms over time.

Malar Rash - Refers to the rash over the cheeks as seen in systemic lupus erythematosus. This is often induced by exposure to the sun.

Meniscus - The cartilaginous portion of the knee. There is both a medial (inner) and lateral (outer) meniscus. In a healthy individual, these act as frictionless surfaces to allow easy gliding of one bone on another. In disease states, there may be breakdown of this material. If injured, the meniscus may actually tear and cause problems with instability with locking and buckling with walking.

Meniscectomy - Surgical removal of a portion or all of a meniscus.

Monarticular Arthritis - Refers to arthritis involving a single joint.

Myalgias - Muscle aching.

Myofascial Pain Syndrome - Is a term used to describe a localized area of muscle pain which may be seen following an injury of some type.

Myopathy - Refers to disease of the muscle which may be associated with weakness.

Necrosis - Death of tissue. This can be in bone with a loss of its blood supply or in different organs.

Nephritis - Inflammation of the kidney tissues such as seen in systemic lupus erythematosus.

Neuropathy - Disease of the peripheral nerves. This is a common complication of long-standing diabetes mellitus, but may also be seen in association with rheumatic conditions such as rheumatoid arthritis or forms of vasculitis.

Nodule - A small node or knob-like area of tissue; in rheumatoid arthritis patients may develop rheumatoid nodules, especially over the forearms, which are often associated with a more aggressive form of arthritis.

NSAIDS (Nonsteroidal Anti-Inflammatory Drugs) - Medications used to control inflammation in the various forms of arthritis.

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Osteoblast - Cells in the bone involved in making new bone and remodeling the bone.

Osteoclast - Cells in the bone involved with removing bone or resorption of bone.

Osteonecrosis - Refers to death of bone which may result from a loss of the blood supply to the bone.

Osteoporosis - Disease of the bone which may lead to increased risk of fracture and is characterized by a decreased density of the bone as measured by a bone densitometer (DEXA). It involves the bone itself and is not a form of arthritis.

Osteotomy - Surgical removal of a portion of bone. A wedge osteotomy is a procedure done to forestall a complete joint replacement by taking a wedge of bone out of the proximal (upper) end of the tibial bone.

Paget's Disease - A metabolic bone disease involving an excessive degree of remodeling of bone with increased bone formation. It may cause significant bone pain as well as bony deformity. Although the bone appears dense on X-ray, it is actually more brittle and has a tendency to fracture.

Palindromic Rheumatism - Refers to the sudden onset of episodes of intermittent joint pain. In some cases, the patients may go on to develop full-blown rheumatoid arthritis in the future.

Patella - Kneecap.

Pericarditis - Inflammation of the lining sac around the heart which may be seen particularly in systemic lupus erythematosus or in rheumatoid arthritis.

Peripheral Neuropathy - Refers to disease of the peripheral nerves in the body.

Pleurisy - Inflammation of the lining of the lung cavity (pleura). This may occur in some patients with SLE. Also involvement of the pleura with pleural fluid production may occur in rheumatoid arthritis.

Polyarthritis - Refers to inflammation in multiple joints.

Polymyalgia Rheumatica - Is a disease primarily seen in patients over age 65 which involves pain in the muscles of the upper arms and thighs with generally a very high sedimentation rate. Some patients with polymyalgia rheumatica also may develop a more significant condition called giant cell arteritis (temporal arteritis).

Polymyositis - An inflammatory disease of the muscles associated with significant weakness.

Popliteal - The area behind the knee.

Popliteal Cyst - A swelling in the posterior aspect of the knee in the popliteal area (the hollow area behind the knee). This is synonymous with a Baker's cyst.

Prosthetic Joint - An artificial joint replacement currently made out of metallic components.

Pseudogout - An acute inflammation of the joint induced by calcium pyrophosphate crystals.

Psoriatic - Relates to psoriasis, a skin condition characterized by scaling type skin lesions seen over the scalp,elbows, knees, and trunk; associated with arthritis in approximately 10 to 15% of cases.

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Radiculopathy - Nerve root irritation which is caused by either compression of the nerve root where it emanates from the spinal cord area or from a stretch injury or inflammation of the nerve. This causes symptoms in the area that the nerve root supplies in the extremity. This may occur in the cervical, thoracic or lumbar spine area and involve any of these nerve roots.

Raynaud's Phenomenon - A significant color change in the digits of the hands or feet generally brought on by cold temperature or emotional upset with whitish or purplish color changes in the digits. This may be seen on its own or in association with other rheumatic conditions such as scleroderma or systemic lupus erythematosus.

Reactive Arthritis - An inflammatory form of arthritis usually following exposure to certain bacteria such as Shigella or Salmonella often causing sausage-shaped changes in the toes, primarily affecting the lower limbs in an asymmetric manner.

Reiter's Syndrome - A condition usually consisting of three components including inflammation of the urethra, pus and inflammation in the conjunctival portion of the eye, and acute arthritis mainly in the lower extremities.

Renal - Refers to the kidney.

Rheumatologist - A physician who specializes in the diagnosis and medical management of all forms of arthritis and other musculoskeletal disease including the diagnosis and treatment of osteoporosis, chronic forms of neck and back pain, bursitis and tendinitis. A stricter definition is a physician who has completed training in internal medicine and then completes a two year fellowship in the specialty area of rheumatology. After completion of the two years of training, the physician is considered board eligible. If the physician then passes a specialty board examination in rheumatology, he or she is then considered board certified in rheumatology.

Sciatica - Pain radiating down a leg usually due to nerve irritation in the lower back area. Sometimes electrical sensations are associated with it.

Scleritis - Inflammation of the white portion of the eye which may be seen in association with rheumatoid arthritis.

Sepsis - The presence of organisms which are usually bacteria in the blood stream or tissues. This is a more life-threatening situation since these organisms can now be spread by the circulation throughout the body. Also the presence of organisms in the circulation often is associated with high fever, shaking chills, and may be accompanied by even a drop in one's blood pressure.

Septic - Refers to a bacterial infectious process such as septic arthritis with bacteria lodging in the joint and proliferating. This can cause significant damage unless treated rapidly and appropriately.

Septicemia - A term referring to the spread of microorganisms usually bacteria through the blood circulation.

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Seronegative Spondyloarthropathy - Refers to the fact that a patient is rheumatoid factor negative but has a form of arthritis which may involve the peripheral joints and spine.

Sicca Syndrome - Refers to dryness of the eyes and mouth and may represent symptoms involved in Sjogren's syndrome.

Spondyloarthropathy - Refers to inflammatory changes involving the spine and the spinal joints.

Stenosis - This term means narrowing. This may occur particularly in the cervical or lumbar spine producing cervical stenosis or lumbar stenosis. If the narrowing is significant, then there is pressure on the spinal cord itself.

Stress Fractures - These are incomplete fractures. They usually result from repetitive abusive activity and are most commonly found in the legs or bones of the feet.

Subcutaneous - Refers to the tissues just under the surface of the skin.

Subcutaneous Nodules - These are nodules that are occasionally seen in rheumatoid arthritis and may occur over the forearms just distal to the elbow.

Synovium - Refers to the lining of the joint.

Synovitis - Inflammation of the synovial lining tissue as is seen in inflammatory arthritis such as rheumatoid arthritis.

Temporal Arteritis (also known as Giant Cell Arteritis) - Inflammation of the blood vessels over the temporal portion of the scalp (on the side of the head) which may be seen in association with polymyalgia rheumatica.

Tendinitis - An inflammation of the connecting tissue that attaches the body of the muscle and to its bony insertion.

Tenosynovitis - Inflammation of the tissue that surrounds the tendon and ordinarily helps allow smoother motion of the tendon. When inflamed, however, this can cause locking or triggering of a finger for example.

Tidal Irrigation - A procedure where a joint such as the knee is rinsed of all of its loose particles and debris with irrigating solution passed through the joint.

TNF - (see tumor necrosis factor)

Trigger Finger - A snapping, triggering, or locking of a finger, which occurs with inflammation of tendons involved in bending or flexing the finger.

Tumor Necrosis Factor (TNF) - A protein (also called a cytokine) which is involved in biologic functions in the body and which helps in cell-to-cell communications or messaging. It is one of two principal cytokines (the other being IL-1) involved in heightening the inflammation and subsequent structural damage seen in inflammatory forms of arthritis (see our Original Feature Article on TNF).

Uveitis - Refers to inflammation of the vascular portion of the eye. This may occur in association with patients with seronegative spondyloarthropathies.

Vasculitis - Inflammation of the wall of the blood vessels in the body which may then lead to changes in the flow of blood to various organs with resultant tissue damage.

Viscosupplementation - A procedure currently approved for use in osteoarthritis where viscous fluid is injected into a joint (currently the knee joint), which results in decreased pain and increased mobility. Currently available products are Synvisc, Hyalgan, and Supartz.

Wegener's Granulomatosis - An autoimmune disorder primarily affecting upper respiratory tract and kidneys. It has characteristic tissue findings and often is associated with positive c-ANCA antibodies. Limited forms of this disease may affect only the sinus cavity.

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