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PATHOLOGY PERSPECTIVES reasons that are not completely clear, the vertebrae are much more likely to grow osteophytes than other bones. These bone spurs are often silent, especially when they grow on the anterior aspect of the vertebral bodies. But when they grow in a place where they can put pressure on a nerve root or the spinal cord itself, this creates a pattern of nerve pain that is unique to spondylitis. AUTOIMMUNE ARTHRITIDES: THE ENEMY WITHIN Rheumatoid arthritis (RA) is an autoimmune disease: an immune system attack against the synovial membranes of joints. RA can affect any joint, but it is most common at the ankles, knuckles, and occasionally the neck. When a synovial membrane is under attack, all the typical Resources Abramson, S. et al. "Development in the Scientific Understanding of Osteoarthritis." Accessed November 2011. www.medscape.com/viewarticle /714866?src=mp&spon=17&uac=78486SY. National Institute of Arthritis and Musculoskeletal and Skin Diseases. "Gout." Accessed November 2011. www.niams.nih.gov/Health_Info/Gout/default.asp. Perlman, A. et al. "Massage Therapy for Osteoarthritis of the Knee." Accessed November 2011. http://archinte. ama-assn.org/cgi/content/full/166/22/2533. Walker, K. "Alternative Treatments for Spondylosis." Accessed November 2011. www.spineuniverse.com/conditions/ spondylosis/drugs-medications-injections-spondylosis. signs of inflammation develop: heat, pain, redness, swelling, and loss of function. Like many autoimmune diseases, RA tends to occur in cycles of flare and remission. During a flare, B cells, antibodies, and many pro-inflammatory chemicals are present inside the joint capsule. The synovial membranes swell and fluid accumulates, which causes pressure and pain. The inflamed tissues release enzymes that damage cartilage and bone. Eventually, tendons and ligaments surrounding the joints may also be affected. All of these factors lead to the deformation of joint capsules and gnarled appearance of RA. RA flares can also affect many other tissues, including the serous membranes around the heart and lungs, the liver, blood vessels, and bursae. Another important difference between RA and osteoarthritis is that RA is not related to wear and tear—people of any age, and activity level, can be affected by this disease. Many autoimmune diseases are diagnosed more often in women than in men; RA shows this pattern with a ratio of about 3 to 1. Another type of autoimmune arthritis is much more common in men, however. Called ankylosing spondylitis (AS), this condition is very similar to RA, except that it usually begins in sacroiliac joints and works its way up the back. As AS progresses, fusions can occur at the vertebral bodies (this is sometimes called "bamboo spine"), but they also occur at the vertebral-costal joints. If the ribs fuse to the spine, the thoracic cavity can no longer expand and contract with the breath, putting the person at increased risk for pneumonia and heart failure. GOUT: THE ENEMY OUTSIDE Gout is one of the oldest diseases in recorded medical history. It used to be called "the disease of kings," because it was associated with rich living. Ben Franklin, King Henry VIII, and Johann Wolfgang von Goethe all had gout. 40 massage & bodywork january/february 2012