Probiotics for children’s immunity viruses and various diseases cost them

Man lives dynamically and in constant contact with environmental factors. In such an ecosystem, there is a certain balance necessary for the normal functioning of the individual. The digestive system is another ecosystem vital to its existence. It provides the necessary nutrients for the development of the body. These are the entrance doors through which a huge number of microorganisms that inhabit various parts of his body enter the gastrointestinal tract. Many of them are actively involved in digestion and the creation of nutrients. Some of the microbial species are pathogenic or toxigenic and cause gastrointestinal infections, diarrhea, microbial food poisoning, bloating, cause carcinogenic promoters and as a result polyps appear, and later malignant tumors and other diseases.

Products with harmful effects, full of pathogenic and toxigenic microorganisms, enter the bloodstream and spread to every cell of the body, subjecting it to slow intoxication. Delayed in the heart, liver, kidneys, reproductive organs, etc. and during a longer stay in them, they cause inflammation of the mucous membrane of the body, and later serious diseases. This leads to the emergence of a number of modern diseases, such as high blood pressure , atherosclerosis, kidney disease, various allergy and other diseases.

Stress and immune system, microflora and probiotics

The stress and psychological stress to which a person is exposed disturbs the functions of the endocrine glands and the balance of the gastrointestinal microflora. There are also changes in the coordination between the endocrine and hormonal systems, metabolic disorders, imbalance of the microflora of the stomach and intestines, and as a consequence, impaired health of the organism. They are expressed by increased or decreased intensity of metabolic processes, increase or decrease in body weight, disorders or constipation, bloating and heartburn. Disturbed balance in the digestive tract leads to inflammation of the mucous membrane of the stomach and intestines, expressed in gastritis, enteritis, peptic ulcer.

We seek immediate pain relief and quickly resort to medication. Many of them temporarily suppress the disease. Excessive and often improper use of antibiotics opens new problems – dysbacteriosis, Fungal Infections , gastrointestinal microflora imbalance, allergic reactions and more.

In conditions of malnutrition and malnutrition, the balance of some vital trace elements necessary for the normal functioning of the thyroid gland, pancreas and other glands is disturbed. This in turn affects the synthesis of enzymes and hormones that are actively involved in the metabolism of carbohydrates, lipids and proteins, which increases the number of people suffering from endocrine disorders, diabetes, high blood cholesterol, impaired digestive function and impaired immune system. As a result of disturbed balance of microelements and in order to maintain a certain concentration in the blood, their slow absorption from tissues and bones begins, which leads to muscle cramps, osteoporosis , multiple sclerosis and others.

How can probiotics help?

Probiotics are successfully used to reduce the negative effects of risk factors on the body, to normalize and maintain the function of the glands of the endocrine system, as well as to balance the gastrointestinal microflora. They contain a high concentration of living active cells of lactobacilli, lactococci, bifidobacteria and products of their metabolism, as well as vitamins and trace elements in digestible form, organic acids and amino acids. Their intake enables the regulation of the gastrointestinal microflora, suppression of putrefactive processes, reduction of bile products and, above all, cholesterol, stopping the slow intoxication of the body with microbial toxins, amines and others.

The inclusion of vitamins and microelements in a biologically active form in the composition of probiotic food supplements enables the insurance and restoration of the functions of important enzyme systems, which supports the synthesis and action of hormones produced by the endocrine system (insulin, L-thyroxine, etc.).

Different types of probiotics for different health problems

Selected and included in probiotics lactobacilli, bifidobacteria, in combination with vitamins and trace elements such as chromium, zinc, magnesium, iron, organic acids and amino acids, enabled the creation of probiotics to normalize the microflora in the gastrointestinal tract and to release toxins for lowering cholesterol and helping diabetics, people with thyroid dysfunction, those suffering from prostate hypertrophy, as well as anemic, allergic and epileptic reactions, to lower blood pressure and improve vascular activity, which has a prophylactic effect to prevent stroke and heart attack.

Organogenic microelements, vitamins and symbiotic strains of lactobacilli and bifid bacteria, as well as the products of their metabolism, protect liver cells from damage and help to restore already damaged liver walls. This regulation of the content of a number of microelements enables their maintenance in the bloodstream in the concentration necessary for the organism. This makes it possible to stop the process of their separation from tissues and bones, as well as the formation of their insoluble salts. And microbial cells strengthen the intestinal mucosa and prevent the absorption of harmful substances and the entry of pathogenic microorganisms into certain organs and systems, and thus protect the body from inflammation and vaginal fungal infections.


Everyday life of modern man is tense and dynamic. It is exposed to environmental factors. Deterioration of the ecological environment inevitably affects the normal functioning of the human body. The negative effects of our environment directly affect the balance of microflora in the digestive tract.

The balance of flora in the gastrointestinal tract is affected by poor and inadequate nutrition, canned food, antibiotic therapy and finally the quantitative and qualitative composition of food.

Any deviation in the ratio of microbial species that inhabit the stomach and intestines leads first to disorders in the digestive tract, and later to serious diseases of the digestive system and related organs and systems of the human body.

Microflora regulators

The main regulators of the microflora in the column are lactobacilli and bifid bacteria. Based on selected strains of the genera Lactobacillus and Bifidobacterium: Lactobacillus acidophilus 12, Lactobacillus delbruskii, Subsp bulgaricus 144, Lactobacillus casei, Lactobacillus helveticus, Lactobacillus plantarum, Bif. bifidum ,, Bif. breve ,, Bif. longum, as well as suitable bases for their development by achieving a high concentration of living active cells while maintaining their activity during separation, created lyophilization probiotics “Enterosan” for the prevention and treatment of some of the most common diseases of modern man, such as diseases of the digestive system.

With the addition of vitamins and trace elements in organogenic form, with the restoration and maintenance of the balance of gastrointestinal microflora, they acquire some more specific purposes: for the treatment and prevention of diseases of digestive and other organs and systems, such as cardiovascular diseases, urinary system diseases, high blood pressure, high cholesterol, atherosclerosis and last but not least, recent allergic diseases, anemia and depressive states of the body.

Enterosan 68 probiotic for bone problems

There are a large number of people who suffer from osteoarthritis, rheumatoid arthritis, gout, psoriatic arthritis. Enterosan 68 increases the production of anti-inflammatory prostaglandins, mineralizes the bone matrix and builds connective tissue. Enterosan 68 helps control arthritis pain and reduces joint swelling. This protects the bones, tendons and ligaments from further damage.

Enterosan MS for multiple sclerosis is a problem with muscles and nerves

Multiple sclerosis is a degenerative disease of the nervous system that affects the brain, optic nerve and spinal cord. At the same time, it damages various parts of the nervous system, destroying the myelin sheaths of the brain. Myelin sheaths consist of a fatty substance that isolates nerve fibers throughout the body.

For the treatment of this disease, traditional medicine uses interferon 1a and 1b (Avonek and Betaseron, respectively) and glatiramer acetate (known as copolymer 2) and representatives of corticosteroids. However, they achieve an effect in only 32% of patients treated with them. And very often they lead to flu-like conditions, depression, nausea, hair loss, weight and limb stiffness.

With frequent urination, characteristic of this disease, significant amounts of vitamins and microelements are excreted from the body, which is a prerequisite for the disease to progress. Probiotic preparations Enterosan MS and Enterosan MS + improve blood circulation and regulate muscle movements. Prevents muscle cramps, stops attacks, tingling in the limbs, frequent urination and generally increases body mobility, stops the progression of the disease When the disease is in a more advanced form with weight and cold in the limbs Enterosan MS + restores nerve impulse transmission.

enterosan MS
Needed by people with multiple sclerosis. Improves blood circulation and regulates muscle movements. Prevents muscle cramps, improves mobility and general physical condition. Affects tissue nutrition. It stops attacks, protects against leg cramps, tingling in the limbs. Regulates urination. Enterosan MS + is intended for advanced disease with weight and cold in the extremities.

In many European countries, probiotics have been used as therapeutic and prophylactic agents in the treatment of degenerative diseases. In that sense, the Bulgarian probiotics Enterosan are necessary drugs in the treatment of these diseases. In the early diagnosis and early stage of the disease, Enterosan MS not only stops the progression of the disease, but also restores the body.


In the last 5 years, the group of probiotics has found its appropriate place in solving a number of specific problems in the field of gastroenterology. Enterosan is a proven product on our pharmaceutical market with real quality, reliable microbial content, efficiency and safety.

The main health problems in gastroenterology, where Enterosan has been shown to be effective, are:

Intestinal dysbacteriosis

This is a condition of imbalance of the intestinal flora, most often a consequence of frequent, prolonged and unjustified use of antibiotics, which leads to disorders of digestion and absorption of food. In the 200 patients observed, Enterosan overcomes dysbacteriosis and restores the normal saprophytic intestinal flora. In this way, digestion and assimilation of food is restored, local intestinal immunity is strengthened and the whole organism is protected. Clinically, there is a reduction and disappearance of dyspeptic symptoms in patients, normalization of the rhythm of defecation and the continuation of the previous “abdominal comfort”. The therapeutic scheme includes a period of satiety – about 20 days – 6 t / day during meals and a maintenance dose of 2 t / day – from 6 to 12 months, restoring the lost flora during defecation with the intestinal passage. I did not notice any side effects related to the intake of Enterosan, as well as laboratory abnormalities. The presence of bloating was reported during the saturation period, which I associate with the “microbiological war” in the intestines, in which Eterosan overcomes dysbacteriosis.

enterosan for the stomach
A dietary supplement that helps the body with gastritis, enteritis, stomach ulcers, in combination with a proper diet.

IBS- / Irritable Bowel Syndrome /

IBS / Irritable Bowel Syndrome / includes all motor disorders, combined with changes in secretory activity, but without morphological changes in the colon. My observations on 115 patients with IBS show that normalization and maintenance of normal intestinal flora through Enterosan achieves a significant reduction in patients’ subjective problems – reduction of abdominal pain and discomfort and normalization of the rhythm of defecation.

Prevention of benign and malignant polyps in the intestine

Prevention of benign and malignant polyps in the intestine. Enterosan, as a complex of probiotic strains of lactobacilli and bifidobacteria, displaces and suppresses putrefactive, pathogenic and toxic microorganisms in the intestines. Thus, they reduce the production and decompose of numerous harmful putrefactive substances, toxins and reduce the time of contact of the intestinal mucosa with carcinogenic and mutagenic metabolites. Strengthening local intestinal immunity in combination with the above-described mechanisms of action of the probiotic Enterosan, determines its prophylactic effect against benign, malignant polyps and bowel cancer. This effect of Enterosan is enhanced by a change in diet – increased intake of fruits and vegetables.

Maintaining and prolonging the period of remission in patients with ulcerative colitis

In combination with the main therapy of this disease with the now accepted autoimmune pathogenesis Enterosan, the intestinal flora is normalized and through the mechanisms described above, it helps to maintain and prolong the period of remission. It has an additional, positive additive effect in complex therapy.

No adverse reactions were observed in all 315 patients taking Enterosan, as indicated and according to treatment regimen. These are empirical observations both on my part and on the part of doctors and patients.


Literature: Murgov I., Z. Denkova, Probiotics Enterosan – achievements and prospects, Scientific-practical conference with international participation “Probiotics Enterosan – technology and health’2002”, VIHVP tom KSLVII, 18-25.2002; Denkova Z., G. Georgiev. New Bulgarian probiotics and probiotic supplements. Journal of Medicine & Pharmacy, No. 6.20, 2001; Denkova Z., I. Murgov. Bulgarian probiotics Enterosan, I National Conference on Nutrition, 14-15. May, Sofia, 2004

Treatment of allergic rhinitis

Causes and symptoms of allergies

This is the immune system’s response to substances such as grass and tree pollen, mold spores, house dust or animal dandruff (hanging fur or peeled pet skin). Symptoms include a stuffy or runny nose, watery eyes, headache, dizziness, scratching in the throat and sneezing.

The cause of allergic rhinitis and hay fever is common allergy on pollen, fungi, hair, fur, dust. These substances are harmless to most people, but in people who suffer from allergies to inhalation, they cause a hypertrophied immune response. This causes a cascade of biochemical reactions, which leads to a mass release into the blood of histamine and other chemical compounds that cause inflammation and the formation of mucus in the nasal passages and sinuses.

Similarities and differences between allergic and non-allergic rhinitis

From a medical point of view, rhinitis is defined as inflammation of the nasal mucosa, which is characterized by rhinorrhea (front and back), sneezing, nasal congestion and / or itchy nose. These symptoms occur for at least two consecutive days and last for more than 1 hour most days.

There are two main forms of rhinitis: allergic and non-allergic.

Symptoms that develop in the nasal cavity as a result of an immune-mediated hypersensitivity reaction are allergic rhinitis (AR). AR is the most common form of non-infectious rhinitis, which develops as a result of an IgE-mediated immune response to allergens. AR is often accompanied by ocular symptoms.

For all other forms of rhinitis in which the involvement of allergic mechanisms has not been proven, it is suggested to turn to non-allergic rhinitis (NAR).

There is a detailed study of potential triggers and criteria for the differential diagnosis of AR and NAR. Many non-allergic effects are known to cause nasal symptoms that mimic allergic rhinitis. These include medications (aspirin and other nonsteroidal anti-inflammatory drugs), occupational factors, food, physical and chemical agents, stress, and viral infections.

Pathognomonic markers that distinguish allergic rhinitis from non-allergic rhinitis are actively sought. Different types of inflammatory reactions, especially eosinophilic inflammation, are the main ones in allergic reactions. However, the presence of an increased number of eosinophils, IL-5 or even polyclonal IgE in tissues and circulating blood, without significant antibody activity, does not necessarily mean an allergic reaction.

The same cytokines (interleukins) they produce immune system cells and / or effector cells and involved in beneficial and harmful effects are not necessarily markers of allergic reactions. It is known that various substances can act as polyclonal IgE stimulants. One example is Staphylococcus aureus enterotoxins, sometimes called “superantigens”, which are apparently able to stimulate eosinophilic inflammation and IgE-mediated response in typical non-allergic nasal polyps. Another example is cigarette smoke. The microscopic and immunological appearance of the nasal mucosa in biopsy samples may be the same for classic allergic and non-allergic rhinitis.

Symptoms of hay fever (allergic rhinitis)

The first symptoms are irritation, secretions in the nose, throat, palate, inflammation and redness of the eyes. This is followed by runny nose, sneezing, shortness of breath, eye irritation. In some cases, conjunctivitis may develop.

Consequences of hay fever

Pollen fever can lead to worsening of chronic diseases of the upper respiratory tract, including infectious sinusitis, otitis, tracheitis, bronchitis and bronchial asthma. It also causes hypertrophy of the tonsils and adenoids, improper obstruction in children with oral breathing, loss of taste and smell, insomnia and increased asthma syndrome.

Allergies – hay fever and rhinitis

Prevention of hay fever (allergic rhinitis)

Window nets and sunglasses greatly reduce pollen access.

The air conditioner keeps the home clean in the heat.

Ionizers help remove pollen, dust and other allergens in the air.

Mattress covers reduce dust irritation.

Diet for hay fever (allergic rhinitis)

Vitamin C in combination with bioflavonoids acts as a natural antihistamine to stop colds or nasal congestion. Increase your vitamin C intake by consuming more citrus. Bioflavonoids are contained in citrus peel: cut the peel of grapefruit or orange and cook it with a little honey and water for 10 minutes. Eat one piece before bed and when you feel symptoms the next day. Vitamin C can be taken in an additional 500 mg. three times a day.

Pantothenic acid also relieves allergic symptoms. Take a dose of 200-500 mg. pantothenic acid and 50 mg. vitamin B complex daily.

Pollen dosing can prevent allergies, especially pollen fever: take 4-6 tablets a day for a few weeks before the fever season.

Licorice and beta-carotene also help – if you buy them from a pharmacy, follow the instructions, otherwise consult a naturopath or dietitian.

Aromatherapy of hay fever (allergic rhinitis)

Dilute 1 drop of lavender oil in 5 ml of carrier oil, store in a glass bottle and lubricate the sinuses on both sides of the nose once a day.

Instead, you can dilute 1 drop of ergot oil in 5 ml. jojoba or almond oil and rub into the sinuses once a day.

Acupressure in hay fever (allergic rhinitis)

To relieve the headache, sneezing and pain in the eyes, find the tip of the muscle in the space between the index finger and the thumb, rub it well for about a minute and repeat the same with the other hand.

Caution: do not use during pregnancy!

To strengthen the immune system, find a point on the top of the forearm, between two bones, two fingers above the wrist, rub well with circular movements of the thumb.

Exercises for hay fever (allergic rhinitis)

Regular exercise controls allergies, which often occur due to great stress. Try running early in the morning, brisk walking or swimming.

Traditional remedy for hay fever (allergic rhinitis)

Antihistamines are usually recommended. Occasionally, inhaled medications, including steroids, can alter and control allergy-induced asthma. In severe cases or when an immediate result is needed, an injection of cortisone is given, which brings relief for almost 3 months.

Homeopathic treatment of hay fever

A preliminary electronic publication based on a study examining the effectiveness of homeopathy in the treatment of pollinosis appeared in the International Journal of Alternative and Complementary Medicine (TJACM). Kushal Banerjee, a fourth-generation homeopath from a family clinic in New Delhi, India, Robert Matti from the Institute of Homeopathy in London, Seira Costello from the London Department of Health Research at Imperial College, and Jeremy Hovik.

The researchers analyzed and systematized the results of 11 previous studies examining the treatment of seasonal allergic rhinitis with glaucoma (grapefruit, an evergreen shrub that grows in Mexico and Central America) and other homeopathic remedies. 8 of these 11 studies were considered inappropriate due to the “high risk of systemic errors”. Three studies on the use of half-chemistry were assessed by experts as of different quality. Only one study proved reliable enough – about the use of homeopathic nasal spray.

Treatment of half-mimicry showed a small positive result in 2–4 weeks: the symptoms of rhinitis in patients using it decreased by 1.48 compared with 1.27 in the placebo group; symptoms of allergic conjunctivitis – by 1.55 compared to 1.37 in the control group. Homeopathic nasal spray does not differ in its action from the usual medicine.

“Since allergic rhinitis is one of the most common manifestations of allergies (according to some estimates, up to 500 million people suffer in the world), all methods of treating this condition are worth paying attention to,” said Kushal Banerjee.

In recent years, medical science has denied the possibility of treating allergic rhinitis with homeopathy. The World Health Organization is 2010. declared the effectiveness of such treatment unproven. However, many people still trust homeopathy more for fear of the serious side effects that traditional treatment can cause.

Preparations that help with allergic rhinitis

Psoriasis is a natural disease treatment

There is no definitive cure for psoriasis, but with good natural treatment, this disease can disappear for a longer period of time, and its intensity can also be reduced.

What is psoriasis?

Psoriasis is a chronic inflammatory process of the skin characterized by accelerated differentiation and proliferation of the epidermis: limited reddish eruptions, sometimes with overlapping plaques covered with silvery scales, and other times with hardening.

It appears on the scalp, the outer parts of the extremities (joints, elbows, knees and ankles) and places of repeated friction. Psoriasis can also be manifested by nail abnormalities.

It affects 2% of the population, is more common in white people and reaches its maximum intensity between 20 and 30 years and between 50 and 60 years.

What causes psoriasis?

The cause of psoriasis is multiple, with genetic and environmental components. Sometimes there is a family history of this disease. When one of the parents suffers from psoriasis, the risk of the child having this disorder is 14%. This figure rises to 41% when both parents suffer from it. In any case, this disease is not transmissible.

Among the factors that affect psoriasis is the malabsorption of proteins, due to which intestinal bacteria create toxic amino acids, polyamines: if they increase, psoriasis worsens. Enzymes which improve digestion reduce polyamines.

Intestinal toxins such as Candida albicans and other yeasts worsen psoriasis. Fasting and gluten-free diets lead to improvements in patients with psoriasis. It also reduces alcohol consumption and intake of milk thistle oil, which improve liver function.

Factors that activate the appearance of psoriasis include physical trauma, changes in the skin (Koebner phenomenon), infections (streptococcal pharyngitis), hypocalcemia, stress, and some medications, such as lithium, malaria medications, or interferon.

Impact of pregnancy on psoriasis: half of women with psoriasis experience worsening during pregnancy, and the other half experience improvement.

Treat psoriasis naturally

It is generally believed that there is no cure for psoriasis, although it may go away for a long time. Conventional treatment focuses on increasingly aggressive drugs with more side effects.

The natural remedy, however, emphasizes skin care, which helps reduce minimal itching and skin trauma. This prevents the Koebner phenomenon in psoriatic lesions.

Here are some recommendations to help improve psoriasis:

Bathing in cold or warm water with mild soaps.

Frequent and periodic application of moisturizers, especially while the skin is still moist, helps keep psoriatic skin smooth and under control. Oatmeal or chamomile and emollient tea will help relieve itching and irritation caused by psoriasis. The same goes for the application of olive oil.

Sunbathing or sun exposure has been shown to be effective for psoriasis, which usually improves during the summer months, when exposure to sunlight increases. Ultraviolet radiation B reduces DNA synthesis and has immunoregulatory effects. Today, several mechanisms are known in which the action of light intervenes in the regulation of this element of the immune system that is involved in psoriasis.

The photosensitive effects of furocoumarin have been known for centuries and explain that the use of bee or rutile plants – such as rue or Ruta graveolens – together with progressive sunbathing helps to combat psoriasis in a simple and effective way.


High intake of omega 3 fatty acids, low-calorie diet and vegetarian diet show beneficial effects in psoriasis.

Some gluten-intolerant patients recover after a gluten-free diet.

Useful Nutrition should be rich in the following elements:

Omega-3 fatty acids, such as flaxseed.

Folic acid : spinach, cabbage, beet greens, lettuce and leafy greens in general.

Vitamin A: Carotene-rich juices, such as carrots, cabbage, melons or tomatoes.

Vitamin E: various seeds.

Zinc: rolled barley, pumpkin seeds, beans, unroasted cashews …

Selenium: chard oil, garlic, orange, flaxseed and evening primrose.

Enzymes: pineapple ( bromelain ), papaya (papain), which promote protein digestion.

You can add foods rich in psoralens such as figs, primroses.


Several herbs can be helpful in solving the problem:

Topical aloe extract appears to reduce peeling, erythema and infiltration of psoriatic plaques.

Although milk thistle (Silibum marianum) has not been shown to be successful in treating psoriasis, it protects against hepatotoxicity as a side effect of methotrexate, an anti-inflammatory drug. Silymarin is the active ingredient of burdock.

It is desirable to take 50 to 100 grams of freshly made bitter melon juice (Momardica charantia).

Topical treatment with mahogany cream aquifolium is effective.

Fern extract Polipodium leucotomos, popularly known as kalaguala, is traditionally used by the natives of Honduras as a medicine against various skin conditions.

Rue (Ruta graveolens) is used to effectively treat psoriasis.

Helichrisum (Helichrisum italicum) has an anti-inflammatory effect.

Chinese medicine and other forms of therapy

psoriasis natural sun treatment

Chinese medicine has an abundance of combined topical preparations, many of which are rich in natural corticosteroids, which would explain its effectiveness. Some of these products do not specify their composition, which has created a bad reputation for Chinese herbal remedies .

Like Chinese medicine, homeopathy considers psoriasis to be a local reflection of a systemic disorder. Each patient is evaluated individually and the treatment is applied on the basis of a “formed strategy”: the chosen drug largely depends on the person.

With homeopathic treatments, patients may experience worsening of symptoms before withdrawing: this is known as a healing crisis.

Water and steam therapies

Some people visit resorts and clinical centers on the Dead Sea and spend two to four weeks in the sun and in salt water. A study of 740 German patients treated there revealed 70% complete remission of symptoms after four weeks in one of these clinics.

Any sea beach can be used to treat psoriasis. Among the most commonly used techniques are sea baths, heliotherapy, including seaweed in sihrana, sea mud and psammotherapy between 40-60 ºC (hot sea sand coating and relaxation for 20 minutes or until you sweat).

Psoriasis is one of the dermatological diseases that is mostly treated in spas. Studies show positive clinical results.

In addition to chlorinated waters and the sea climate, spas offer sulfur water to treat psoriasis. This water is good for the fact that it is attributed the following advantages:

The main effect of hydrogen sulfide baths comes from their antioxidant capacity. Sulfur waters have an anti-inflammatory effect and, due to the transformation of sulfur and hydrogen sulfide into pentatic acid in the deep layers of the epidermis, they have antifungal, antibacterial and antipruritic capacity.

Sulfur waters appear to play a role in skin immunoregulation. The beneficial effects on the immune system are also attributed to rest and sun.

The most commonly used application techniques in spas are:

Baregina peloid or sulfurized glycerin water is very often used in psoriasis.

Another option are very warm baths at 42 ° C, for 15 to 30 minutes, followed by a jet of hot water for 2-3 minutes or a filiform shower at 30 cm from the skin, which have an antipruritic effect.

Ingran treatments are also performed, which consist of a bath with very hot water, at 40-42 ºC for 10 minutes in combination with sun exposure.

In general, the improvement of psoriasis in the treatments used in spas can be attributed to several reasons:

Thermal stimulation. It is associated with vasodilation: it increases blood circulation and lowers blood pressure. Hyperthermia is used to relieve pain and produce an immunosuppressive effect. It also has an anti-inflammatory effect.

Mechanical effects. The effects are seen on muscle tone, joint mobility and pain intensity. Physiological changes also occur, such as an increase in urine output and a decrease in plasma levels.

Psychological factor. The psychological factor is added to the advantages in the treatment of skin lesions, because these centers are mostly pleasant places, far from stressful daily activities and where those who are ill can communicate with other people who suffer from the same pathology.

Increased stress in psoriasis

It is well known that patients with psoriasis have increased stress as a result of their disease. Extensive research by members of the National Psoriasis Foundation has documented that suffering from psoriasis has profound emotional, social, and physical effects on quality of life.

Likewise, emotional factors, especially stress, have been shown to be strongly correlated with the onset and worsening of psoriasis.

The mechanism of action of stress on psoriasis has long been known.

It has also been confirmed that the degree of stress affects the therapeutic results. Patients in the group with increased stress achieved remission 19 days later than those in the group with reduced stress anxiety (it was 1.8 times slower).

Polycystic ovary syndrome successful natural treatment!

Polycystic ovary syndrome is the most common hormonal imbalance, affecting approximately 5-18% of women of reproductive age. This endocrine disorder is characterized by a heterogeneous clinical picture determined by different signs and symptoms, which makes diagnosis very difficult.

Menstrual cycle dysfunction (oligo / anovulation)

Clinical or biochemical hyperandrogenism (hirsutism, acne and / or alopecia).

Ultrasound criteria (polycystic ovarian morphology)

Polycystic ovary syndrome, symptoms:

Very irregular menstrual cycles


Absence of menstruation. It occurs in 70% of cases.


Decreased menstruation (long cycles, greater than 35 days).


Very frequent menstrual periods (short cycles, shorter than 25 days)


Prolonged, heavy and painful menstruation

Premenstrual syndrome

Premenstrual syndrome (PMS) is characterized by various physical changes (nausea, weight gain, fatigue, headaches, etc.) and mental (irritability, altered libido, depressed mood, behavioral changes …). These symptoms occur in the luteal phase of the menstrual cycle (a week before menstruation) and women with polycystic ovary syndrome tend to have a harder time withstanding them.

Fertility problems

Anovulation is the absence of ovulation and is one of the most common causes of female infertility.

Excess androgens (hyperandrogenism) is an increase in the male hormone in the blood. Excess androgens can lead to hirsutism (increased body hair in areas such as the face or breasts), acne or seborrhea (excessive production of sebaceous glands) and / or acanthosis nigricans (presence of localized hyperpigmentation on the back of the head, armpits or wrinkles).

Overweight women are more likely to suffer from polycystic ovary syndrome. Women with normal weight (BMI 18.5-25) also suffer from this syndrome. Therefore, it cannot be claimed with certainty that there is a direct link between being overweight and Polycystic Ovary Syndrome.

Insulin resistance

Insulin resistance code Polycystic ovary syndrome occurs due to a defect or inability of the muscle insulin receptor to capture glucose, which leads to an increase in blood glucose. Therefore, women with polycystic ovary syndrome are at increased risk of complications such as diabetes mellitus, premature atherosclerosis, hypertension, heart attack, abortion and coronary heart disease.

The exact cause of polycystic ovary syndrome is unknown. Most experts agree that this is a multifactorial entity that is increasingly influenced by genetic factors. Genes associated with gonadotropins (hormones produced by the pituitary gland responsible for the release of the female hormones LH and FSH) and other hormones associated with insulin and its receptors have been identified.

The most common causes

Hormonal changes

The pituitary gland is responsible for secreting female hormones luteinizing (LH) and follicle stimulating (FSH). In the case of Polycystic Ovary Syndrome, decompensation occurs in the production of these hormones and more LH is secreted than FSH (in normal situations, it should be the other way around). This decompensation leads to increased androgen production. Elevated levels of the male hormone can prevent the separation of the egg from the ovary (prevent ovulation) and disrupt the female menstrual cycle.


Insulin is a hormone produced by the pancreas that is involved in the metabolic use of nutrients and is responsible for regulating the amount of glucose in the blood until it is converted into energy. In women with Polycystic Ovary Syndrome, changes in insulin receptors have been observed, leading to an increase in blood glucose. The pancreas as a compensatory response produces more insulin and this overproduction has direct effects on the ovary. Excess testosterone levels are produced and typical signs of the syndrome are generated (hirsutism, anovulation, acne, etc.)

It is important to consider other causes such as stress, emotions, diet and an inactive lifestyle because they can affect and cause changes in the hormonal system.

Fertility, pregnancy and PCOS


Women with polycystic ovary syndrome have problems with the menstrual cycle (anovulation is the leading cause of infertility in these patients). Insulin resistance and associated changes in endometrial development may adversely affect fertility. Approximately 85-90% of women who do not ovulate and want to get pregnant go to in vitro fertilization centers, although that does not mean that they cannot get pregnant naturally. 60% of women with Polycystic Ovary Syndrome are fertile and can become pregnant in less than 12 months. The chances of getting pregnant spontaneously are reduced if you have oligoovulation.


Women with polycystic ovary syndrome have a higher risk of certain complications during pregnancy (gestational diabetes, hypertension, preeclampsia, premature birth). Common diseases such as metabolic syndrome (insulin resistance) and hyperandrogenism can increase the risk of pregnancy. Several studies claim that babies are more likely to be older for their gestational age and will suffer a spontaneous caesarean section or suffocation during birth.

Diet and Polycystic Ovary Syndrome

The most effective treatment for Polycystic Ovary Syndrome is to lead a healthy lifestyle accompanied by a balanced diet and regular physical activity.

Recommended diet

Whole carbohydrates

Consumption of whole grains can reduce the risks of inflammation and obesity that characterize the development of insulin resistance. Cereals contain fiber and a lower glycemic index, slightly raising blood glucose levels, unlike refined or simple sugars. It is advisable to include in your diet the consumption of cereals such as quinoa, buckwheat, millet, oats, amaranth.

What is the glycemic index (GI)? Can the GI of food be altered?

The glycemic index is the ability of foods to raise blood glucose.

Hydration, maturation and heat have the ability to increase the GI in food. It is recommended to avoid too long cooked foods: rice, white pasta and potatoes, sweet potatoes because they raise blood glucose faster (it is better to cook “al dente”).

Fruits and vegetables

Fruits and vegetables are rich in vitamins, fiber, minerals and antioxidants. Its consumption is necessary for a healthy and balanced diet. They have a very low caloric value, are well satiated, reduce appetite and are therefore recommended in all diets for weight loss.


The fruit has a very variable GI which can be high -medium -low. Fruits consumed with the skin (strawberries, blueberries, cherries) tend to have a lower GI than those fruits that are eaten without the skin (watermelon, pineapple, mango, etc.). It is recommended to avoid consuming dehydrated fruit, fruit in the form of syrups as well as natural juices with artificial sweeteners.


Vegetables can be classified according to their starch content. Starchy vegetables (pumpkin, peas, carrots) have a higher glycemic index, so they can raise blood glucose more than those that do not contain it (green leafy vegetables, peppers, zucchini, peppers, etc.)

Fruit juice is not equivalent to a portion of fruit, no matter how natural it is. When we process the fruit (cut it, peel it, squeeze it, etc.), approximately 50% of vitamins and minerals are lost along with the fiber.

The fruit contains natural sugar, but it also contains other nutrients that provide numerous benefits to our health if we consume it unprocessed. If we take it in the form of juice, because it does not contain pulp or fiber, it raises blood glucose levels faster.

We have to chew the whole fruit, it gives us more satiety than the intake of juice, which is quickly absorbed and digested. You should always give priority to consuming whole fruits over juices. You do not have to eliminate vegetables that contain starch from your diet, but it is recommended to include them in your diet in small quantities.



Legumes are rich in fiber and have a low GI, in addition to providing satiety, they are associated with weight loss. In several studies, it has been noticed that their regular consumption (at least 2-3 times a week) can help increase the levels of the transport protein SHBG (sex hormones), which would help reduce the levels of free testosterone in the blood.


Proteins do not raise insulin levels like carbohydrates. Their consumption is associated with weight and fat loss, as well as with the stabilization of blood sugar levels. Proteins are found in foods of animal and plant origin (legumes, nuts, tofu …). There is no standard protein intake. Your recommendation should be personalized, because it varies depending on the intensity and type of sport you play. Although not standardized, several studies have found that consuming about 1.8-2g / kg / day of protein has positive effects on weight loss.

Healthy fats

Omega-3 fats are essential because they improve insulin sensitivity and blood cholesterol levels. Women with polycystic ovary syndrome can have very high levels of prolactin (a hormone produced by the pituitary gland), which leads to changes in the menstrual cycle (anovulation) and possible fertility problems. It is necessary to include the consumption of healthy fats in order to increase the level of HDL cholesterol, which is necessary for optimal hormone production (all sex hormones come from cholesterol). Healthy fats are found in walnuts, seeds, egg yolks, avocados or extra virgin olive oil.

Not recommended foods:

Simple carbohydrates

Simple carbohydrates quickly raise blood glucose levels by increasing insulin resistance and body weight. We can find them in ultra processed products such as pastries, sweet cereals, chocolate, ice cream, pastries, sweets, soft drinks.

Refined carbohydrates

Refined carbohydrates are low in nutrients. They do not provide many nutrients other than starch. By purifying them, in addition to fiber, large amounts of microelements are lost, which makes them useless food. Like simple carbohydrates, they raise blood glucose levels, but not as fast. More energy is needed to process them. White bread, pasta, rice and sweet cereals would be examples of simple carbohydrates.


Pastries are enriched with sugars, saturated or trans fats and refined flour. They have a high GI that worsens insulin resistance, and its consumption is especially counterproductive in women who suffer from Polycystic Ovary Syndrome. Examples are sweets, cookies and pastries.

Fruit juices

Fruit juices do not saturate, are easily digested, quickly raise blood glucose levels and contain almost no vitamins. It is better to opt for a whole piece of fruit and reduce the use of juices, regardless of whether they are natural or not.


There is a lot of controversy and discussion regarding milk consumption. There is evidence that milk, especially skim milk, can contribute to an increase in androgens, worsening acne and hirsutism. This association was not found in fermented dairy products, because they generate less activation of IGF-1. In conclusion, it is advised to limit the consumption of milk and increase the consumption of fermented dairy products (kefir) or herbal drinks without added sugar.

Soft drinks and alcohol

They raise the level of glucose in the blood, worsen insulin resistance and their consumption seriously harms our health.

Vitamins to consider


A substance that belongs to the B group of vitamins and provides numerous benefits: it helps regulate hormonal cycles (reduces the level of free testosterone and increases the level of LH), improves hirsutism and acne, and intervenes in the metabolism of sugar and fat in favor of weight loss. It has been determined that taking 3-4 g of inositol a day increases insulin sensitivity and improves ovulation. Foods that contain: citrus fruits, legumes, nuts.

Folic acid

Folic acid

Vitamin B9 supplementation can help treat ovulatory infertility. Several studies have shown that the addition of vitamin B9 together with inositol has a positive effect on women and regulates their menstrual cycle. Green leafy vegetables and legumes are rich in folic acid.

Vitamin D

Vitamin D deficiency is associated with increased insulin resistance and weight gain. Sun exposure is a major factor in the production of calciferol (vitamin D3). It can also be found in foods such as dairy products, oily fish and egg yolks.

Polycystic ovary syndrome and physical activity

The impact of physical exercise on women with Polycystic Ovary Syndrome provides a number of benefits:

Improves emotional state (depression, anxiety, mood swings …)

Increases insulin sensitivity

Improves the hormonal profile of LH / FSH

Increasing SHBG helps reduce testosterone levels in the blood

Weight loss and body fat

Reduces and improves premenstrual pain

Allergy in children and adults and how to reduce symptoms

An allergy is an excessive reaction immune system to substances that do not cause any reactions in non-allergy sufferers, because they are actually completely harmless. But there are just as many allergies that have a completely different cause. Since the reasons for an allergic reaction are as diverse as its symptoms, the triggers are not always immediately recognizable.

Allergies and the immune system

Most people are affected by allergies these days. The number of allergy sufferers is constantly growing, and even small children are increasingly affected by the symptoms. The effects of an allergic reaction can be as different as its causes.

The most common symptoms of allergies include runny nose, severe lacrimation, itching, asthma, headache, gastrointestinal problems, skin rash and many other phenomena.

An allergic reaction indicates that the immune system overreacts to substances that are actually harmless. These substances are called allergens. Their most famous representatives are certainly pollen, house dust mites, animal poisons (wasp or hornet poison) and metals such as nickel.

But we have many more allergens. Nowadays, practically any substance can become an allergen and thus trigger allergic reactions. This can especially affect people with weakened immune systems.

Therefore, an allergist often does not react to only one allergen. An inappropriately strong reaction of his immune system over time leads to an overreaction in more and more situations.

As a result, the allergist finally shows an overreaction to more and more substances – ie. reacts allergic.

Allergy due to weakened adrenal glands

The adrenal cortex produces various hormones – including glucocorticoids such as cortisone and cortisol. These so-called stress hormones are able to precede allergic reactions due to their anti-inflammatory effects.

However, this only works if the adrenal glands are not already weakened.

Weakened adrenal glands are often the result of a diet high in sugar and carbohydrates. Drinking a lot of coffee or alcohol also burdens the adrenal glands. The main cause of adrenal fatigue, however, is a chronic stressful situation.

Chronic stress can cause the adrenal glands to become depleted. The production of cortisone and cortisol decreases and the body’s susceptibility to allergies increases to the same extent.

Stressful situations can trigger an allergy

Allergy sufferers have similar experiences regarding their symptoms. They usually already have some allergy symptoms in childhood, but the symptoms disappear in adolescence.

As soon as stressful situations appear in adulthood, such as high stress at work, problems with children, divorce that tears the nerves or the death of a loved one, the symptoms reappear.

Thymus gland – a school of defense cells

Vaccines, drugs, chemicals can also be responsible for allergic reactions such as skin rashes, itching, asthma, etc., because these substances significantly disrupt important tasks of the thymus gland.

The thymus gland is considered to be a school of T lymphocytes (defense cells), because here these important defense cells are trained to be able to recognize allergens and make them harmless.

In this way, these cells make a significant contribution to the interception or at least the reduction of allergic reactions. This clearly shows that the thymus gland also plays a decisive role in the development of allergies.

External proteins often trigger allergies

External proteins in the bloodstream can cause an immediate allergic reaction in the body. These proteins include animal proteins.

Special mention should be made of milk and egg proteins. But it is also known that wheat proteins often cause allergies.

For that reason, allergy sufferers must pay special attention to what foods they eat.

Gluten intolerance can cause allergies

In case of existing intolerance to gluten, foods that contain gluten can activate an allergic reaction.

The intestinal mucosa is constantly irritated, causing inflammatory processes that break down the parts of the mucous membrane that are responsible for the absorption of nutrients.

The resulting thinning of the intestinal walls enables toxic or in any other way harmful substances to enter the bloodstream faster, where they eventually trigger allergic reactions.

Lactose intolerance and allergies

Milk intolerance is also a widespread phenomenon. Many people are born with a deficiency of a special enzyme – lactase – which is needed for the processing of milk sugar.

In other people, the production of this enzyme stops much later.

If there is not enough lactase in the body, dairy products cannot be digested, which results in its breakdown in the intestines.

This results in symptoms such as diarrhea, constipation, gas, abdominal pain or other allergic reactions. In addition, milk protein itself – as an exogenous protein – can trigger additional symptoms.

Babies are especially prone to allergies

Improper infant feeding is responsible for gluten and milk intolerance. The baby’s gastrointestinal tract is not yet fully developed, so its mucous membrane is far more permeable than it is in adults.

Breast milk protects the child from external proteins that enter the bloodstream by practically closing the gastrointestinal area and thus making it less permeable.

Nowadays, however, very few children are breastfed long enough. Instead, they get pasteurized, homogenized and cow’s milk contaminated with antibiotics, pesticides and growth hormones.

If babies are fed prematurely external proteins – such as animal milk products, eggs or wheat products – this can pave the way for a lifelong allergy. Therefore, it is of the utmost importance to breastfeed a newborn for at least 9 to 12 months.

Wheat products promote allergies

In addition to dairy products, our children also get wheat products too early. It takes at least four to six months for the digestive enzymes responsible for starch processing to form in the body.

It can be noticed that children, who often suffer from immune deficiency (colds, allergies, etc.), are usually given starchy foods too early.

On the other hand, children who have been breastfed for a long time and who ate fruits and vegetables instead of starchy foods, in the first year of life are generally much more stable in their health and rarely show allergic reactions.

How to prevent allergies

As a rule, it is the case that parents who feed their children with unknown food until then do not pay attention to how they react to new stimuli. But do you really believe that it is good for your child to eat what you eat?

Can you imagine that fried eggs, fried potato products, burgers, chips, sweets, cola or other sweet juices are good for your child’s health? Probably not.

Therefore, it is extremely important that the first food that your child eats is as natural as possible. It should be consumed either raw or lightly steamed. In addition, the child should be offered only small amounts of one food.

So, during the period of 2 to 3 days, you can very well observe whether the child got a rash or other allergic reactions after eating the newly introduced food. If there is no such reaction, you can slowly increase the amount of food and combine it with other already tested dishes.

Healthy food can also trigger allergic reactions

If you find that your child shows unusual reactions to healthy foods such as broccoli, cabbage, etc … you should not give them to your child for six to eight weeks. Then you can try again.

If your child still reacts to that food, they are likely to have a food allergy. However, it is the case that such allergies are very rarely noticed if the food is previously properly integrated into the child’s diet.

Liver problems weaken the immune system

Other factors in the development of allergies are the so-called liver and blood poisoning. If these problems occur simultaneously with the lack of certain digestive enzymes or other chronic digestive problems, the intensity of the allergic reaction will increase.

In this case it should be executed holistic liver cleansing to relieve it, but this is not suitable for children. If possible, it should be performed under the supervision or in the company of a naturopathic therapist.

Genetic engineering and artificial additives

The widespread use of chemicals, pesticides, genetically modified organisms and other destructive additives used in food production (eg aspartame, glutamate, dyes and preservatives) is often a trigger for the development of allergies.

Yeast allergy

In the case of particularly persistent allergies, yeast infection can often be observed in patients. The yeast spreads in the intestines and irritates the sensitive mucous membrane there. You are already familiar with the effects of inflammation and such permeable intestinal mucosa.

Measures for people with a tendency to allergies

Basically, it is important to consistently avoid a known allergen first – this applies to all allergens.

Since food allergies can often be accompanied by chemicals, pesticides, additives, genetically modified organisms, etc., contained in food, you should eat only organic food.
The diet should have very little sugar and carbohydrates, because glucose strongly acidifies the body and creates a huge effort on the intestines. Both factors weaken the immune system and thus encourage the development of allergies.

In the acute phase of an allergic reaction, the so-called fast juice is warmly recommended. This form of therapeutic fasting supports the rapid removal of existing toxins and thus relieves the liver and immune system.

Any allergic reaction also has serious negative effects on the intestinal environment. That is why it is extremely important for allergy sufferers to clean their intestines well once or twice a year. Accumulated toxins, metabolic residues and other contaminants must be able to dissolve, bind and excrete. After that, the intestinal flora must be stably renewed using the appropriate strains of bacteria.

There are a number of efficient ones on the market probiotics .

If these measures are implemented consistently, the allergist is well on his way to saying goodbye to allergy symptoms.

Food allergies – precautions, treatment, diet

After ingestion, food breaks down into components – proteins, fats and carbohydrates. In some cases, some of these components can enter the bloodstream. As a result of the absorption of antigens in the bloodstream, the body’s immune system perceives them as a threat. As a result, immune system produces a response that includes special proteins – immunoglobulins and inflammatory neurotransmitters – antihistamines.

It takes some time for the immune system to prepare everything needed for an allergen response. Over a period of time, the cells of the immune system produce specific antibodies directed at a specific allergen. Therefore, nothing unusual can happen during the first encounter with a potentially dangerous product. An acute immune response can come much later. This is the insidiousness of allergies as a disease.

However, it should be noted that true allergy, ie a pathological process that involves the resources of the immune system, is relatively rare. Much more often, food allergies are mixed with intolerance to certain foods or food poisoning.

The foods that most often cause allergies are dairy products, eggs, strawberries, fish and sea shells, cereals and some spices.

Symptoms of food allergy

Allergic reactions can develop as soon as the allergen enters the body and after a few hours or even days. In the latter case, they talk about a delayed allergic reaction.

In some cases, food allergies in adults can affect only certain organs: skin, digestive tract, respiratory organs, and in other cases, a systemic allergic reaction develops that affects the whole body.

Clinical symptoms of food allergies are most common in the following types atopic dermatitis


bronchial asthma,

angioneurotic edema,

anaphylactic shock.

Symptoms also include nausea, vomiting, diarrhea, bloating, migraine, skin irritation, hypersensitivity, mood swings, fatigue, and insatiable appetite.

What are the most common food allergies

According to available information, more than 70 foods can cause food allergies.

Most allergic reactions in adults are caused by fruits, vegetables, nuts and peanuts.

People who are allergic to pollen or latex often have allergic symptoms when they eat certain fruits, vegetables or nuts.

Such “cross-reactivity” is due to the fact that the body cannot distinguish between allergens in pollen or latex and related proteins in food. In Europe and the United States, peanuts and walnuts are the most commonly reported food that causes a life-threatening reaction.

Foods that cause allergies:

• cereals that contain gluten, ie. wheat, rye, barley, einorn or their hybrid varieties and their products;

• Crustaceans and molluscs and products thereof;

• Eggs and egg products;

• Fish and fish products;

• peanuts, soybeans and products thereof;

• Milk and dairy products (including lactose);

• hazelnuts and walnuts;

• Sulphides at a concentration of 10 mg / kg or more.

Precautions for food allergies

• Food allergies are sometimes the result of a baby’s premature weaning. Try to breastfeed for at least the first six months, and if possible longer. Slowly and carefully get your baby used to the new food, before you move on to the next one, you should make sure that the baby has accepted the previous one. Start with rice and baby millet. In the first year, do not give wheat or milk to babies.

What else can cause food intolerance

Genetically predisposed to allergies. Approximately half of patients with food allergies suffer from other allergic diseases (hay fever, atopic bronchial asthma, etc.). Their blood relatives have these diseases. Of great importance is the genetically determined ability of the body to produce allergic antibodies.

Eating disorders during pregnancy and lactation (abuse of certain products with pronounced sensitizing activity: fish, eggs, nuts, milk, etc.).

Early transfer of the child to artificial feeding. Eating disorders in children, expressed in the mismatch between the volume and the ratio of nutrients to the body weight and age of the child.

Lack of calcium salt in the diet helps increase protein absorption.

Increased permeability of the intestinal mucosa, which is observed in inflammatory and degenerative intestinal diseases, dysbiosis, helminthic and protozoal invasions.

Reduced acidity of gastric juice, pancreatic insufficiency, enzymopathy, biliary and intestinal dyskinesia contribute to the absorption of high molecular weight compounds.

Composition of intestinal microflora, state of local immunity of intestinal mucosa.

Food allergies

The first step is to find out what food (or drink) you can’t stand. You can use the following method:

• Make a list of all foods that are bad for you or cause fatigue, skin reactions, overactivity, irritability, etc.

• Make a list of the foods and drinks you eat each day.

• Make a list of all foods that regularly whet your insatiable appetite.

• Make a list of foods you will miss if you do not have them on hand.

• Make a list of all the foods you have recently consumed.

• Any product that repeatedly appears on these lists is a potential cause of allergies.

• You can identify the causes of allergies by measuring your heart rate. Measure it after waking up, just before eating, 30 minutes after and before bed. If the measurements are constant, it is unlikely that the food you eat causes allergies. If the pulse varies by 6 or more beats, it is very possible that the food causes an allergy. Check the diagnosis of foods you suspect. Stop eating foods you suspect for at least 2 weeks, then try again and see if those foods cause symptoms. Replace foods that cause allergies with similar ones, such as soy, goat’s milk or powdered milk, which can replace cow’s milk. After 6 months, try the food again: you will probably find that your sensitivity to it has disappeared.

Specialized help with food allergies

To reduce sensitivity to food allergies, naturopaths usually recommend a diet to remove toxins. However, you should consult a specialist for this.

If you can’t determine what is causing the allergy, a kinesiologist will come to your aid and examine the muscles to determine which foods lead to weight loss.

The advice of homeopaths will strengthen the immune system as a whole and thus reduce the sensitivity to potential allergens.

Traditional medicine for food allergies

Doctors recommend avoiding potential allergens. Carefully inspect the contents of processed foods to make sure they do not contain substances that can cause an attack.

Types of food allergies

Today there are many types of food allergies. The most common are five:

common allergens

1. Egg allergy

Chicken egg allergy is an adverse immune reaction caused by consumption and contact with the egg. This type of allergy develops only in people who have produced IgE immunoglobulins directed against egg proteins. In these patients, an allergic reaction will occur every time they come in contact with the egg.

The most common risk factors for egg allergy are family history, if someone in the family had an allergy to other foods or atopic dermatitis.


According to Elena Alonso, a specialist in allergology and pediatrics in the Allergy Service Gregorio Maranon General University Hospital , in Madrid, as with other allergies, the symptoms of egg allergy can be very different and can vary in mild manifestations, such as mild itching in the mouth and / or throat, to more serious symptoms that can lead a person to a dangerously bad condition.

“Symptoms appear in a short time, at most an hour, after eating an egg. The most common are redness of the skin, itching, swelling of the lips and eyelids. “Digestive symptoms with vomiting, abdominal pain and diarrhea are not uncommon,” says Alonso, respiratory symptoms occur less frequently, which can be accompanied by difficulty breathing and swallowing. These are very serious symptoms, so the patient must consult a doctor as soon as they start to occur.


70% of children allergic to eggs eventually recover. In fact, sometimes it happens early. “At 24 months, 20% of children tolerate eggs,” explains Alonso, who points out that this figure grows to 30-35% in three years and 50-55% in five years. “Later, the evolution to tolerance is slower, reaching 60-75% in 9 years.”

The prognosis for adulthood is still unknown.

Treatment and diet:

The treatment of people who have an allergy to eggs is based on maintaining a diet without this food and all the products that may contain it. However, this diet is often difficult to achieve, which is why specialists recommend that patients and relatives be well acquainted with the symptoms and the care protocol that should be followed if eggs are consumed.

Patients with this allergy can have problems when they follow a diet, because many products contain eggs without the consumer knowing it, and they appear in other foods, such as sauces or pastries, as well as in cosmetics.

Allergy to fish and shellfish

These two types of allergies are side effects that occur when the immune system reacts to food. In these two cases, the immune response is mediated by IgE antibodies specific for fish and shellfish.

According to Ana Fiandor, an allergy specialist at the Allergy Service at the Universitario La Paz Hospital in Madrid, fish allergies develop in countries with high consumption of this food, such as Spain.

“Reactions occur in the first years of life and coincide with the introduction of fish into the diet, according to the first year of life,” explains Fiandor. “In children, it is the third largest cause of allergies, and in adults it is responsible for 12-14% of cases of food allergies in our country.

“In Spain, the fish that most often produce reactions are hake, rooster or moth,” says Pereiro.

Fish allergies can last for decades, even a lifetime.

In the case of shellfish, this type of allergy is more common in adults than in children


The clinical manifestations that occur with allergies to fish and shellfish are similar to those with other types of food allergies. Symptoms appear after consumption, although in fish and shellfish they can appear only by inhalation of cooking fumes or particles that are released when handling food.


The only treatment currently available is to adhere to a diet that does not include fish, shellfish and their derivatives and, in severe cases, to avoid contact and exposure to fumes.

3. Milk allergy

Milk allergy is an adverse reaction of the body to the proteins in this product. However, according to Maria Flora Martin, an allergology specialist at the Allergy Service at La Paz Hospital, not all side effects are milk allergies.

This reaction usually has a hereditary basis, so it can be transmitted from parents to children through genes, although environmental factors also participate in development.

It usually appears in the first year of life. In Spain, one or two children in every hundred develop a milk allergy in the first year of life. In fact, in developed countries the incidence is between 2 and 3%. “Most children overcome milk allergy during the first three years, and clinical sensitization to milk is rare among the adult population,” adds Martin.


The manifestations of this reaction are various, as well as the severity, which depends on the degree of sensitization and the amount of food eaten. In addition, symptoms may worsen if the patient exercises, consumes alcohol, or is treated with certain medications.

The most common manifestations are cutaneous, which occur in 70% of reactions. Itching is usually accompanied by redness of the skin with hives, edema in places such as lips or eyelids, etc. In addition, pathologies such as atopic dermatitis tend to worsen when a reaction occurs.

Other common symptoms are indigestion: abdominal pain, vomiting, occasional diarrhea, or difficulty swallowing. Eventually, respiratory symptoms may occur, although less frequently, such as rhinitis or asthma.

Treatment and prognosis:

Currently, the only effective treatment is the exclusion of milk of animal origin, its derivatives and products that may contain milk from the diet.

Most cases of this type of allergy occur temporarily and the prognosis is good in children. “More than 70% of those diagnosed in the first year achieve tolerance during the first three years. Within one year, tolerance is established in 50-60% of children; in two years in 70-75% and in four, in 85% “, explains Martin. “Since the age of 10, allergy to cow’s milk proteins still exists in 10% of initial cases. Evolution in adulthood is unknown.

4. Allergy to vegetables and fruits

Fruit allergy is the most common cause of food reactions in children older than 5 years and in adults. According to an allergy study, 7.4% of people who go to an allergist have a food allergy. Of this percentage, 33% are allergic to fruits and 7% to vegetables.

Prevalence is subject to genetic factors (that a family member has an allergy), environmental factors, such as eating habits depending on the area, or the presence of various pollens that can be felt by an individual.

The most allergic fruits and vegetables:

There are many fruits and vegetables that cause allergic reactions. In the case of fruit, rosacea is the most allergic. From this family, peach is the one that causes the most allergies. Other fruits included in this group are apple, cherry, pear, apricot, plum, nectarine, strawberry and so on.

In addition to these, other fruits that cause allergies are kiwi, melon, pineapple, watermelon, grapes, avocado and mango.

As for vegetables, the most allergic are vegetables, such as tomatoes, carrots, cabbage, lettuce, eggplant or pepper. Other vegetables that cause reactions are onions, spinach, asparagus, as well as spices such as pepper or cumin.

Symptoms and treatment:

The most common manifestations are the appearance of local symptoms such as itching, erythema of the lips, swelling of the lips and tongue, the appearance of red spots on the skin, dermatitis. Manifestations that affect the digestive and respiratory systems can also occur.

As with other food allergies, the only effective treatment is to eliminate fruits and / or vegetables from the diet.

5. Allergy to nuts, legumes and grains

Allergic reactions within the group of cereals, legumes and nuts are very common after consultation with allergists. In fact, according to Ernesto Enrique Miranda, an allergology specialist in the allergology department at Castellon General Hospital, nuts, along with fruit, are the leading cause of food allergies in adults and one of the first in childhood.

Symptoms and treatments coincide with all other food allergies.


According to Miranda, the prevalence of grain allergies is low compared to other food groups, although it varies depending on age and geographical area. This type of allergy is common during childhood and usually disappears with age.


Most allergies to legumes are caused by eating soy, lentils, peas, chickpeas, green beans, peel or beans.

This allergy is more common in countries with a Mediterranean diet, in the Middle East, the Far East and India.


Peanut allergy is the most common of all. In Anglo-Saxon countries, it is considered a public health problem, because 0.5% of the population is allergic to it, and in 50% of cases, the reactions it produces are so serious that they can even cause death.

Hazelnut is the second nut that causes the most allergies. In addition, in Spain, walnuts and almonds cause a large number of reactions.


When a patient suffers a reaction when consuming any food, Fernandez Rivas recommends consulting a doctor. In these cases, the family doctor or pediatrician will consider the patient’s symptoms and, if they suggest an allergy, refer them to an allergist.

When you are in a specialist’s office, he or she will collect a detailed clinical history of the reaction in an attempt to establish which food caused the reaction and establish the temporal relationship between intake and symptoms and give the necessary tests to diagnose and confirm IgE responses to food.

In the same direction, Pereiro comments that, “in case of suspicion of food allergy, parents should avoid contact with suspicious food and consult their pediatrician, who will refer a pediatric allergist to children who need it.”

The Seicap expert confirms that “depending on the case of each patient, different tests will be performed to confirm or rule out the diagnosis. Skin tests (puncture tests) or blood tests may be needed. When we perform skin tests, we get results quickly. The puncture test is performed by placing drops of different solutions prepared with small amounts of potentially allergenic substances (in this case, food extracts) in a regular manner and a few centimeters apart. Each drop is then pierced so that the solution penetrates the surface layer of the skin. After 15 minutes, the reaction produced will be evaluated and compared with the controls applied. “


“The main treatment until a few years ago was to avoid food that causes allergies. It is recommended to avoid eating food, but also contact with the skin and vapors that occur in its preparation (for example, cooking fish steam) “, says Pereiro.

Fernandez Rivas recommends reading food labels and the exact composition of meals when consumed outside the house to avoid accidental poisoning.

The Seaic expert admits that the elimination diet can be complicated for some basic foods (such as milk or eggs) due to the high frequency in which they are found in processed products. “In case of accidental contact with food, serious reactions can occur, especially in those patients who are more sensitive to it. The symptoms that occur should be treated. In the most serious cases, even if the amount of food consumed is minimal, anaphylaxis (can cause a serious allergic reaction that affects two or more systems) and requires intramuscular administration of adrenaline. Therefore, it is recommended that patients with food allergies have adrenaline auto injectors and carry with them, as well as being available in schools for children suffering from allergies. “

Other data

News in therapeutic research of food allergy

As Pereiro describes, “the main novelty in the treatment of food allergy are food desensitization procedures or oral immunotherapy (ITO). They are based on the patient gaining tolerance to food by giving successively increasing amounts in a controlled environment. This method is widely used to treat allergies to cow’s milk or egg proteins. The goal is to avoid the symptoms that result from food exposure. Asymptomatic food consumption is achieved through desensitization. In this way, the risk of inadvertent consumption of food in the diet that is avoided and the anxiety that it creates is eliminated, improving the quality of life of the patient. “

Based on the studies published so far, the Seicap expert points out that “desensitization is successfully achieved in 80-90% of patients, who can take food without restrictions. The requirements for desensitization can be that the centers meet the minimum standards of quality and safety and that they are applied by experienced medical workers and trained for the treatment of allergic children. The child must be checked in the center after the application of the prescribed dose of food in order to check whether there are allergic reactions resulting from the therapy. “

By modifying the immune system with its balanced activity with preparations such as cordicpes and with the enzyme serapetase, allergic reactions can be reduced.

Allergies – 9 ways to cure autoimmune diseases

Inflammation in the body is a scorching topic in medical circles. This body condition is associated with almost all chronic diseases such as heart disease, cancer, diabetes, autism to dementia, and even depression. Other inflammatory diseases such as allergies, sun allergy, asthma, arthritis, and autoimmune diseases rise dramatically across the entire world population.

Doctors are taught to treat inflammation with aspirin, anti-inflammatory drugs such as Advil or Motrin, steroids, and increasingly strong drugs that suppress the immune system with severe side effects.

But doctors are not trained to find and treat the causes of inflammation in chronic diseases. Hidden allergens, infections, environmental toxins, an inflammatory diet, and stress are the real causes of these inflammatory conditions. Autoimmune diseases, specifically, impact as many as 24 million people worldwide, and they encompass rheumatoid arthritis, multiple sclerosis, thyroid disease, inflammatory bowel disease, and others.

Autoimmune diseases treatment

Doctors more often deal with the suppression of symptoms with medication and do not solve the cause of the problem. It’s like taking large amounts of aspirin and standing on a nail. Treatment should be based on eliminating the cause.

If you want to calm the body’s inflammation, you must find its source. Extinguish the fire, not the smoke. In medicine, in most cases, we give a diagnosis according to the identified symptoms and not according to the hidden factors that cause them.

Functional medicine of the 21st century teaches us to treat the cause, not only the symptoms, and to ask ourselves why the patient is ill and not just what disease he is suffering from.

Conventional medicine and allergies

allergies itching pictures

I recently participated in a group discussion with conventional medical doctors, rheumatologists, and patients with autoimmune diseases. One of my patients, who had a complex problem, also took part in discussing autoimmune disease by treating the cause.

The focus of other doctors was on suppressing the inflammation with medication and not finding and treating the cause. Functional medicine has another line of thinking and approaching the disease that helps us find and treat the real causes of inflammation instead of finding ways to reduce symptoms.

Autoimmune diseases are associated with a single central biochemical process that results in immune system response, also known as systemic inflammation. Your body begins to attack its own tissue.

Let’s get back to the conversation. When my patient described how he cured his autoimmune disease by finding and eliminating the causes of inflammation from the environment and his diet, the whole case was characterized as a “spontaneous withdrawal” accompanied with little interest with many anecdotes on the subject.

My patient could barely function from the many inflammations he had all over his body. Treating the hidden causes of inflammation now works very well without any inflammatory processes.

A story like this is not an anecdote but a huge guideline that determines how we should look for answers to our health problems.

What is actually autoimmunity?

In today’s article, I will explain what autoimmunity is, how the inflammatory spiral gets out of control, describing some of the basic causes of fire in the body, and I will also guide you through nine steps on how to reduce fire and overcome conditions that range from arthritis allergies.

We are facing an epidemic of allergies, asthma, and autoimmune disorders. Autoimmune diseases include rheumatoid arthritis, lupus, multiple sclerosis, psoriasis, celiac disease, thyroid disease, and many other syndromes that are difficult to classify.

These are all autoimmune conditions, and they are connected by a central biochemical process, more precisely by the reaction of the immune system in which it attacks its own organism.

Your immune system is the body’s defense against the occupiers. An internal army must clearly distinguish a friend from an enemy. Autoimmunity occurs when your system becomes confused, and your tissue finds itself in the crossfire.

Your body is fighting something, some infection, poison, allergen, food, or in response to stress. The immune system redirects its attack on the joints, brain, thyroid gland, stomach, skin, or sometimes on the whole organism.

This immune confusion stems from what is called molecular mimicry. Conventional approaches have no way to find the source of the problem itself. Functional medicine offers a way to determine the source of a problem.

What are the predispositions for autoimmune diseases and allergies?

Interestingly, autoimmune diseases occur almost exclusively in developed countries. People who live in developing countries without a modern way of life, including special filtration of running water, flushing toilets, washing machines, and sterilization of living space, do not get these diseases.

If you grew up on a farm with many animals, you are also less likely to get any of the above inflammatory disorders. Exposure to mud, dust mites, bugs, and animals train your immune system to recognize foreign and what is actually an integral part of your body.

Worldwide, autoimmune diseases are a major health burden. In addition to being the eighth leading cause of death in the female population, they shorten the average patient’s life expectancy by about 8 years. The annual cost of health care for autoimmune diseases is about 120 billion dollars, which is almost twice the cost of world health care for cancer, about 70 million dollars a year.

Treatment autoimmune reaction

Unfortunately, many of the conventional treatments can make the condition worse. Anti-inflammatory drugs such as Advil, steroids, drugs with reduced immune activity such as methotrexate, and TNF alpha-blockers such as Enbrel and Remicade can lead to internal bleeding, kidney disease, depression, psychosis, osteoporosis, muscle loss, and diabetes, not to mention severe infections and cancer.

When used selectively, these drugs can help people reduce symptoms and improve quality of life, but they do not represent a long-term solution. They should be used at the end of treatment until the inflammation has cooled by treating the disease’s cause.

There is another way to treat autoimmune diseases. I will share with you the story I told the doctors at that gathering.

I am his case of cure

How to treat autoimmune reactions Mark Hyman MD

My patient Sam completed a long adventure of the health system before he decided to visit me. For years he wandered from doctor to doctor and received various markers for his problem without real help in treating his illness.

This adventure has developed various inflammatory conditions, including chronic inflammatory infections of the sinuses and prostate. All the doctors gave Sam various antibiotics for his infections.

Shortly afterward, very severe chest pains appeared, and he ended up in the emergency room. While he was there, doctors found swollen lymph nodes, and he was told he had lymphoma, a form of cancer. Sam lived in despair for three weeks until the biopsy results arrived. It turned out that he did not have cancer but an autoimmune disease. What is an autoimmune disease? The doctors weren’t sure.

He has abnormal blood test results that included low levels of red and white blood cells, high levels of antibodies, high immunoglobulin, and indications of autoimmune thyroid disease. All doctors were left in doubt as to the cause of this abnormal condition of the organism.

Meanwhile, Sam developed a metabolic weight gain syndrome (before diabetes) due to constant inflammation in the body.

Here is a quote from the notebook of one of the specialists who treated Sam:

“Whether he has lupus or some other disease is completely unclear. Regardless, she needs observation without therapeutic intervention. “

This was, unfortunately, not the standard case. What exactly did they plan to observe? Or maybe they were waiting for him to be upstairs to intervene?

When he realized the hopelessness of his situation, he came to me. Using functional medicine, a new way of thinking about the basic causes and imbalances that lead to chronic disease, I began to ask Sam simple questions. Then I went hunting for poisons, allergens, and infections that are the most common cause of inflammation, and I found the real causes of its symptoms.

He took so many antibiotics that he disturbed his intestinal flora and bacteria, which caused an increase in yeast and its development. Fungi and yeast flooded his body, even starting to grow between his toes, on his feet, groin, and his scalp. He had Helicobacter pylori in their intestines. He had a susceptible stomach that reacted to many foods, including dairy products and gluten. He was exposed to toxins in his work and had a very high mercury level. He also had a chronic sinus infection.

How am I? treated Sema?

Then we started the general cleaning. I treated the yeast with anti-fungal preparations H. Pylori with antibiotics. He got rid of food that causes allergies in his stomach, sorted out his intestinal flora, detoxified it from metal, and cleaned his sinuses.

Then I helped him treat his immune system by adding some nutrients, zinc, fish oil, vitamin D, various herbal preparations, and probiotics. I introduced him to a healthy diet, which did not produce allergic reactions to the anti-inflammatory diet.

After the entire treatment and his visit, I asked him how he felt, expecting him to say that he was better. His answer surprised me because he said he felt great.

He lost about 10 kilograms, and when his laboratory findings came, his blood count results were completely normal. His white blood cells increased, and his immune markers calmed down.

Sam’s results reflected a new model of thinking, functional medicine.

Protect your child from allergies

Although allergy predisposition is inherited, there are a few things we can do to reduce the likelihood of allergies and alleviate the discomfort that allergies cause in a child:

Allergen free and in utero

Especially if there is a predisposition to allergies in the family, you can reduce the baby’s risk of developing allergies by reducing exposure to allergens during pregnancy. This is especially true for food allergies. Avoid highly allergenic foods: hazelnuts, eggs, cow’s milk, and shellfish (sometimes even wheat and soy)

Breastfeed your baby

Asthma and other allergies are less common in breastfed babies. Breastfeed often and for as long as possible to protect your baby. The American Academy of Pediatrics and the WHO recommend breastfeeding as an ideal diet for 6 months of life. Breast milk contains protective IgA antibodies that the baby’s intestines do not contain. IgA antibodies reduce the occurrence of nutritional allergies. Unfortunately, there is not enough evidence that breastfeeding prevents the development of allergies later in life.

Delay the introduction into the diet of foods that can cause an allergic reaction

Dairy products, especially cow’s milk, should not be given to children under one year of age. Postpone hazelnuts, egg whites, and shellfish until they are two years old.

Clean the room where the child sleeps

Regular cleaning and ventilation of the room where the child sleeps will reduce allergenic particles’ presence in the air. 

Allergen-free cot

Remove fluffy stuffed animals and stuffed toys from the crib, avoid woolen and feather pillows and blankets. Try anti-allergy pillows and mattress covers. A crib board can also cause allergies if treated with formaldehyde during production. Check with the manufacturer to see if your bedroom furniture is made of formaldehyde-treated wood.

Smoking is not allowed.

Do not allow smoking in your home or near a child. Now that you have become a parent and you have a good reason to eliminate these limiting habits. “But I only smoke outside,” you might rationalize – anyway, you ingest allergens from smoke on your hair or clothes and expose your child to them as you hug and cuddle him. You could, very politely, say to your doctor, “Our doctor says she’s very allergic to tobacco smoke.”

Postpone going to the nursery or kindergarten

Research shows that kindergartens are more likely to suffer from respiratory infections (ear, sinus, asthma) that can worsen allergies. The impact of kindergarten on allergies also depends on other factors such as. How many children stay in how big space and time children spend outside. If possible, choose a kindergarten that is attended by smaller children and has larger rooms and a kindergarten where children spend a lot of time outside.

The home located away from allergens

If your child suffers from allergies and you have allergies in the family when choosing a location for the home, you should avoid:
· Proximity to motorways or roads with weighty traffic.
· Proximity to areas where weeds grow like ragweed.
· Areas with trees whose pollen causes allergies.
· Older houses with damp and moldy rooms.
· Wet basement apartments.

Clean the nose

The nose is the entrance for allergens. Make it a habit to clean your baby’s nose daily with saline or sprays containing seawater.

What do if you have a autoimmune disease?

If you have an autoimmune disease or allergies, here’s what to think about and what to do.

Check for hidden infections caused by viruses, bacteria, yeast, and fungi. If you find them, the doctor should treat them with certain medications.

Ensure you are not allergic to certain foods with food tests designed to eliminate most allergens containing certain foods.

Test for celiac disease, which is tested by taking blood.

Perform heavy metal toxicity testing. Mercury and aluminum, as well as other heavy metals, can cause an autoimmune reaction.

Fix your stomach and check for symptoms of irritable bowel syndrome.

Use fish oil, vitamin c, vitamin d probiotics to calm the autoimmune reaction naturally.

Exercise daily is a natural way to eliminate inflammation.

Use relaxing methods such as yoga, deep breathing, massage as stress activates the immune system.

Give this treatment system a chance and focus on your inflammation. After a while, you will feel that your inflammation is slowly decreasing and that your body’s functionality has significantly improved.

Rheumatoid arthritis is an autoimmune disease

Rheumatoid arthritis is chronic, systemic autoimmune disease characterized primarily by chronic symmetrical polyarthritis. Rheumatoid arthritis is a disease in which one’s own immune system “attacks” and causes inflammatory changes in symmetrically affected peripheral joints. The clinical course varies from mild to progressive rheumatoid arthritis that severely damages the joints. Because rheumatoid arthritis is a systemic disease, organs other than the joints, such as the skin, blood vessels, heart, lungs, and muscles, are often affected. Although it has a highly variable course, the most common are symmetrically inflamed peripheral joints (wrist, metacarpophalangeal joints), leading to progressive destruction of joint structures, usually accompanied by systemic symptoms.

Patients with this disease have a higher cardiovascular risk and increased mortality, i.e., shortened life expectancy. Life expectancy is shortened by 8-15 years in the most severely ill. About 40% of patients become permanently disabled after 3 years and in a milder form of the disease after 20 years.  There is a rapid decline in the function of the affected parts of the body in the first year after the onset of the disease, and the first year is an important prognostic indicator for the further course of the disease.

Rheumatoid arthritis affects 0.5-1.0% of the population. Women get sick 2-3 times more often than men. The disease’s onset can be at any age, but the most common time of onset of the disease is between 30 and 50 years.

The exact cause of Rheumatoid Arthritis is not known. It is probably multifactorial. It is known that women are affected three times more often before menopause than men, and after menopause, the frequency of disease onset is similar between the sexes. The disease has a higher incidence in the family, i.e., among relatives in the first generation and with a high incidence in monozygotic twins (up to 15%) and dizygotic twins (3.5%). Occasionally in families, it affects several generations. Genetic factors are thought to contribute up to 60% to disease susceptibility. There is a strong association between susceptibility to rheumatoid arthritis and HLA-DR4  haplotype that occurs in 50-70% of patients and correlates with a poorer prognosis.

Chronic inflammation of the joint envelope is caused by CD4 + type T lymphocytes’ activation.

Genetic and environmental causes of rheumatoid arthritis

genes cause rheumatoid arthritis

The frequency (prevalence) of rheumatoid arthritis is relatively uniform in the population of most countries in Europe and North America and ranges from 0.5-1.0%. A higher frequency in the world was found in the American ethnic group Pima and Chippewa Indians  (5.3-6.8%), while the lowest frequency was found in Southeast Asia, including China and Japan, where it is only 0.2-0.3%. (Picture).

The disease is most common in age groups over 65 years. Women have a higher prevalence of rheumatoid arthritis than men.

Epidemiological studies on rheumatoid arthritis have found that hereditary and environmental factors are important in the disease’s occurrence. 

The disease’s development requires environmental factors or a trigger (“trigger”) in genetically predisposed individuals. Taking oral contraceptives has been shown to have a protective effect. The frequency is restored in the subfertile and postpartum periods. Infections (EBV, CMV, parvovirus, and bacteria such as Proteus mirabilis and mycoplasma ) via HSP (heat shock protein) participate in the rheumatoid formation factor.

Among other reasons, smoking is significant, and to a lesser extent, various dietary, climatic, and geographical influences. Smoking is also associated with poorer efficacy in DMARD treatment and biologic therapy.

As part of the infection, several comorbidities associated with the development of rheumatoid arthritis should be mentioned as possible triggers of the disease, namely periodontal disease, which is a chronic infection that begins as gingivitis and progresses to periodontitis and bone destruction, urinary tract infection: Proteus, gastrointestinal infections caused by salmonella, shigella, campylobacter, yersinia, and chlamydia trachomatis.

The following factors are rheumatoid arthritis.

Several epidemiological studies have shown the importance of genetic factors on the onset of the disease.

1. Research on “migrant” population groups has shown that despite living in countries with a certain prevalence of the disease, the population of other ethnic groups that have immigrated and lived in those countries for generations has maintained the disease frequency characteristic of the countries from which they migrated. Thus, a very low incidence of RA was found in England among the population of the Caribbean and Pakistani origin, which is significantly lower than that in the domicile English population.

2. Familial grouping of diseases. It is estimated that RA’s occurrence is about 2 times more common among family members. However, it is significantly less than in some other chronic diseases such as diabetes or multiple sclerosis. 

3. Research on twins has shown that their common genetic characteristics can explain 50-60% of both twins’ disease occurrences. Some genes responsible for the onset of the disease are known today, such as HLA DRB1 and HLA DRB1 * 0404, which are estimated to be responsible for about 50% of RA’s genetic effect.

HLA genes

HLA gene polymorphism plays an important role in developing the disease, and most people have HLA-DR4, HLA-DR1, and HLA-DW15. DR4 is present in most ethnic groups, while, e.g., DRW more important in Japanese.
There is also significant polymorphism for other genes:

  • PADI4 – peptidyl arginine deiminase type, present in the bone marrow and peripheral leukocytes
  • PTPN22 – Protein tyrosine phosphatase, a nonreceptor type 22, encodes an intracellular tyrosine kinase that is a potent inhibitor of T-lymphocyte activation.
  • STAT4 – Signal transducer and activator of transcription 4, a transcription factor that interferes with activation by cytokines IL-12, IL-23, and IL-27.
  • CTLA4 – Cytotoxic T lymphocyte-associated antigen 4, from the membrane immunoglobulin family, inhibits T-lymphocyte activation.
  • TRAF1 – TNF receptor-associated factor 1 plays an important role in apoptosis, proliferation, and differentiation of inflammatory cells.
  • Polymorphism for TNF-α

Environmental factors

The meaning of “environmental” means all the factors that affect the disease’s occurrence, which cannot be explained by heredity or established genes. In a broader sense, environmental factors are outside the person and are related to food, water, air, etc. 
In rheumatoid arthritis, several environmental factors are known that may be more closely related to the onset of the disease:

1. Hormones and pregnancy.

Using birth control pills and your pregnancy are associated with a reduced risk of developing RA. However, in the postpartum period, especially after the first birth, the risk of developing the disease is increased. It is also considered that breastfeeding after the first pregnancy is the riskiest for the disease’s occurrence, compared to breastfeeding after other pregnancies.

2. Infections

There is more indirect epidemiological evidence that previous exposure to infectious agents may cause RA. This attitude stemmed, among other things, from the observation that the incidence of rheumatoid arthritis in the world is constantly decreasing, which is most likely due to the constant decline in the number of infectious diseases. Another indirect evidence is the higher incidence of the disease in persons receiving transfusions, through which the transmission of an infectious agent is also possible.
Epstein-Barr virus, the causative agent of infectious mononucleosis, and Proteus and Mycoplasma bacteria are most commonly associated with RA.

3. Other environmental factors

And. Diet.
Few epidemiological studies on the association of RA with diet have suggested a possible protective role of omega-3 fatty acids in developing the disease.

b. Smoking.
Somewhat more research has shown that people who smoke have a higher risk of developing this disease.

Rheumatoid arthritis continues to be a challenge for epidemiological research, which seeks to detect and elucidate both the hereditary and environmental factors of this disease and their interactions. 


The disease’s onset is characterized by infiltration of the synovial membrane lymphocytes, plasma cells, dendritic cells, and macrophages. CD4 lymphocytes, including TH1 cells, which secrete IFN-ϒ, and Th17 cells, which secrete IL-17A, IL-17F, and IL-22, play a central role in pathogenesis because they interact with other cells.

Lymphoid follicles develop within the synovial membrane in which interactions between T and B lymphocytes occur, leading to cytokines and autoantibodies in B lymphocytes (including rheumatoid factor ACPA – anti-citrullinated peptide antibodies).

Immunocomplexes activate synovial macrophages due to local damage, and they begin to produce inflammatory cytokines (TNF, IL-1, IL-6, IL-15).  These secreted inflammatory cytokines act on synovial fibroblasts, leading to synovial membrane edema and soft tissue and cartilage damage.

Activated fibroblasts are a rich source of cytokines, chemokines, leukotrienes, and matrix metalloproteinases that exacerbate local tissue damage and cause remodeling. The synovial membrane becomes hyperplastic.

An important event is the activation of osteoclasts by RANKL (secreted from T-lymphocytes and macrophages). The activation of chondrocytes by IL-1 and TNF exacerbates bone and cartilage destruction.

The joint structures in rheumatoid arthritis become hypoxic, and new blood vessels are formed (neoangiogenesis). The inflammatory altered synovial membrane becomes vascularized with activated endothelial cells that promote further leukocyte chemotaxis and maintain and enhance the joints’ inflammatory response.

Cytokines and their influence

Of all the cytokines, they play the most important role in TNF  and IL-6. Interleukin-6 has a role in regulating systemic effects in rheumatoid arthritis through induction of the acute phase of inflammation, anemia, chronic disease, dyslipidemia, fatigue, and reduction of cognitive functions. TNF plays the most important role in endothelial cell activation, fibroblast protection, and neoangiogenesis.

The consequences of the above processes are the formation of granulation tissue, rheumatoid nodules, and hyperplastic lymph nodes and bone marrow:

  • Inflammatory granulation tissue (pannus) spreads above and below the articular cartilage, which is progressively damaged. Later, fibrous or bony ankylosis of the joint develops. Muscles adjacent to the inflamed joint may also be affected and infiltrated with lymphocytes.
  • Rheumatoid nodules consist of a central region of fibrinoid material surrounded by a palisade of proliferating mononuclear cells. Apart from the joints, such nodules can also be present in the pleura, lungs, pericardium, and sclera.
  • Lymph nodes in rheumatoid arthritis are often hyperplastic, with numerous lymphoid follicles with large germinal centers and numerous plasma cells in the lymph node’s sinus and medulla.
  • The bone marrow is also hyperplastic.

Pathology of the disease

Rheumatoid arthritis is characterized by widespread, long-term synovitis (inflammation of the joint membrane). As mentioned, the cause is unknown, but the role is certainly played by a rheumatoid factor produced by plasma cells and local inflammation with immune complexes’ formation. The normal joint sheath is thin and comprises several layers of cells.

These cells are synovial cells similar to fibroblasts and macrophages that cover the loose connective tissue. Synoviocytes play a central role in the inflammation of the joint sheath.

In rheumatoid arthritis, the joint sheath thickens greatly, so much so that it can be palpated as a swelling around the joints and tendons. There is a joint envelope’s proliferation into folds, and the tissue is infiltrated by many different inflammatory cells, including polymorphonuclear cells, lymphocytes, and plasma cells. Therefore, the normally thin joint envelope becomes hyperplastic and thickened. There is also a significant proliferation of blood vessels.

Increased permeability of blood vessels and the joint envelope’s inner layer leads to effusion in the joint space, and the effusion contains lymphocytes and dying polymorphonuclear cells.

The hyperplastic joint sheath extends from the joints’ edges to the cartilage surface. This is called “pannus.” The panes of the inflamed envelope damage the underlying cartilage by blocking its normal diet (cartilage feeds passively from the joint fluid) and the direct effect of cytokines on chondrocytes. The cartilage thins and the bone beneath it becomes exposed. Local cytokine production causes juxta-articular osteoporosis during active synovitis.

Fibroblasts from the proliferating joint sheath also grow around the blood vessels between the edge of the joint sheath and the pineal bone and damage the bone. This is seen on MRI in the first 3-6 months after the onset of arthritis before diagnostic bone erosions appear on X-ray.

Therefore, these early lesions justify the use of DMARDs in the first 3–6 months after arthritis onset. Low-dose steroids and anti-TNF-α drugs stop or even reverse the formation of erosions. Erosions lead to various deformities and contribute to long-term disability.

Rheumatoid factor and anti-CCP antibodies

Rheumatoid factor is a circulating antibody to which the Fc is part of the IgG antibody-antigen. This nature of the antigen means that it independently accumulates in immune complexes and therefore activates complement and promotes inflammation, causing chronic synovitis.

Transient production of rheumatoid factor is an important part of the body’s normal mechanism for eliminating immune complexes. Still, in rheumatoid arthritis, they show much higher affinity, and their production is constant and occurs in the joints. They can be any immunoglobulin class (IgM, IgG, or IgA), and clinical tests usually detect IgM rheumatoid factor.

About 70% of patients with polyarticular rheumatoid arthritis have IgM rheumatoid in serum. Positive titers may precede the onset of rheumatoid arthritis.

The term seronegative rheumatoid arthritis refers to patients whose standard IgM tests for rheumatoid factor are consistently negative. They usually have a more limited pattern of synovitis.

IgM rheumatoid factor is not diagnostic for rheumatoid arthritis, and its absence does not rule out the disease, but it is a useful indicator of prognosis. A consistently high titer in early disease indicates more consistently active synovitis, greater joint damage, and greater disability eventually, and justifies earlier use of DMARDs.

Antibodies against citrullinated proteins (anti-CCP antibodies) and rheumatoid factor together are more specific for rheumatoid arthritis. Anti-CCP predicts the development of erosions and a worse prognosis.

Clinical picture, symptoms and signs

The typical presentation of rheumatoid arthritis (about 70% of cases) begins as a slowly progressive, symmetrical, peripheral polyarthritis that develops over a period of weeks to months. The patient is usually in his thirties to fifties, but the disease can occur at any age.

Less commonly (15%), rapid onset of the disease may occur over several days, or even overnight, with severe symmetrical polyarticular involvement. These patients often have a better prognosis. A worse prognosis than average (with a predictive accuracy of about 80%) correlates with female gender, gradual onset of the disease over several months, positive IgM rheumatoid factor, and/or anemia within 3 months disease onset.

Most patients complain of pain and stiffness in the hands’ small joints (metacarpophalangeal, proximal, and distal interphalangeal) and feet (metatarsophalangeal). Wrists, elbows, shoulders, knees, and ankles can also be affected. In most cases, multiple joints are affected, but about 10% present with knee or shoulder monoarthritis or carpal tunnel syndrome.

The joints are usually warm and hard, with some degree of swelling. There are limited movement and loss of muscle mass. Typically, joint stiffness lasts more than 60 minutes after waking up but can occur after prolonged physical activity. Light activity can relieve symptoms.

Systemic symptoms include afternoon fatigue and malaise, anorexia, generalized weakness, and occasionally low-grade fever.

Rheumatoindi arthritis joint involvement

X-ray of rheumatism

The effect of rheumatoid arthritis on the hands is great. In early disease, the fingers are swollen, painful, and stiff. Inflammation of the tendon sheaths increases functional damage and can cause carpal tunnel syndrome. Damage to the joints causes various typical deformities.

The most typical combination is ulnar deviation and palmar subluxation of metacarpophalangeal joints. This deformity may look ugly, but the function can be good when the patient learns to adapt, and the pain is controlled. Fixed flexion (boutonniere deformity) or fixed hyperextension (swan neck) of the proximal interphalangeal joints impairs hand function.

The disease can often affect the shoulders’ rotational ability, with pain in the hands at night. Stiffness also occurs that will interfere with daily activities such as dressing and feeding. 

Elbow synovitis causes swelling and painful flexion deformity.

Swelling of the ankles

One of the earliest manifestations of rheumatoid arthritis is a painful swelling of the foot’s metacarpophalangeal joints. The foot becomes wider, and a “hammer” deformity of the big toe develops. Exposing the metatarsal joint surface to pressure and pushing the protective fat pad forward causes pain. Ulcerations and blisters may develop under the metatarsal heads and the dorsum of the fingers.

Rheumatoid arthritis of the joints of the middle and back of the foot causes a flat medial arch and the foot’s flexibility. The ankle often occupies a valgus position. Therefore, wide, deep, padded shoes are appropriate, but they are rarely fully adequate, and walking is often painful and limited. Surgery may be required.


knee pain

Massive synovitis and knee effusions occur but respond well to aspiration and steroid injections. Persistent effusions increase the risk of popliteal cyst formation and rupture. In the later stages of the disease, cartilage and bone erosions cause joint space loss visible on X-ray and damage to the medial or lateral and/or retropatellar section of the knee.

Depending on the involvement pattern, the knees may develop varus or vargus deformities. Secondary osteoarthritis develops. A complete knee endoprosthesis is often the only way to restore mobility and relieve pain.


The hips are rarely affected in early rheumatoid arthritis and are less commonly affected than the knees in all disease stages. Pain and stiffness are accompanied by radiological loss of joint space and juxta-articular osteoporosis. The latter may allow medial migration of the acetabulum (protrusio acetabulae). Later, secondary osteoarthritis develops. An endoprosthesis is usually needed.

Stiff neck

Painful stiffness of the neck in rheumatoid arthritis is often muscular. Still, it may be due to rheumatoid synovitis involving the upper cervical spine’s synovial joints and bursae that separate the dance from the anterior arch of the atlas. Synovitis leads to bone destruction, damages the ligaments, and causes atlantoaxial or instability of the upper cervical spine.

Subluxation and swelling of the local synovial membrane can damage the spinal cord, creating pyramidal and sensory signs. The best way to visualize this damage is by MRI. In the later stages of the disease, walking difficulties can occur. Joint diseases cannot explain that weakness of the legs or loss of bowel or bladder control can occur due to the spinal cord’s compression and is a neurosurgical emergency.

Imaging of the cervical spine in flexion and extension in patients with rheumatoid arthritis before surgery or upper gastrointestinal endoscopy is required to check for instabilities and reduce the risk of spinal cord injury during intubation. 

Other joints affected by the disease are temporomandibular, acromioclavicular, sternoclavicular, cricoarytenoid, and any other synovial joint.

Extraarticular manifestations Rheumatoid arthritis

Subcutaneous nodules are solid, intradermal, and generally occur over pressure areas, typically the elbows, finger joints, and Achilles tendon. Histologically, a necrotic center is surrounded by rows of activated macrophages, resembling synovitis without synovial space. Nodules can ulcerate and become infected but usually disappear when the disease comes under control. The doctor can remove the nodules surgically, or a corticosteroid can be injected into them if they cause problems. They often come back. 

Olecranon and other bursae may be swollen (bursitis).

Tenosynovitis of the affected flexor tendon in hand can cause stiffness and curl of the finger. Swelling of the extensor tendon and dorsum of the wrist is common. 

Loss of muscle mass around the joints is also common. Muscle enzyme concentrations are normal. Myositis is sporadic. Corticosteroid-induced myopathy may occur.

Peripheral intrapulmonary nodules are usually asymptomatic but may cavitate. When pneumoconiosis (Caplan’s syndrome) is present, large cavitation lung nodules may develop. Other manifestations may be serositis causing pleural effusions, pleural nodules, fibrosing alveolitis (pulmonary fibrosis), obstructive bronchiolitis, infectious lesions (e.g., tuberculosis in patients on drugs that modify the immune response).

Vasculitis is caused by immune complexes deposited in the artery walls, which is not common. Smoking is a risk factor. Other manifestations are nail bed infarctions due to cutaneous vasculitis, widespread cutaneous vasculitis with skin necrosis seen in patients with the highly active and highly seropositive disease, mononeuritis multiplex, intestinal infarction due to necrotizing arteritis of mesenteric blood vessels (which is difficult to distinguish from polyacid nodules).

Elevated CRP

Poorly controlled rheumatoid arthritis with long-term elevated CRP is a risk factor for premature atherosclerosis of the coronary and cerebral arteries independent of traditional risk factors. Clinical pericarditis is rare. In severely seropositive rheumatoid arthritis, a post-mortem echocardiogram shows that 30-40% of patients have pericardial involvement. Endocarditis and myocardial disease are rarely seen clinically, but 20% of cases are also found post-mortem. It also occurs  Reynaud’s syndrome.

Amyloidosis causes nephrotic syndrome and renal failure. It is presented by proteinuria. It occurs mainly in severe, long-term rheumatoid disease due to the deposition of stable serum amyloid A protein (SAP) in various organs’ intercellular matrix. SAP is an acute phase reactant normally produced by the liver. Amyloidosis is rare, and disease-modifying drugs more commonly cause proteinuria in RA. 

Felty’s syndrome is splenomegaly and neutropenia in patients with rheumatoid arthritis. Complications are ulcerations on the legs and sepsis. HLA-DR4 is found in 95% of patients, compared with 50-75% of patients with rheumatoid arthritis alone. Lymph nodes can be palpable, usually in the distribution of affected joints. It may be peripheral lymphedema of the arm or leg. 

Anemia is almost universal and is usually normochromic, normocytic anemia of chronic disease. There may also be iron deficiency due to gastrointestinal blood loss due to taking nonsteroidal antirheumatic drugs, or even rarely hemolytic (positive Coombs test). There may be pancytopenia due to hypersplenism in Felty syndrome or as a complication of DMARD treatment. High platelet counts occur with active disease.


The diagnosis is based on the ACR (The American College of Rheumatology) criteria. Their diagnostic algorithm is shown in the figure and the table’s criteria.

Initial searches include:

  • complete blood count. Anemia may be present. Erythrocyte sedimentation rate and CRP are elevated in proportion to the inflammatory process activity and are useful for monitoring treatment.
  • Serological tests. Anti-CCP is positive earlier in the disease, and in early inflammatory arthritis indicates the likelihood of progression to RA. Rheumatoid factor is present in about 70% of cases, and low titer ANA in about 30% of cases.
  • X-ray of affected joints. Only soft tissue swelling is seen in early disease. MRI can show early erosions but is rarely sought.
  • Aspiration joint if the effusion is present. The aspirate appears cloudy due to the presence of white blood cells. Septic arthritis may be suspected in a suddenly painful joint.

Differential diagnosis

Many disorders can mimic rheumatoid arthritis:

  • crystal-induced arthritis
  • osteoarthritis
  • the systemic lupus erythematosus (SLE)
  • sarcoidosis
  • reactive arthritis
  • psoriatic arthritis
  • ankylosing spondylitis
  • arthritis associated with hepatitis C.

Rheumatoid factor may be nonspecific and is often present in several autoimmune diseases; as already mentioned, anti-CCP is more specific for RA. For example, hepatitis C may be associated with RA-like arthritis clinically, and RF is positive. However, anti-CCP is negative.

Some patients with arthritis-induced crystals may meet the RA’s diagnostic criteria, but an examination of synovial fluid should clarify the diagnosis. The presence of crystals makes RA amazing. Joint involvement and subcutaneous nodules can result from gout, cholesterol, and amyloidosis as well as RA; you may require aspiration and nodule biopsy.

SLE can usually be distinguished if there are skin lesions on light-exposed areas of the skin, hair loss, lesions of the oral and nasal mucosa, absence of joint erosions even in long-term arthritis, synovial fluid often having less than 2000 white blood cells per microliter (predominantly mononuclear cells), antibodies to double-stranded DNA, renal disease, and low serum complement levels.

Unlike RA, deformities in SLE can usually be reduced due to lack of erosions and damage to cartilage or bone. RA-like arthritis can also occur in other rheumatic disorders (e.g., polyarteritis, systemic sclerosis, dermatomyositis, or polymyositis). There may be features of more than one disease, indicating an overlap syndrome.

Sarcoidosis, Whipple’s disease, multicentric reticulohistiocytosis, and other systemic diseases can affect the joints. Acute rheumatic fever has a migratory joint involvement pattern and evidence of previous streptococcal infection.

Reactive arthritis

Previous gastrointestinal or genitourethral symptoms can distinguish reactive arthritis; asymmetrical grip and pain on the grip of the Achilles tendon, sacroiliac joints, and ankles; conjunctivitis, iritis, painless buccal ulcers; circulatory balanitis; keratoderma blennorhagicum on the soles and elsewhere. 

Psoriatic arthritis

Psoriatic arthritis is usually asymmetric and usually not associated with RF, but differentiation can be difficult without nail or skin lesions. Involvement of the distal interphalangeal joints and arthritis mutilans strongly indicates the diagnosis and the presence of diffusely swollen fingers (“sausage” fingers). Ankylosing spondylitis can be distinguished by the spinal and axial joints’ involvement, absence of subcutaneous lesions, and negative RF.


Osteoarthritis can be distinguished by affected joints, the absence of rheumatoid nodules, systemic manifestations, significant amounts of RF, and less than 2,000 white blood cells per microliter of synovial fluid. Osteoarthritis of the hands most typically affects the distal interphalangeal joints, the thumbs’ bases, and the proximal interphalangeal joints. Rheumatoid arthritis does not affect the distal interphalangeal joints.


The diagnosis of rheumatoid arthritis inevitably causes concern and fear, and the patient requires a lot of explanation and support. Early diagnosis with early referral to a rheumatologist is the most important component. You should note that most patients will continue a more or less normal life with the help of medication despite arthritis; 25% fully recover.

The earliest years are often the most difficult, and people should be encouraged to stay at work during this phase if possible. Planning is hampered by uncertainties about when the disease will have remission or worsening, when and whether medications will work, and whether they will produce side effects. People learn to adapt very well, but it takes time and support. 

No drug will cure rheumatoid arthritis, but drugs are available that prevent the disease from getting worse. Symptoms are controlled with analgesics and nonsteroidal antirheumatic drugs. Studies now support the use of disease-modifying drugs (DMARDs) in early disease to prevent irreversible damage due to arthritis, and drugs that block TNF-α and IL-6, and the use of rituximab B-cell ablation revolutionize the management of rheumatoid arthritis.

Non-steroidal anti-inflammatory drugs (NSAIDs)

Most patients cannot cope with night pain and stiffness without nonsteroidal antirheumatic drugs. NSAIDs do not reduce the underlying inflammatory process. Everyone acts on the cyclooxygenase pathway. The individual response to nonsteroidal antirheumatic drugs varies greatly, so it is advisable to try several different medications to find the one that suits the person the most. Each of these drugs should be given for at least a week. It makes sense to start with cheaper NSAIDs that have fewer side effects and that you are more familiar with. Regular doses are needed for therapy to be effective.

If gastrointestinal side effects are present and the patient is older than 65, it is not bad to add a proton pump inhibitor. Slow-release formulations (e.g., diclofenac slow-release 75 mg, after dinner) usually work well and can be given with other therapies if needed. For additional analgesia, a simple analgesic (e.g., paracetamol or a combination of codeine or dihydrocodeine and paracetamol) may be taken as needed. Many patients need night sedation.


Some studies suggest that early use of corticosteroids slows the disease’s course. Intraarticular injections of semi-crystalline steroids have a powerful but sometimes only short-lived effect. Intramuscular depot injections (40-120 mg methylprednisolone depot) help control severe disease exacerbations but should not be used frequently. The use of oral corticosteroids causes many problems. They are powerful in controlling the disease but should be avoided for a long time because of the inevitable side effects. 

Disease-modifying antirheumatic drugs (DMARDs)

Traditional DMARDs, which mainly act by inhibiting cytokines, reduce inflammation, reduce joint inflammation, reduce acute phase reactants in plasma, and slow the development of joint erosion and irreversible damage. Their effect is not rapid and can only be partial or transient.

DMARDs often have a partial effect, achieving between 20 and 50% improvement in ACR criteria for disease remission (morning stiffness lasts less than 15 min, no fatigue, joint pain, soft tissue swelling; erythrocyte sedimentation less than 30 in women and less than 20 in men). Drugs that block TNF-α and rituximab achieve almost 70% improvement in about 20% of patients and act faster. Sulfasalazine, methotrexate, leflunomide, TNF-α blockers, cyclosporine, and rituximab all show a reduction in the rate of progression of joint damage in early and late disease.

Generally, DMARDs are used after symptomatic treatment. However, patients positive for rheumatoid and anti-CCP with persistent joint swelling have a poor prognosis. They should be treated early with DMARDs – preferably before X-ray erosions appear on the hands and feet.

Studies in early cases of RA suggest that DMARD intervention 6 weeks to 6 months from the onset of the disease improves outcome. The use of combinations of three or four drugs (steroids, methotrexate, sulfasalazine, and hydroxychloroquine) in early RA, with a reduction in the number of drugs, when remission is achieved, is not widely accepted, and the efficacy of such therapy has yet to be proven. Effective DMARD treatment reduces cardiovascular risk in RA patients.

People who will not develop erosions should not be over-treated. Most prognostic estimates in early disease are only 80% accurate for the risk of erosions and consequent disability. Clinicians’ estimates remain the most important link in rheumatoid arthritis management.


Sulfasalazine is a combination of sulfapyridine and 5-aminosalicylic acid, where sulfapyridine is probably the active ingredient. It is well-tolerated, and for most, DMARDs are the first choice, especially in younger patients and women planning a pregnancy. It generates a response in about half of patients in the first 3-6 months. Serious side effects are rare, mostly leukopenia and thrombocytopenia.


Methotrexate is, according to many, the first option. It is strictly contraindicated in pregnancy. Therefore, you should delay conception for at least 3-6 months after taking methotrexate for both partners. It is given in an initial weekly dose of 2.5-7.5 mg orally, increasing to 15-25 mg if needed. It is well-tolerated, and this therapy can be used early in the disease. Nausea or poor absorption may limit its effectiveness.

It can be given by subcutaneous injection alone. You should give folic acid with methotrexate to limit side effects, although this may reduce effectiveness. You should monitor the complete blood count for liver function tests. Methotrexate usually works within 1-2 months. Most patients remain on methotrexate, indicating that this is an effective therapy with relatively few side effects.


Leflunomide is a DMARD that achieves its immunomodulatory effects by preventing pyrimidine production in proliferating lymphocytes by blocking the enzyme dihydroorotate dehydrogenase. Most cells can bypass this blockade, but T cells cannot – therefore, it has a specific effect on blocking T cells’ clonal expansion by slowing the progression through phases G and S1. It is well absorbed when taken orally. It has a long half-life, 4-28 days. A bolus dose of 100 mg is usually used for 1-3 days, followed by 20 mg (10 mg if diarrhea is a problem).

The main side effects are diarrhea, nausea, alopecia, and rash. Diarrhea decreases over time. Monitoring of the complete blood count is mandatory. The onset of leflunomide onset is 4 weeks, in contrast to methotrexate which has 6 weeks. The initial response is similar to that of sulfasalazine, but progression continues and is better maintained after 2 years.

Leflunomide works in some patients who do not respond to methotrexate or may be given methotrexate to improve the response. As far as planning a pregnancy is concerned, one should wait 2 years after taking leflunomide for conception in women, 3 months in men, so it is best to avoid it in women planning a family.

Biological therapy

The availability of drugs that block TNF-α has significantly changed DMARDs’ traditional use. They are used because of their cost when at least two DMARDs (usually sulfasalazine and methotrexate) have been tested. 


Infliximab is a chimeric monoclonal antibody against TNF-α, administered intravenously and prescribed with methotrexate to prevent loss of efficacy due to antibody production.  Adalimumab is a fully-humanized monoclonal antibody against TNF-α and is also co-administered with methotrexate.

These drugs slow or stop the formation of erosions in up to 70% of patients. Patients often report that their fatigue and tiredness improve in a way not seen with other DMARDs. There is a 50% incidence of secondary failure with infliximab in the first year, less with adalimumab and another TNF-α blocker, etanercept. The change to another anti-TNF drug is justified, and disease control is achieved again. 

A small proportion of patients taking biologic therapy may become ANA positive and develop a reversible lupus-like syndrome, leukocytoclastic vasculitis, or interstitial lung disease. Reactivation of old tuberculosis may also occur (therefore, a chest X-ray or quantifier test is required before treatment), and you should treat tuberculosis before starting therapy. There is an increased risk of infection that requires closer monitoring.

Biologic therapy is costly compared to classic DMARDs but can reduce the cost of treatment in the long run by reducing disability and the need for hospitalization.


Rituximab is a chimeric monoclonal antibody that causes lysis of CD-20 positive B cells. CD-20 is a surface phosphoprotein antigen. Its expression is limited to pre-B and mature B cells but is not present on stem cells and is lost before differentiation into plasma cells. Rituximab produces a significant improvement in rheumatoid factor-positive rheumatoid arthritis at 8 months to several years when used alone or in combination with corticosteroids and/or methotrexate.

This is associated with six to nine months of B cell lymphopenia with small circulating immunoglobulins changes. Reactivation of the disease is associated with a return of peripheral lymphocyte counts and elevated CRP levels. Rituximab can be re-used if the disease is activated. Repeated therapies over 5 years are acceptable and well-tolerated, and about 80% of RF-positive patients respond, and 50-60% show long-term disease control. Therefore, you should try this drug in patients who have not responded to anti-TNF therapy. 

Less commonly used medications

Hydroxychloroquine is an antimalarial used in mild diseases as an adjunct to other DMARDs. The most serious side effect is retinopathy, but it is rare at least 6 years before treatment.

Azathioprine at a maximum dose of 2.5 mg/kg body weight and cyclophosphamide 1-2 mg0 kg body weight were usually used when other DMARDs were not effective. They are often used with severe extra-articular manifestations, especially with vasculitis. There is a high risk of neutropenia and possible liver toxicity in genetically deficient patients in the enzyme thiopurine methyltransferase.

Cyclosporine 2.5-4 mg/kg is used for active rheumatoid arthritis when conventional therapy has been ineffective. Side effects include elevated creatinine levels and hypertension.


Rheumatoid arthritis reduces life expectancy by 3 to 7 years, where the main culprits for death are heart disease, infections, gastrointestinal bleeding; treatment, malignant diseases, and underlying diseases may also be responsible.

At least 10% of patients eventually have a permanent disability despite full treatment. Caucasians and women have a worse prognosis, as do patients with subcutaneous nodules, older age at onset, inflammation of more than 20 joints, early erosions, smoking, higher erythrocyte sedimentation rate, and higher levels of rheumatoid factor or anti-CCP.

Pain relievers

IN winterize glucosamine and chondroitin sulfate supplements to reduce pain and slow cartilage loss. Evidence suggests that this combination may be effective for people with mild to moderate arthritis. Follow the proofing instructions on the label and persevere: it may take a month or more before you start to feel the beneficial effects.

Take half a teaspoon of powdered ginger or up to 35 g (about 6 teaspoons) of fresh ginger a day. Research shows that ginger root helps relieve pain in arthritis, probably because of its ability to increase blood circulation, removing inflammatory compounds from painful joints.

Take two doses of 400 mg SAM_a (S-adenosylmethionine) per day. It has been shown that the addition of SAM_a, a chemical found in all cells of the body, helps relieve arthritis pain by increasing levels of proteoglycans in the blood – molecules that appear to play a key role in preserving cartilage by helping it stay “inflated” and well oxygenated.

If you get good results from 800 mg per day, reduce the dose after two weeks to 400 mg per day. SAM has several side effects, although it can cause indigestion and nausea. It is safe to take with most prescription and over-the-counter medications. Still, if you are taking medications prescribed for bipolar disorder (manic depression) or Parkinson’s disease, you should consult your doctor before taking SAM_a supplements.

Look for warm relief and cool comfort

Applying heat to a sore joint can provide significant relief. You can use electric blankets and hand warmers, heating pads, or warm pads as heat sources. Heat a sore joint for 20 minutes. Simply bathing in warm water can also be soothing.

Cold treatments can work well when the joints are inflamed. Wrap ice cubes in a larger face towel and hold over the sore wrist. You can use a bag of frozen peas instead.

A natural way to reduce disease symptoms

Recipe 1. Bone pain

Take three tablespoons of finely chopped onion, horseradish root (grated), and fresh cabbage (grated). Mix everything and pour over with 100ml of oil. Lightly fry over high heat. Cool and get the obtained, mash, put the obtained porridge on a linen cloth, and attach it to the diseased bone. The dressing lasts all night. After removing the dressing, wash the place where you kept the dressing (the affected area) with lukewarm water, and then rub it with wine vinegar for 10 minutes. Bone pain should pass after 3-4 treatments (nights).

Recipe 2. Tea against rheumatism

Mix two tablespoons of finely chopped willow bark, walnut leaves, juniper berries, and buckthorn grass. Pour 1400 ml of boiling water over the resulting mixture of herbs. Cover and let stand for two hours. Strain and drink 200 ml during the day before breakfast, lunch, and dinner.

Recipe 3. Massage solution for patients with rheumatism

Mix 50 g of finely chopped rosemary and St. John’s wort. Pour the resulting mixture of herbs into a one-liter glass bottle. Fill the bottle with homemade lump brandy, or 70% ethanol. Keep the bottle in a warm (warm room or sunny window) for 20 days. Shake the bottle several times during the day. After 20 days of extraction, strain the bottle and use the obtained liquid to massage the body’s diseased parts. The affected areas are massaged for a maximum of 30 minutes until the skin absorbs fluid or until a tingling sensation is felt.


  1. Aletaha D, Neogi T, Silman A, Funovits J, Felson D, et al. 2010 Rheumatoid Arthritis Classification Criteria: An American College of Rheumatology / European League Against Rheumatism Collaborative Initiative. Arthritis Rheum 2010; 62: 2569-81
  2. Davidson’s Principles and Practice of Medicine, 21st. edition with student consult online access; Nicki R. Colledge, BSc, FRCP (Ed), Brian R.Walker, BSc, MD, FRCP (Ed) and Stuart H. Ralston, MD, FRCP, FMedSci, FRSE
  3. Vrhovac B. et al. (ed.): Internal Medicine, IV amended edition, Naklada Ljevak doo, Zagreb 2008
  4. Gibofsky A. Overview of epidemiology, pathophysiology, and diagnosis of rheumatoid arthritis.Am J Manag Care. 2012 Dec; 18 (13 Suppl): S295-302.
  5. Izabela Korczowska. Rheumatoid arthritis susceptibility genes: An overview. World J Orthop. Sep 18, 2014; 5 (4): 544–549.
  6. Song Li, Yangsheng Yu, Yinshi Yue, Zhixin Zhang, and Kaihong Su. Microbial Infection and Rheumatoid Arthritis. J Clin Cell Immunol. Dec 2013; 4 (6): 174

Sun allergy symptoms and how to alleviate them

Sun allergy, whose trigger is sunlight and photosensitive changes on the skin that react to certain medications or care products, especially worsens during the summer.

The effect of light from the UV spectrum can cause changes in the structure of certain skin proteins, which then immune system cells recognize, so an allergic reaction occurs. This is how primary (idiopathic) photodermatoses occur, skin diseases that affect 10-20 percent of the population. These skin reactions are most common during the summer months when the sun’s radiation is strongest.

For patients with this problem, sun protection with a high protection factor is necessary, although sometimes it is not enough, so drug therapy is also applied. There are also secondary photodermatoses that occur as a result of sun exposure and some diseases, contact with certain chemical substances, taking medication … Many drugs can cause photosensitivity reactions, so in the summer months, patients should be additionally warned about this possibility and possibly modify the time of application of these drugs.

What is a sun allergy?

 svrab po telu alergijaPhotoallergic (photosensitive) dermatoses, i.e., sun allergy, are diseases that occur due to increased skin sensitivity to the effects of UV rays. It is most often about autoimmune reactions formed by the cells of the immune system mistakenly recognizing skin cells as antigens after changes in the structure of skin cell proteins caused by UV radiation.

In most people who are allergic to the sun, allergic reactions manifest themselves in the spring if unprotected skin is exposed to the sun. 

What is the difference between sunburn and sun allergy?

Although these two problems’ symptoms are similar, the mechanism of occurrence is completely different. In photosensitivity reactions, the patient’s immune system is activated, which leads to the appearance of symptoms even if the person has been in the sun for a relatively short time. On the other hand, burns occur when the body is exposed to UV radiation for so long that it exceeds the skin’s ability to produce melanin, which protects it from the sun’s radiation.

Sun allergy is manifested by the appearance of itching, hives, or burning of the skin, with or without a visible rash, as a reaction to sun exposure. Depending on the type of photosensitivity, the symptoms appear at different speeds, from a few minutes to a few hours after any exposure to the sun, and they also pass.

Are all sun allergies the same?

sun allergy

Idiopathic (primary) photodermatoses are commonly called sun allergies and actually involve different reactions: polymorphic light eruption, actinic prurigo, chronic actinic dermatitis (characteristic of the elderly), solar urticaria.

The polymorphic light eruption is widespread, and according to the latest research, every fourth patient who has a sun allergy has this diagnosis. This type of allergy to the sun often affects young women, and it occurs much less often in men.

Symptoms of this type of sun allergy are manifested in the lower part of the neck, on the back of the hands, on the folds of the legs and arms, a few hours after exposing the skin to the sun’s rays. The polymorphic light eruption is characterized by rash, severe itching, and flushing of the skin, with the appearance of swelling. The swellings resemble insect stings and the inflammation and inflammation that occurs after them. The veil symptoms often disappear after a few days if re-exposure to the sun is prevented and adequate protection is used. Symptoms are present in spring and early summer and decrease as skin exposure to sunlight and strong sunlight decreases. The symptoms decrease as the summer passes but reappear the following year at the same intensity.

Solar urticaria is also a common occurrence of sun allergy. It is very soon after the first exposure of the skin to sunlight. The symptoms are hives, unbearable itching, redness of the skin, very sixth, and flatulence. Solar urticaria is difficult to distinguish from sunburn, but these symptoms quickly disappear as the skin is removed from the sun in less than a day.

Symptoms appear on the lower part of the neck, the back of the hands, the folds of the arms and legs a few hours after exposing the skin to the sun.

What causes a sun allergy?

It is difficult to say why sun allergy occurs. It is assumed that genetics has a certain role because it has been noticed that sun allergies are more common in people who have already had this problem in their family. Risk factors include race, although allergic skin reactions can occur regardless of skin color and amount of pigment, gender (more common in women) and age (polymorphic light eruption more common in 20-35 age groups, chronic actinic prurigo more common in the older adult).

Chemical photosensitivity occurs when various substances are taken into the body or applied to the skin in contact with light. Symptoms similar to these allergies can occur in patients suffering from diseases such as systemic lupus erythematosus (SLE), porphyria, or even side, but also skin diseases such as vitiligo, eczema, rosacea, and the like.

Can some medications cause a reaction on the skin that is similar to that of an allergy?

drugs and sun allergies

Various chemicals can cause skin symptoms similar to an allergic reaction in skin and hair hygiene and care products (perfumes, soaps, anti-dandruff shampoos) and numerous medications. These reactions are usually more serious in patients allergic to the sun than in healthy people. A reaction such as contact dermatitis, which occurs when using sunscreen, is not uncommon. It can occur on any part of the skin on which the preparation is applied, but it is most common on those parts that are exposed to the sun.

Drugs that most often cause photosensitivity reactions include retinoids, nonsteroidal anti-inflammatory drugs (ketoprofen, naproxen, piroxicam, ibuprofen), antibiotics (tetracyclines and sulfonamides), antifungals, oral antidiabetics, diuretics, phenothiazines, tricyclics, but also some hormonal preparations for oral contraception. Photosensitivity can occur when the drug is administered orally and applied to the skin. St. John’s wort preparations also often give photosensitive reactions.

How is sun allergy diagnosed?

Since the rash is a nonspecific symptom, sun allergy cannot be diagnosed solely based on rash and redness. However, if the rash occurs only on parts of the skin exposed to the sun, it may be a sign that it may be an allergy. The diagnosis of sun allergy is made mainly after performing specific tests when the skin is exposed to UV light of different wavelengths.

Photo-patch testing is used if the doctor suspects that some photosensitive substances with which the patient came in contact could cause a reaction on the skin. In such tests, two patches impregnated with the substance suspected of causing the reaction are used. The patches are left on the skin for 24 hours, and then the skin under one of the patches is exposed to UV light to see if there are photosensitive reactions.

Are there any recommendations for relieving symptoms?

Beta carotene, the most important form of Vitamin A, is very good for people who suffer from sun allergies and can reduce the skin’s photosensitivity. You should be careful with the use of vitamin A, and you should not overdo it because this vitamin can be toxic.

You should refresh the skin with moisturizing cream and lotions that reduce irritation, peeling, dryness, and itching. Preparations rich in aloe are great for these problems. People who are allergic to the sun should spend as little time in the sun as possible. Exposure time, in particular, should not be increased between ten and sixteen hours. The use of sunscreen is mandatory.

How to best protect yourself from the sun?

Patients who suffer from sun allergies are recommended to wear long-sleeved clothes and legs, preferably one that is not too thin, so that UV rays do not pass through it, and a hat.

All parts of the skin exposed to sunlight, and you should protect those under thin clothing with sunscreen with a high protection factor (SPF 20 or higher). Since there are allergies to UVA, UVB, or both types of UV rays, it is essential to use a product that contains both types of UV filters. You should also protect the skin indoors because UVA rays pass through the glass.

It is important to protect the lips with a suitable contact with a protection factor of at least 20. Patients are recommended gradual sun exposure. You should avoid san-block preparations, with a high content of mechanical filters such as zinc oxide and titanium dioxide, and preparations with para-aminobenzoic acid (PABA) because they can have an additional irritating effect on the skin.

What is the appropriate protection factor for people allergic to the sun and how often should a sunscreen be applied?

People allergic to the sun should not use a protection factor of less than 20, although there are recommendations to use at least a factor of 30. Since UVA rays also cause an allergic reaction, you must indicate the product to have high UVA protection. Sunscreen should be applied to the entire skin area half an hour before sun exposure and then at least once every two hours.

Although the product is waterproof, you should apply it every time after swimming and after each towel wiping. Water resistance, namely, depends on the time spent in the water, and the products that are so declared imply protection for 40 minutes, which includes the time required to dry the skin without rubbing with a towel.

What to do if a rash appears?

If a rash appears when a person is exposed to the sun, especially if it is happening for the first time, it should be treated as a burn. It is best to put on a cold compress and soothe any pain with paracetamol. You should then seek a doctor’s advice, who will see if it is just a burn or a photosensitive reaction of the primary or secondary type.

When is drug therapy recommended?

Itching is a basic symptom complained of by patients who have a problem with photosensitive skin reactions. If the patient does not tolerate itching, the use of oral antihistamines (loratadine, cetirizine, desloratadine, levocetirizine) is recommended. In more severe forms, corticosteroid preparations for topical use can also be used, most often with hydrocortisone or triamcinolone.

Some cases may require the oral use of corticosteroids, such as prednisone. It is generally short to minimize side effects. It is indicated before prolonged exposure to the sun, for example, before summer vacations or trips to the tropics, in people with severe allergies.

It is also possible to do phototherapy – desensitization of the skin with repeated exposure to light. It is usually recommended for patients with solar urticaria or polymorphic light eruption. It is performed under the supervision of a doctor, usually five times a week for three weeks, to induce tolerance and alleviate symptoms.

What is a protective factor?

Sun protection factor (SPF) is a measure of protection against UVB radiation. The ratio between the dose of UV radiation leads to erythema’s appearance in protected skin and the radiation dose that leads to the same phenomenon in unprotected skin. SPF 2 can absorb about 50 percent of the received radiation, while SPF 45 absorbs 98 percent of UVB radiation. According to the European Union directive, in order not to confuse the users, the biggest factor that you can find on cosmetics on the European market is 50+.

You should bear in mind that the degree of protection does not increase linearly with SPF growth. It is important to note that laboratory tests that determine the SPF involve applying 2 mg / cm2 of a protective agent, which means that a standard 200 ml bottle is used for about four to five smears of the whole body. Patients usually apply four times less protection (0.5 mg / cm2), so you should bear in mind that this significantly reduces the stated protection factor.


To prevent photoallergic eruption caused by sunlight and application to the skin body cream, perfumes, lotions, make-up … Dermatologists advise you not to use these products when exposed to the sun because the chemicals that these products contain can also cause allergies. 

The causes can be some medications, primarily antibiotics and birth control pills. Even sunscreens can cause side effects on the skin, so you should test them – apply a small amount, preferably on the forearm, and wait a while to see if the skin will react or not.

Sounds amazing, but artificial sweeteners, lettuce, carrots, celery, figs, primrose, parsnips, and dill can be the cause, so it is advisable to avoid these foods during sun exposure.

Preventive measures are gradual adjustment of the skin to the sun, application of UV protection cream with a high factor, and adequate clothing – best in white, long sleeves and socks, and a hat, cap … something that covers the face enough. 

Doctors say yes, sun allergy is not dangerous to health, but if you notice any more violent reactions on the skin, consult a dermatologist.

How is osteoporosis noticed and treated?

Osteoporosis is a chronic disease of the skeletal system, in which the bones become weak, brittle, and prone to fractures. The word osteoporosis itself means “porous bone.”

Osteoporosis develops over several years, most often without signs of disease. That is why we often call it a silent epidemic. Today, osteoporosis is one of the leading public health problems in developed countries. Large material resources are spent on treating and caring for patients with osteoporosis. Despite this, even in the most developed countries globally, up to 20% of patients with osteoporosis are treated.

Until recently, osteoporosis was considered a natural aging process. But there is nothing natural about that. Losing height or breaking a bone when climbing stairs or coughing is not a natural process. Furthermore, osteoporosis is not just age-related. Today, osteoporosis is also diagnosed in younger people with certain chronic diseases (more on this later).

Also, until recently, osteoporosis was considered a disease of postmenopausal women. However, one-third of people living with osteoporosis are men (Croatian Osteoporosis Society).

This leads to the division of osteoporosis:

-Primary (postmenopausal and senile)
-Secondary (which, regardless of age, is found in chronic patients either as a result of taking certain medications or lifestyle changes).

Let’s start with a little look at the history of osteoporosis.

Hip fractures have been observed in ancient Egyptian mummies. This indicates that osteoporosis has been around for thousands of years. It was considered an inevitable aging process. Stereotypes from literature, art, and other media encouraged this misconception by portraying the elderly as shaky, insecure, bent, and hunched over, often with a coat of arms on their backs.

starija pogurena ženaIn 1830 in France, one doctor noticed that the bones were full of cavities and resembled honeycombs in some people. He noted that such a condition greatly weakens the bones’ strength and structure. Then, for the first time in the literature, such a condition of the bones was described, which was later called osteoporosis. But that French doctor continued his research in another direction. Nothing was known about the causes for a long time. It wasn’t until around 1940 in America at a Massachusetts general hospital that a family doctor discovered an association between estrogen hormone reduction in older women and the onset of osteoporosis. Then begins the era of hormone replacement therapy.

Over the years, discoveries have changed osteoporosis and very complex disease that affects health.

It is never too early and never too late to fight osteoporosis! Namely, building strong bones in youth is just as important as procedures that slow down bone weakening in old age.


Before we begin to describe osteoporosis symptoms, it is necessary to explain the concept of osteopenia.

Osteopenia is a condition of reduced bone mineral density relative to normal values. Some doctors call osteopenia a precursor to osteoporosis (a condition that precedes osteoporosis). Osteoporosis does not develop in all individuals diagnosed with osteopenia (at the densitometry finding), but they are all at high risk for osteopenia to progress to osteoporosis.

Bone mass is built in youth and at the age of sexual maturity. The amount of bone mass stabilizes around the age of 30. After 40 it is gradually lost, approximately 0.5 to 1% per year.

Osteopenia occurs in women after menopause due to the loss of estrogen hormone.
It can also be caused by lifestyles (in both men and women) such as lack of exercise and movement, excessive alcohol consumption, smoking, prolonged use of drugs such as glucocorticoids (in some diseases such as asthma), long-term use of drugs for thyroid disease. Osteopenia can also occur in younger women who are intensely involved in athletics or, for example, marathons and younger women who have problems with proper nutrition (anorexia, bulimia).

Osteopenia should be taken seriously, and you should make efforts to prevent it from progressing to osteoporosis.

The difference between osteoporosis and osteoarthritis

Before describing osteoporosis symptoms, it is also necessary to mention the difference between osteoporosis and osteoarthritis Osteoporosis is not osteoarthritis!  Osteoporosis is a disease that affects the bones, while osteoarthritis affects the joints, i.e., the places where two bones join.

In osteoarthritis, damage to the cartilage serves as a shock absorber between the two joint surfaces, and damage to the cartilage also damages the bone. Then there is pain and restriction of movement in the joints. This is how deformed joints are formed.

Unlike the mentioned visual signs of osteoarthritis, osteoporosis usually occurs “quietly” and is often the first sign of a bone fracture.

Furthermore, it is important to mention that osteoarthritis and osteoporosis conditions can occur simultaneously.

Symptoms of osteoporosis

bone fracture X-ray

Bone loss develops painlessly over several years. There are no visible signs or symptoms in the early stage of the disease, even with a large loss of bone structure.

The most common first sign of osteoporosis is a bone fracture at the regular daily activity or at a minor fall or exertion, such as lifting a lighter load, with compressive vertebral fractures occurring with symptoms: back pain, loss of body height, and hunched posture. 

Although the main causes of back pain are muscle tension and arthritis, if you have been diagnosed with osteoporosis, such pain can also be associated with osteoporosis and requires a detailed medical examination.

Osteoporosis often remains unrecognized for a long time because, as it has already been said, it is a disease without characteristic symptoms and typical pain. 
So insidious back pain and fatigue are mostly ignored, while this should actually raise suspicion of osteoporosis, especially in old age.

Primary osteoporosis

Primary osteoporosis occurs as a result of a specific process. However, the direct cause is not recognized. At the same time, secondary osteoporosis (which is less common) occurs due to a known cause, which is mostly a chronic disease or long-term use of certain medications.

The two most common forms of primary osteoporosis are postmenopausal osteoporosis and age-related osteoporosis.

Both forms can be present in the same person.

Postmenopausal osteoporosis

Postmenopausal osteoporosis occurs during or after menopause (as the name suggests). As the concentration of the sex hormone estrogen decreases, so does the disease.

In most women, menopause begins around the age of 50. The hormone estrogen is important in building bones, so by reducing its concentration, the bone becomes more porous.
Estrogen depletion can occur several years before menopause.

Entering menopause with low bone mass (osteopenia) can lead to osteoporosis’s faster formation. Therefore, the onset of menopause is the last minute to take active measures to prevent osteoporosis if measures are not started earlier. By the age of 70, women lose up to 50% of their bone mass.

Age-related osteoporosis

All people lose bone mass with age, the process of building bones slows down, and decomposition speeds up or stays the same. The inner structure of the bone weakens, and the outer thins. It is a natural phenomenon of aging, but if too much bone mass is lost (which is not natural), age-related osteoporosis occurs. This condition usually appears at the age of 75. Age-related osteoporosis in women is often associated with postmenopausal osteoporosis.

Secondary osteoporosis

Secondary osteoporosis is caused by other diseases, medications that can speed up bone breakdown, and some surgical procedures. It is important to mention here that men also have osteoporosis (we will write about this later), most often a secondary form of osteoporosis. 

The causes of secondary osteoporosis are diseases of endocrine disorders such as. Lack of sex hormones increased parathyroid hormone levels, adrenal gland diseases, type I diabetes, and digestive tract diseases. Crohn’s disease, lactose intolerance, liver disease, rheumatoid arthritis, amenorrhea (absence of menstruation), prolonged immobility due to illness, or excessive physical activity such as. In younger athletes. 

Drugs such as secondary osteoporosis include corticosteroids, anticonvulsants, thyroid medications, gastric medications, some hormone inhibitors (for the treatment of tumors), and surgical procedures caused by organ transplantation, gastric and upper gastrointestinal surgery.
Other causes should be considered when determining osteoporosis’s exact condition and prognosis: bone structure, lifestyle, habits, gender, and age.

Densitometry in the detection of osteoporosis

What is densitometry?

Densitometry measures the amount of bone tissue in a particular part of the body, usually in the lower spine, hip, forearm, or heel bone.
Doctors use densitometry to assess the risk of fractures and whether treatment is needed.

What does densitometry show?

Densitometry of any bone can predict the overall risk of bone fracture. The amount of bone tissue measured is often called “bone density.” 
Bone density varies in humans, as does height, for example, but the lower the bone density, the greater the fracture risk. Densitometry is a much more effective method for determining bone density than X-rays, although some use ultrasound instead.

What is the densitometry of certain parts?

Densitometry of certain parts is a much more convenient method for some patients. Hip densitometry, for example, better predicts hip fracture, but some patients cannot be adjusted to the position to perform that examination.

Forearm densitometry is fast and accurate but cannot be performed in people who have previously had fractures of the wrist or suffer from some types of arthritis.

Spine densitometry sometimes gives false results in people over the age of 60 or in too thin or fat people.

How often do you need to do densitometry?

A single test is sufficient for most people to assess fracture’s future risk. Repeated densitometry may be needed after two to three years if a new treatment decision is needed. 
Densitometry is performed every two to three years in people receiving corticosteroid therapy.

So reduced bone density is always osteoporosis?

No, some other conditions can cause decreased bone density and cause fractures. These include osteomalacia (vitamin D deficiency), some glands’ overactivity, some digestive disorders, brittle bone disease (osteogenesis imperfecta), and some inherited conditions that cause fractures in childhood.
It is important to find these problems because they require different treatments.

Diet and nutrition for osteoporosis


In addition to bone structure, calcium plays a vital role in the proper functioning of muscles, heart and nerves, and normal blood clotting. It is found in every cell of our body, although about 99% of total calcium is found in our bones, which serve as a storehouse of calcium in the body.

Vitamin D

It is said to “unlock the door to calcium” because it maintains the calcium concentration in the blood and increases the absorption of calcium from the small intestine. Suppose there is not enough vitamin D, the concentration of calcium in the blood decreases. The sun plays the most important role in the supply of vitamin D. Under the sun’s influence, about 90% of the required amounts of vitamin D are produced in the body. Experts recommend exposing the face, shoulders, and arms to sunlight for 10-15 minutes two to three times a week, regardless of the season.


It is present in most foods such as meat, poultry, fish, eggs, dairy products, hazelnuts, legumes, cereals, and cereals. Phosphorus is important for the normal development and function of bones and tissues. In the last 20 years, e.g., in the United States, dietary phosphate intake increased by more than 15% due to increased consumption of foods with additives and carbonated beverages (unhealthy phosphates are formed).


They are the building blocks of bones and are important for tissue structure and regeneration. They are needed for fracture healing and the immune system’s normal functioning. The recommended daily amount is 44 grams for women and 56 grams for men. That means 56 grams = 2 large cups of milk and 150 grams of meat.

Useful tips to increase calcium intake

Use the knowledge of which foods are rich in calcium in your daily diet, and try to add at least one meal of foods rich in calcium to each meal. 

Three meals a day will provide you with at least 900 mg, compared to a daily requirement of 1200 to 1500 mg. 

a) A serving of 2 cups of soup with milk (maybe soy) will provide you with at least 300 mg of calcium
b) Oatmeal with 1 DCL of milk will provide you with 150 mg of calcium
c) Plain yogurt (2 DCL) contains an average of 450 mg of calcium;
d) One cup of cooked green vegetables (kale, spinach, red cabbage) contains 200 mg of calcium
e) By adding 3 mg of ground almonds to salads or stews, you will provide an additional 50 mg of calcium
f) Most soy dishes contain a lot of calcium:
g) One cup contains about 260 mg of calcium; 
h) solid tofu contains 860 mg of calcium per ½ cup;

Foods rich in calcium

Dairy Products

a) Yogurt, usually low fat (1 cup, 480 mg calcium, 140 kcal);
b) Soy milk (1 cup, 250 mg calcium, 80 kcal);
c) Milk usually (1 cup, 300 mg calcium, 150 kcal);
d) Swiss cheese (30 g, 270 mg calcium, 110 kcal);
e) Mozzarella (30 g. 205 mg calcium, 115 kcal)
f) Tofu (½ cups, 860 mg calcium, 180 kcal); 
Fish and seafood 
a) Sardines in a can (85 g (6 sardines), 325 mg of calcium, 177 kcal);
b) Salmon (85 g, 180 mg calcium, 120 kcal);


a) Orange juice (1 cup, 300 mg calcium, 105 kcal);
b) Papaya (1 medium, 70 mg calcium, 120 kcal); 
a) Soy (1/2 cup, 230 mg calcium, 125 kcal);
b) Kale (½ cups, 130 mg calcium, 30kcal);
c) Spinach (½ cups, 120 mg calcium, 20 kcal);
d) Cabbage (ice cups.115 mg calcium, 25 kcal);
e) Beans (½ cups, 100 mg calcium, 80 kcal);