Prerequisite before commit the sport or physical exercise, for the peoples whose have aged more than 40 years necessarily physician examination before commit the sport to prevent unwanted incident. Not be recommended to commit the sport if be found the condition as below (dr. Suwetra, on Seminar Kesehatan Olahraga, June 2008):

• Systolic blood pressure same with or more than 160 mmHg, and or diastolic blood pressure same with or more than 100 mmHg.
• Fast blood sugar content same with or more than 250 mg/dl.
• Have history of heart disease.
• Obesity with body weight 50% above of ideal body weight.

How the sport is committed?
In order the sport can give the result optimally, the sport need be committed regularly and be continued, because sport effect will decrease after three days and pass away after seven days be stopped.

Already be known that physical activity or sport with moderate intensity give best effect toward health. For the peoples whose do not usual commit the sport or physical activity, be recommended to start with mild activity and in shorter time than target, and then be increased step by step appropriate with the condition that be propertied.

Moderate aerobic exercise is the aerobic exercise with criteria as below:

• Type: fast walking, relax bicycling, swimming, and others.
• Intensity: 50 - 70% of maximal pulse beat (maximal pulse beat: 220 - age).
• Duration: 30 - 60 minutes
• Frequency: 3 - 5 times a week without rest more than two days and better every day.

Measuring of pulse beat very important in every commit the sport or physical activity to know do the sport already enough or no or otherwise instead too high.

Physical exercise be started by warming up during 5 - 10 minutes, core / principal exercise during 30 - 60 minutes and be finished by cooling down during 5 - 10 minutes. Warming up be committed by walking along far as 400 meters during 5 - 10 minutes with speed 1, 6 km/20 minutes. Core or principal exercise is committed by walking with speed 1, 6 km/15 minutes until arrive to target of pulse beat and be defended during 30 - 60 minutes. Cooling down be committed by walking along far as 400 meters during 5 - 10 minutes.

Mavis Lindgren a woman who on 60 years age about, began escaped because she had health problem and finally constituted a woman record holder on 11^th marathon competition of Portland. And finally accordance with routine she participated on marathon competition in USA and England. White clarifies that walking accordance with regularly more benefit than all of medicine which is given by doctor. Research about reparation of lifestyle include of  reduce of  the calories intake and increase of physical activity be compared with giving metformin medicine for prevention of  Diabetes Mellitus  on overweight population  during plus minus two years showed  that decreasing of Diabetes Mellitus case on reparation of lifestyle and metformin each amount of 58% and 31 % be compared with control. This showed that physical activity or sport as part of lifestyle has big function as medicine to prevent diseases like Diabetes Mellitus, and so other of degenerative diseases.

According to Darwiniah (evolutionary) medicine theory, rising of physical activity pushed the rising of genes activity which expressive the health promoting protein (HPP) and blocked the genes activity which expressive the disease promoting protein (DPP). For examples: Health promoting protein is AMPK (adenosine monophosphat activated protein kinase) and eNOS. And Disease promoting protein is nuclear factor kappa B (NFkB) which constitutes becomes as source of degenerative diseases. But not all of sport intensity level or physical activity has characteristic as medicine. Only moderately of sport or physical activity constitute as the best medicine for disease because it doesn’t rise super oxide or reactive oxygen species, oxidative most fat, raised antioxidant enzyme like super oxide dismutase (SOD), glutathione and catalase, and others.

Physical activity toward Diabetes Mellitus

Diabetes Mellitus disease is signed by complex metabolic disorder as the consequence of unhealthy lifestyle i.e. less of activity and ate more food as consequence of raising the community prosperity. As the complication of Diabetes Mellitus could happened cardiovascular disease, stroke, gangrene and others. Of these complications need be developed prevention efforts through raising the activity (sport) and reducing the calorie intake. While do the physical activity or sport occur raising removal of  glucose skeletal muscle cells amount 7 - 20 times folding than while rest condition, be depended of  physical activity or sport intensity. On early of moderate physical activity, energy source come from glucose oxidation which come from glycogen lyses of muscle glycogen and then from oxidation of muscle fat and glucose which be taken from blood. If moderate sport or moderate physical activity being continuously, so then the more much glucose and fat from blood are oxidized as energy source, where proportion fat more big with increasingly the time. Energy source which come from muscle fat in shape triglyceride and diacylglycerol (DAG). Increasing of DAG in skeletal muscle constitute the etiology of decreasing insulin activity until develop become Diabetes Mellitus. Increasing the oxidation of fat in skeletal muscle cause reducing of fat of skeletal muscle included of reducing DAG value until can repair activity of insulin. Beside that increasing the physical activity cause increasing the solve of ATP become AMP. AMP activate the AMPK and induce the removal of glucose which isn’t depended of insulin or need not insulin helping.  Physical activity so increase NO (nitric oxide) production which participates in increase the removal of glucose by muscle without insulin helping. So that moderate sport or moderate physical activity constitutes the medicine for Diabetes Mellitus sufferers.

Physical activity toward Cardiovascular Disease

Cardiovascular disease like as coronary heart disease, stroke and hypertension constitute the etiology of death number one in Indonesia although in the world. This disease be caused by genetic factor and west lifestyle i.e. less of physical activity and ate more food. By that cause WHO (2003) declared that therapy of cardiovascular disease which the best were with lifestyle modification i.e. increase the activity, reduce the calorie intake, reduce smoking and hard drinks. Reducing the calorie intake or decrease the body weight, increase protein give protect effect toward heart disease that be known with adiponektin. Reducing of body weight will more effective, if is followed by raising the moderate physical activity. The moderate physical activity increase enzyme activity of nitric oxide synthase (NOS) and NO production in endothelial cell and by parakrin cause relaxation the smooth muscle of blood vessel, and cause reducing the blood pressure on hypertension. NO so has effect to increase enzyme production of super oxide dismutase and maybe so katalase enzyme until increase capacity of antioxidant in body. Other functions of NO prevent atherosclerosis through prevention of inflammation process on blood vessel and prevent LDL-Cholesterol oxidation which also participates in atherosclerosis development.

Physical activity toward Cancer

Effect of moderate sport or moderate physical activity on prevalence of cancer because sport or physical activity reduce oxidative stress and increase antioxidant defense system, reduce free sex hormone (testosterone, estrogen, dihydrotestosterone), reduce sex hormone that be bundled globulin (SHBG) until reduce interaction target tissue, reduce insulin production and IGF-1 (prostate cancer, breast cancer, colorectal cancer).

Physical activity toward Osteoporosis

Walking very benefit for muscle strength and back bone be followed with stretching some kind of muscles like as muscular of   pectorals major and minor (chest muscle), muscular of latisimus dorsa (back muscles), deltoid muscles and trapezius  (shoulder muscles), muscular lumbalis (lumbar muscles), abdomen muscles, buttocks muscles, quadriceps muscle, hamstring muscles, biceps and triceps muscles, and calf muscles. Stretching is enforced during 15 - 30 seconds for each kinds of stretching.

]]> http://azygosmc.com/physical-activity-may-as-the-good-medicine-for-some-diseases.html/feed http://azygosmc.com/mental-health-servicing.html http://azygosmc.com/mental-health-servicing.html#comments Mon, 15 Sep 2008 14:29:09 +0000 admin http://azygosmc.com/?p=88

Mental Health according to medical science understanding now is a condition that enable optimally of physical, intellectuality and emotional development of a person, and that development run harmonious with other person. Meaning of mental health is a person has harmonious characters and focus interest to all side in their life and in their interaction with other person.

To arrive to that condition need be enforced efforts, like as: mental health maintenance in growing and development of child; manage the balance of mental by adaptation of manpower placing harmonious with aptitude and competency; improve the place and situation of occupation; and enhance the mental health level of a person in their relation with family and community.

Mental Health service by physician or nurse toward the individual is giving psycho-pharmaca medicines if be needed by patient, and solve the problem which be sided by patient and family.

Healthy mental and illness mental understanding, according to social-culture pattern of a community are different, beside almost all of physical disease content mental side and with good mental health approach will has profit in solve all problem of sufferer.

Sufferer of Mental disorder is not always with abnormal behavior, often the disorder that be indicated only by complain base. By that because all of physician and nurse whose work in Public Health Center  must have basic knowledge about mental health.

Several of character that can be used as holding in examination a person who has healthy mental, as below:

1. Has a quiet emotional, enough happy in their life and can interact by good with their children, family, and environment of live place or work place. Some time so can feel not happy, dispute, angry, but generally relative free from apprehensive about feeling, dislike feeling and anxiety feeling.
2. Can maintain the balance of mental accordance with steady, i.e. enough resolute, full understanding, and can make decision, so has responsible.
3. Has happy small child feeling, the meaning arrangement of living on small child period is very importance in development become adult. Some things importance have to be gotten in small child period are lovely, pity, praising, support, and healthy discipline.

Sport has prevention effect toward health disorder accordance with primary, secondary, and tertiary. Primary prevention means that sport regularly on people who healthy can prevent appearing of certain disease. Secondary prevention means that physical exercise regularly and with precise dosage can recover certain disease. Tertiary prevention means that physical exercise regularly and with precise dosage can prevent or decelerate the occurring of disease complication.

Physical activity that descends will increase prevalence of Diabetes Mellitus disease really. Epidemiology study proof that the participant of Harvard Nurse Health who do physical activity less than 150 minutes per week indicate the prevalence of Diabetes Mellitus and death by coronary hearth diabetic disease higher each 85% and 92% than who do physical activity more than 150 minutes per week. On year 1990 the prevalence of Diabetes Mellitus higher six time multiplies on Indian Pima Arizona families who adopt west lifestyle be compared with Indian Pima Mexico families with physical activity equivalent with 500 - 600 kilo calorie higher and consume food lower fat and higher fibrous. These indicate that changing of prevalence of disease support actor of environment genotype interaction.

The decreasing of physical activity on population during 200 years hold on actor on adapt some gene with together and with characteristic very complex. This interaction according to Darwiniah concept (evolutionary) medicine that less of physical activities (inactivity) cause the failing to defend expression of gene like on ending palaeotik level until occur barrier toward genes which expressive “health” promoting protein and activate “disease” promoting protein until increase the prevalence of disease on population with less physical activity.

Of that because, sport or physical activity if be enforced regularly can reduce risk of occurring of some diseases like as heart disease, stroke, diabetes mellitus, some cancers, hypertension, depression, anxiety, obesity, and osteoporosis. Beside that physical activity regularly very important to help to support mental stability, steadying of mental, standing alone for old ages, increase the power of muscle and body balancing, increase the stamina, vitality and metabolism of body.

Physical fitness level is related to incident and death risk of certain diseases. Increasingly high the level of physical fitness of population increasingly low the risk of incident and death of certain diseases. Risk of heart attack descend on population who do foot walk five hours per week, can reduce the heart attack 59% be compared for population who relaxed and death incident by many kinds of diseases 4,5 times multiplies on population who relaxed be compared with good physical fitness level. Populations with high physical fitness level have C - reactive protein values (a sign of chronic degenerative disease) which lower 2, 3 and 3, 3 times each on woman and man, risk of stroke lower three times than who has not physical fitness, and reduce death risk by hypertension and hypercholesterolemia diseases.

Raising the activity can reduce the incident of Acute Respiratory Tract Infection 34% and 20% each on man and woman, reduce the incident of fracture an amount of a third be compared with who has not physical fitness. Such so raising physical activity can reduce the incident risk of Diabetes Mellitus and Cancer. Increasing long of physical fitness or sport be enforced then increasingly small the risk to hit of Diabetes Mellitus and Cancer. Raising the physical activity so can reduce the risk of Mamma Cancer, Colon Cancer, and Pancreas Cancer each an amount of 18 - 21%, 40 - 67% and 54% be defended of long and intensity of physical activity that be done. Rising of physical activity so can rehabilitate frustration feeling, anxiety and depression. Specifically for depression who be cured by medicine and physical exercise regularly give repair effect same with therapy after 16 weeks, with note physical activity repair mental ability better in matter of concentration and planning. Raising physical activity prevent lowering of mental. The best method to prevent lowering of mental is by walking. Raising physical activity will increase fat burn and accelerate lowering of body weight. The coverage of body weight lowering is depended of duration of physical activity that is done and lowering of intake energy from foods. The success in lowering of body weight gives stronger effects toward the prevention of disease particularly of chronic degenerative disease (Suwetra, on Seminar Kesehatan Olahraga, June, 2008).

]]> http://azygosmc.com/sport-effects-for-health.html/feed http://azygosmc.com/dance-effect-on-physical-fitness-and-health.html http://azygosmc.com/dance-effect-on-physical-fitness-and-health.html#comments Thu, 17 Jul 2008 14:43:54 +0000 admin http://azygosmc.com/?p=82 An Experimental research about the effect of Balinese Baris Modern Dance toward Physical Fitness and Health has been done with result as below (dr. Adiputra, on Seminar Kesehatan Olahraga, June, 2008):

Balinese Dance Movements reliable has an effect toward body composition. Body composition is body density, body fat, body weight without fat. By do regular dance movements continuously, its will give positive effect toward body composition. For example: by do Balinese Baris Modern Dance during 11 minutes three times a week during 8 weeks period can improve body composition. Body fat can decrease in percent and so it can decrease of body fat weight. The meaning that by enough dance exercises then the body fat will decrease, with the result that occur reducing of body weight that be caused by reducing fat weight.

As the conclusions of that an experimental research were: physical fitness from moderate value become good value; body become more and more healthy with improvement on rest pulse beat, work pulse beat, blood pressure, body composition, body somatotipe, and body fat profile; Balinese Baris Modern Dance as reality not only for social-cultural dimensions, but so for health dimensions.

]]> http://azygosmc.com/dance-effect-on-physical-fitness-and-health.html/feed http://azygosmc.com/sport-and-physical-fitness.html http://azygosmc.com/sport-and-physical-fitness.html#comments Thu, 26 Jun 2008 14:06:00 +0000 admin http://azygosmc.com/?p=77 According to experts group, by sport we will find physical fitness. Generally physical fitness can be defined as an ability to adapt and comply of the environment demand. Maybe you have healthy body but you haven’t good physical fitness yet. Many athletes who are sick, but they have high level of physical fitness instead they can solve the record. An employee who has high level physical fitness will be able to carry out his task successfully. A sportsman who has high level physical fitness will be able to carry out his task in sport branch that be wrestled optimally. Healthy is a condition that includes physic, mental and social that by whole is in well condition and not only free from sick, deformity and weakness, along with productivity in accordance with social and economic. Fitness word has functioned almost same with freshness word. But freshness so contain meaning not only freshness of body, but so spiritual. And fitness more contains meaning about freshness body only.

Be found four key words need be given definition in order to be gotten the same perception i.e.: physical activity, sport, physical fitness and health.

Physical activity: the movement of body which is enforced by aware with goal to comply of basic needing of human life i.e.: physiologic and biologic, secure and peace senses, be loved, love and belonging, prestige, and self actuality.

Sport: amount of regular movement and be planned which be enforced by aware with goal to increase functional ability of cell, organ and body system.

Physical fitness: freshness of body. Physical fitness constitute of optimal ability to enforce daily task without experience significant exhaustion, along with still has reserve energy to do sudden task.

Health: the condition includes physic, mental and social that by whole is in well condition and not only free from sick, deformity and weakness, along with productivity in accordance with social and economic.

The aim of sport can be divided as below :

• Education
• Recreation
• Physical fitness
• Health
• Achievement

Education sport: to educate in order sportive, discipline, be responsible, cooperation, honest and healthy. Recreation sport: happiness, gladness, relax and healthy. Health sport: sport activity to prevention and curative of diseases. Physical fitness sport: sport activity to get optimal ability to do daily task. Achievement sport: sport activity by using ability maximally to get achievement.

• Better if planning the pregnancy, you should consult to doctor to enforce toxoplasmosis test examination before pregnancy. The aim of this action is if you have positive toxoplasmosis infection, then can be enforced optimal therapy before begin in your pregnancy.
• Avoid eat the food that uncooked or half baked.
• Clean and wash better fruits or vegetables before be eaten.
• Clean and wash hand, kitchen tools which be used to manage uncooked meat. This to prevent contamination with other foods.
• Don’t drink unpasteurized milk of animal.
• If clean trash or trash spot, don’t forget use hand sheath, and wash the hand, or give please this task to other family member while you in pregnancy condition.
• Use hand sheath if you want to work in the garden or home yard to avoid direct contact from infected feces of animal.
• If you have a planning that you will make pregnancy or if you in pregnant condition, better don’t take care of cat during pregnancy.

Usually the cat which be taken care at home that is not given uncooked meat, and it is not catching bird or rat, it is not infected.

Suggestion :

If you suspicious that you are suffering like the symptom of Toxoplasmosis, be suggested to you in order to consult with your trust physician.

Toxoplasmosis or usually be named “toxo” is the disease that be caused by parasite : Toxoplasma gondii. This parasite the first time be found in spleen and liver Ctenodoctyles gondii, a type of rodent animal from Sahara, North Africa at year 1908. And in human be found in Cekoslowakia at year 1923.

Cat constitute the definitive host (excellent life place) of Toxoplasma parasite. On the fact this parasite so can be found on several type of animal, however only in cat intestine the parasite can develop accordance with sexual or asexual by self cracked. Infection will occur if infective shape of this parasite has been swallowed by appropriate host, i.e. : mammalian, avian, non except of human. In the body of this parasite host the parasite only can develop by asexual. Cat can suffer Toxoplasma after swallow minimally one of three shapes of infective parasite i.e. : cystic, oocystic, or takizoit. Intraintestinal cycles will occur if cystic in the body of avian or rat ( as intermediate host ) be swallowed by cat which constitute it predator. Parasite next will multiply itself on intestine wall and result out of oocystic which be excreted pass through feces of cat at time 2 - 3 weeks. On 5 days periods, oocystic has changed become infectious shape toward human and many type of other animal.

This infectious shape has enough high endurance toward environment condition, along with it can hold out on moist earth and sand in several month periods. During intra intestinal cycle is continuing, amount of Toxoplasma parasite make penetration on intestinal wall and self multiply become takizoit shape. Not long next this shape will exit from intestine and spread to other part of body to begin extra intestinal (outside of intestinal) . In finally immune system of cat will barricade the development of this infectious shape, and can cause accumulation of bradizoit shape that has dormant (sleep) characteristic in brain tissue and muscle tissue. Most cystic shape will permanent in body host during it’s life in dormant (sleep) condition. By slowly this shape will change become cystic shape and cause chronic infection in intermediate host. This extra intestinal cycle (outside of intestine) doesn’t only occur in cat body, but so can occur in the body of intermediate host, be included of human.

Although the incident of Toxoplasmosis has not experience change that enough significant yet at last several years, caution and attention toward this disease have drastic increasing. Be estimated around 30 - 50% of world population have been infected by Toxoplasma and more than 3000 Toxoplasma infection occur on pregnancy in USA, a big part without symptom. The research that be enforced by Gandhahusada year 1995 showed that prevalence rate of Toxoplasmosis in human revolve between 2 - 63%, in cat between 35 - 73%, in dog 75%, in goat between 11 - 61%, in pig between 11 - 36%, and less than 10% in cow/water buffalo.

Most of infection in adult human occur without symptom, or only show mild symptom like are increasing body temperature and enlargement of spleen gland. By base of impact that can be appeared this infection, congenital infection constitute the matter that need be concerned. Around about 45% spreading of Toxoplasma occur pass through congenital infection. From this amount, 60% of its constitute sub clinical infection, 9% with consequence of fetal death and 30% make appearing the enough severe impact (hydrocephalus, retinochoroiditis, and mental retardation).

Impact of infection very seldom be shown if mother suffer infection at last three semester her pregnancy, but more bad risk occur on infection at the first of three semester pregnancy infection, i.e. fetal death and baby malformation. More clear of symptom be shown after bearing, so can appear at some weeks, some months, moreover some years after bearing ( some clinical symptom so can show at puberty period as consequence of congenital infection ). Abnormality of nerve system ( mental retardation ) and vision ( blindness ), hydrocephalus, hearing disorder, fever, jaundice, with many kind of its complication, constitute as clinical manifestation that usually be suffered by patient of Toxoplasmosis. Symptom and other signs that maybe occur are macro cephalic or micro cephalic, skin eruption, bruised, and under skin bleeding, anemia, along with liver and spleen enlargement.

The symptom that appear of this infection i.e. :

• On many peoples appear without symptom of this disease.
• Fever, sore throat, exhausted, enlargement of lymphatic gland on neck and armpit area.
• On some cases can cause eyesight become blurred or loss of eyesight.
• Woman who in pregnancy time, or human who suffer a disease with low immunity system, like AIDS or cancer has high risk be attacked by this infection.

Read about :
Toxoplasmosis treatments

Indications :

To prevent the incident of atherothrombotic on :

• Patient who suffer Myocardial infarct (from some days until less than 35 days), stroke ischemic (from 7 days until less than 6 months) or established peripheral arteriole disease.

• Patient with acute coronary syndrome.

• Increasing acute coronary syndrome with elevation on non ST segment (unstable angina, or myocardial infarct non Q wave) in combination with Acethylsalicylic acid.

• Acute Myocardial Infarct with elevation on ST segment. In combination with Acethylsalisilat acid on therapy the patient accordance with thrombolytic therapy.

Dosages :

Adult and older ages :

Clopidogrel be given as single dose 75 mg per day with meal or without meal. On patient with acute coronary syndrome :

• Elevation of non ST segment (unstable angina, or myocardial infarct non Q wave): be started with load dose 300 mg and be continued by 75 mg single dose per day (combination with Acethylsalicylic acid 75 - 325 mg once per day). Because high dose of Acethylsalicylic acid relate with the increasing of bleeding risk, so dose of Acethylsalicylic that be recommended not more than 100 mg. The long therapy according to formal not be established.

• Increasing acute myocardial infarct on elevation of ST segment: be started with single dose 75 mg with or without load dose in combination with Acethylsalicylic acid with or without thrombolytic. For patient age more than75 years, clopidogrel be started without increasing load dose. Combination therapy be started at early maybe after appear the symptom of disease and be continued until minimal 4 weeks.

Children and younger adult :

• There is not supporting data for children.

Contra Indications :

• Patient who hypersensitive toward Clopidogrel and its components.
• Severe liver damage.
• Active pathologic bleeding like as peptic ulcer or intra cranial bleeding.
• Give suck.

Warning and Attentions :

• Because of bleeding risk and hematologic effect which are not be wished, so blood cell count must be done during medicinal treatment.

• Like other anti platelet clopidogrel must be given carefully on patient who has increase risk of bleeding as consequence of trauma, surgical therapy or other pathologic condition and on patient who receive Acethylsalicylic acid, Anti inflammation non steroid medicine be included barricade Cox-2, heparin, or barricade glycoprotein IIb/IIIa.

• Patient must wary toward bleeding sign include of hidden bleeding, specifically at the first week of treatment and or after cardiac invasive procedure or surgery.

• Patient who experience surgery and doesn’t need anti platelet effect, giving clopidogrel must be stopped 7 days before surgery.

• Clopidogrel will make length of bleeding time and must be given carefully on patient with lesion which trend to experience bleeding ( particularly on gastrointestinal tract and eye ).

• Patients must inform to doctor or dentist that they are using clopidogrel surgery be scheduled and before receive other medicines.

• Thrombotic Thrombocytopenia Purpura ( TTP ) has been reported after using clopidogrel short period be signed with thrombocytopenia, hemolytic anemia microangeophatic related with neurological sign, kidney function disorder and fever. TTP be included the condition may be fatal and must be handed quickly.

• Clopidogrel doesn’t be recommended for patient who suffer acute ischemic stroke ( less than 7 days ), kidney function disorder and moderate liver disease.

• Patient with galactose hereditary intolerance, lap lactase deficiency or malabsorption of glucose galactose better doesn’t use this medicine.

Side effects :

• Bleeding and hematologic disorders.

• Central and peripheral nerve system disorders, not generally: headache, dizzy, paraesthesia, vertigo.

• Gastrointestinal system disorder, generally: dyspepsia, abdominal pain and diarrhea, not generally: gastric ulcer, duodenum ulcer, gastritis, vomit, nausea, constipation.

• Platelet disorder, bleeding and coagulation disorder, not generally: increasing of bleeding time, decreasing of platelet.

• Skin disorder, not generally: skin eruption and itchiness.

• Leukocyte disorder, not generally: leukopenia, , decreasing of neutrofil and eosinophil.

Body joints rigidity on rheumatoid arthritis particularly appear at morning and able to continue 1 - 2 hours. Rigidity of the body joints for this long times relative constitute evidence diagnosis that enough specific because not all diseases of body joints disorder have that symptoms. Although the rheumatoid arthritis can attack many kind of body joints , but small joints on hand and foot have trend more be attacked by rheumatoid arthritis. Other symptoms that can follow rheumatoid arthritis i.e. loss energy, mild fever, loss appetite, drying eyes and mouth, rheumatoid nodule on elbow and hand. These symptoms different for every patient.

Rheumatoid arthritis be caused by autoimmune process, where occur function disorder of certain cells on immune system which attack body joint.Inflammation process particularly occur on sinovium tissue of body joint which constitute the tissue that is layering the body joint. Inflammation cells that be resulted by immune cells will attack cartilage bone. Diagnosis of Rheumatoid arthritis be made by background of some symptoms and sign on physic and laboratories examination like as: warm of body joint, swelling, painful of joint, anemia, rheumatoid factor, and increasing of erythrocyte sediment.

Rheumatoid arthritis therapy purpose to minimize the symptoms and function disorder by giving early therapy before occur permanent damages. No one therapy effective for all peoples and some patients need change therapy method during pathogenesis of disease. Generally the patient of rheumatoid arthritis be given medicine that can reduce pain sensation like as acetaminofen (paracetamol). Now be recognized medicine of rheumatoid arthritis that is not only work symptomatic, but it can block bad progress of disease too.

To reduce joint inflammation progress, the first therapy usually include of analgesic be followed medicine of anti inflammation non steroid (AINS) like as ibuprofen, naproxen, celecoxib and others. As addition so be given corticosteroid like as prednison, low dosage per oral or on joint injection. Patient with persistent swollen usually be given medicine by Disease Modifying Anti Rheumatic Drugs (DMARDs), it often be used with together AINS and or low dosage of corticosteroid. DMARDs can give biggest correction toward symptoms, function and correction of life quality of patient with rheumatoid arthritis. Which be included of DMARDs i.e. methotrexate, leflunomide, sulfasalazine, azathionprine and cyclosporine.