text:
So, I don't currently have an Android tablet, but was thinking of buying one for my new XBMC setup I'm working on. I would like to do the following with it:
Use it to remotely choose shows and music through XBMC to play through my stereo, without having to turn on my TV.
Use it as a remote for the blu-ray software, which will be run as an external program outside of XBMC.
Use it as a regular keyboard / mouse for my Windows XBMC box.
I would also like to be able to turn on and off my TV, and control the volume on my receiver. (Griffin Beacon seems to be the ticket here).
Is all of this a pipe dream? If not, can anyone recommend a cheap tablet that would perform this? Looks like I'll need bluetooth to make this work.
Windows - Which Android tablet as XBMC remote?
Jeff Bannow
Junior Member
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2012-04-01 06:45 Post: #1
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Jeff Bannow
Junior Member
Posts: 3
Joined: Apr 2012
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2012-04-01 07:23 Post: #2
Partially answering my own question - The Vizio VTab1008 is available refurbed for $180, and has a built in IR blaster and Bluetooth.
Still looking for input on the other functions though.
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Posting Freak
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2012-04-01 08:10 Post: #3
Control XBMC: there's the official XBMC remote for ANDROID.
Control XBMC: also XBMC Constellation Remote soon to be for ANDROID.
turn on and off TV and Stereo: check HARMONY LINK device for ANDROID
Keyboard / mouse: MobileMousePRO for ANDROID
(This post was last modified: 2012-04-01 08:12 by eskro.)
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Jeff Bannow
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2012-04-02 17:11 Post: #4
Thanks eskro. That helps a lot.
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htpc guy
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Location: Near St. Louis Mo
2012-04-02 17:43 Post: #5
I use a Nook Color with ICS. ICS is a little rough around the edges at the moment but the Gingerbread rom (cm7) runs flawlessly.
How to use Git
| AMD Athlon II X3 Triple Core Processor 2.9 GHz |GIGABYTE GA-MA785GM-US2H Mobo 2GB DDR2 Ram | MSI N430GT |
| Logitec Harmony Smart Control Remote| 52" Sharp Aquos LED TV | Denon AVR-X1000 |
| Freenas Server with 18TB ASRock Intel Avoton C2750 |
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Team-XBMC Developer
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Location: Canada
2012-04-02 18:12 Post: #6
I have a cheap Pandigital 9" colour - works great as long as you can handle the resistive touch screen. If you can find a compatible capacitive touch screen that would be the way to go though. I love being able to select and play music from anywhere in the house (and on my deck)
System: XBMC HTPC with HDMI WASAPI & AudioEngine - Denon AVR-3808CI - Denon DVD-5900 Universal Player - Denon DCM-27 CD-Changer
- Sony BDP-S580 Blu-Ray - X-Box 360 - Android tablet wireless remote - 7.1 Streem/Axiom/Velodyne Surround System
If I have been able to help feel free to add to my reputation +/- below - thanks!
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Posting Freak
Posts: 8,598
Joined: Nov 2010
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2012-04-02 20:53 Post: #7
yepp, a tablet is soon gonna be the way i'll control my HTPC.
its just that i dont wanna spend anymore..
i have to put a stop somewhere u know :/
but if i had a tablet,
i'd use these 3
1. Control XBMC: also XBMC Constellation Remote soon to be for ANDROID.
2. turn on and off TV and Stereo: check HARMONY LINK device for ANDROID
3. Keyboard / mouse: MobileMousePRO for ANDROID
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Senior Member
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Location: Lacey, WA.
2012-04-02 21:03 Post: #8
I use my Moto Razr and the Samsung Tab 10.1 for a XBMC remote. They both work fine with the stock XBMC remote and the YATSE widget remote.
The phone is nice, as it fits in your hands nicer than a 10.1 tablet.
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2012-04-03 01:01 Post: #9
Since you run windows and your builds seem to be unique you should totally use the built-in XBMC web server and Eventghost since you are windows based. Create an easy webpage to control all of your system. If you can take a look at some of the stuff I created for my home automation project, I was able to use the HTTP API commands to control XBMC and Eventghost web server which controls all my com devices. BTW the system works flawlessly in eden and dharma.
IMO would rather have an interface, rather than having to open app after app just to get something done. I am sure you have some programming skills in simple html if not I would help you out no problem and come up with something unique and functional.
I have yet to find a negative, however one of the plus sides to creating an interface is you could use your own artwork to create buttons and backgrounds and add on pretty much anything you like. Integrating your system this way can create macros using a single button, the possibilities are really endless.
I use tablets to control my home all you need is one really although I have three, They are V210 Viewsonic 10" touchscreens and I have zero complaints about the size and speed. One sits on a dock on my Living Room coffee table, another one sits in my bedroom, and the last one is wall mounted in the hallway. I can control the entire house from a tablet using a web interface that I specifically built.
Just to give you an idea.
(This post was last modified: 2012-04-03 01:13 by XMBC_FREAK.)
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Posting Freak
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2012-04-03 01:17 Post: #10
yeah i recall your thread, its nice
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2012-08-16 23:48 RE: Which Android tablet as XBMC remote? Post: #11
This is pretty awesome. I am building an HTPC setup and am torn between Win7/8 MCE and XBMC, but just read today you can integrate XBMC into WMCE. I Need to keep the WAF as high as possible. WAF=Wife Acceptance Factor.
Working on some basic stuff at the moment but would sure like to move to what you have accomplished.
If I can figure out how to friend someone in these forums, I will sure do so.
Already have my Flirc for two systems. Now have to get the video card to work correctly/again in my windows system for the big TV.
Have a laptop with the XBMC live running on it for the bedroom tv.
My home network consists of:
The office hard cabled
AT&T Uverse 12mb. Motorola Modem/Router
Home built Windows Home Server 2TB for Recorded TV and Movie Storage. working fine
Desktop system with Win7 Media Center +Hauppauge TV Tuner for recording TV working fine
SunRoom No network connections other than wireless
10" Acer Laptop for travel and Family Room use. Old eyes so connect usb keyboard/mouse and 20" monitor to it.
Dell XPS 200 Windows XP running XBMC hooked to Panasonic 52" rear projection TV. component, Composit and S-Video is all. work in progress
Visio 7" Android Pad
Bedroom hard cabled for network
HP Laptop running XBMC Live hooked via VGA to 32" Visio Flat Panel TV. work in progress
Samsung Android phone (personal)
Iphone 4S (work)
Spare equipment
Netgear 824 wireless router
Cisco n router (can't remember model)
Another wireless router but can't remember the model. G band though.
A couple of Video cards,
PNY GEForce8400 256 pcie Dell XPS 200 would not boot with this in it after a couple of days. was working
Another one but will have to pull it to see what it is. Video output works but is very bad, distorted and totally wrong.
(lots to do here to diagnose the problems)
X10 Cameras various places around the house but they are old models and probably will not be able to be used.
I really like your interface idea. Makes good sense for overall control.
(2012-04-03 01:01)XMBC_FREAK Wrote: Eskro:
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text:
English authors contend strongly for placing the names in this order: Adams, Leverrier and Galle.
Leverrier's faith in Vulcan, however, has remained unshaken.
But to point out Leverrier's poverty-stricken average—or discovering planets upon a fifty per cent.
Not until he was satisfied, did Leverrier reveal his identity.
Leverrier gave the name "Vulcan" to the object that Dr. Lescarbault had reported.
Hansen's note of alarm in 1854 was echoed by Leverrier in 1858.
Newcomb finds the anomalous motion of the perihelion to be even larger (43′ instead of 38′) than Leverrier made it.
So the Astronomer-Royal thought on reading Leverrier's paper.
For this reason, Leverrier pronounced, in 1867, the Perseid to be of older formation than the Leonid system.
This followed the mathematical researches of Lagrange and Leverrier.

subset: commoncrawl


text:
Every day is different at Woodland Park Zoo. See what the animals are up to today!
Discover how Woodland Park Zoo collaborates with conservation partners across Asia to save wildlife and wild places.
Get involved
Phase one of the Bamboo Forest Reserve exhibit complex is now open! Visit squealing Asian small-clawed otters, a tropical aviary and kid's nature play area, all bringing to life the sounds, smells and sights of the Asian tropical forest. People who experience such wonders of nature are inspired to save it. That's the power of Woodland Park Zoo's Bamboo Forest Reserve.
Phase one of the exhibit complex opens May 2013 featuring:
A splashing, almost musical stream leads you to a dynamic pair of the smallest otter species in the world, running, hunting for fish, grooming and tumbling over each other, cavorting in a marsh or on the beach. This charismatic species is new to Woodland Park Zoo.
The otter exhibit is the first animal area visitors will encounter when entering the exhibit complex—a fitting introduction to the wildlife of tropical Asia as the otter is considered a conservation indicator species, its survival so dependent on the health of the forest and interconnected waterways.
Enjoy exquisite avian diversity from high in the trees to low in the bush. Seemingly everywhere, the forest birds will captivate with their electric color and musical calls. The aviary—one of the first stops visitors will encounter upon entering the new exhibit complex—will be home to the shama thrush, collared finchbill, red-billed leiothrix, Nicobar pigeon and great argus.
Specially designed with early learners' needs in mind, this active area will spark a sense of wonder in young visitors and develop their mental and motor skills through full-bodied play. Young explorers will learn about the forest through joyful nature play—balancing on logs, crossing a wobble bridge, flying along a mini-zipline—all safely designed to stimulate development while setting the scene of a conservation field site where boundaries between humans and wildlife collide.
Phase one of the Bamboo Forest Reserve is the opening chapter of a dynamic, new exhibit complex at the heart of Woodland Park Zoo. With your continued support, we will be able to complete fundraising for the second and final phase of the exhibit complex, which will bring new homes for Malayan tigers and sloth bears to the zoo. Join us now!
Learn more about the exhibit plans and how to get involved
Celebrate the arrival of the new Asian small-clawed otters with a ZooParent adoption.
Adoptions make great gifts and help support the daily care of the zoo's animals. $5 from each adoption go directly to zoo conservation efforts at home and around the world.
Become a ZooParent today
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firstname.lastname@example.com email@example.com


text:
Did you honestly delete my post.?
You too man. You too.
Nice interface
What about it?
I don't know actually, I'm interested so next time I'm at my dad's I'll setup these things for sure
Okay thanks
I dunno how to get it. Or Dissidia on it for that matter.
Can't rep you atm and didn't want to clutter up the thread with unnecessary posts, but what excactly are your intentions with the streaming thread? Is it a one-time thing for the coming 1 day tourney or will it be used in future tournaments as well? Just curious.
Sounds like a fun idea though
I never used it, is it easy to setup?
Retired Staff
Chocobo Tamer
Airship Pilot
Advent Hero
Ron Swansonesque
Makin' it rain.


text:
Washington : Government Printing Office
|Public Law 91-557
|Soboba Indian Reservation, Calif. Water distribution system. Claim release agreement. Payment.
|Public Law 91-557
|Effective date.
|Sec. 2
|Land annexation.
|Sec. 2
|Annexation charge, etc., waiver.
|Sec. 2
|Water service agreement.
|Sec. 2
|1466 Maintenance.
|Sec. 2
|New service connections, financing.
|Sec. 2
|Sec. 2
|Sec. 2
|Sec. 2
|Sec. 2
|Delinquent payment.
|Sec. 2
|Transfer of title.
|Sec. 3
|Sec. 3
|Sec. 4
|Trust lands, alienation, etc.; prohibition.
|Sec. 5
|Sec. 5
|Time limitation. Construction plan, submittal to Congress.
|Sec. 6
|Sec. 6
|Sec. 6
|Deductions for payment.
|Sec. 6
|Sec. 7
|1468 Land modification.
|Sec. 8
|Long-term leases. 81 Stat. 559, Ante, p. 302.
Page 1212
Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled, That the Secretary of the Interior is authorized to approve a release agreement to be negotiated by and between the Soboba Band of Mission Indians, the Metropolitan Water District of Southern California, hereinafter called Metropolitan, and the Eastern Municipal Water District, hereinafter called Eastern, which provides among other things that—
(a) Metropolitan shall pay to the Secretary of the Interior for the use and benefit of the Soboba Indians the sum of $30,000. Payment shall be made when the lands that comprise the Soboba Indian Reservation have been annexed to Metropolitan and to Eastern. The annexation shall be subject to the terms and conditions of the release agreement and the annexation and water service agrement to be executed pursuant to section 2 of this Act.
(b) The Soboba Band of Mission Indians releases Metropolitan and Eastern, their successors or assigns, from all claim it may have based on past, present, or future actual or claimed damage to, or interference with, the flow of waters from the springs on the Soboba Indian Reservation lands, or on actual or claimed interference with, or damage to; the water supply to or upon the lands of the Soboba Indian Reservation, which claims arise from construction and operation of a certain tunnel through the San Jacinto mountains constructed in the 1930's.
(c) The release agreement shall be effective upon the completion of the concurrent annexation of the Soboba Indian Reservation lands to Metropolitan and Eastern and upon the execution of an annexation and water service agreement authorized by section 2 of this Act.
The Secretary of the Interior and the Soboba Band of Indians are authorized to enter into an annexation and water service agreement with Eastern which provides, among other things, that—
(a) The Soboba Indian Reservation lands may be annexed to Eastern and Metropolitan.
(b) No annexation charge or back taxes regardless of form shall be made for said annexation.
(c) The Secretary and Eastern shall jointly determine the additional new water supply and distribution facilities that shall be constructed and the existing facilities that shall be rehabilitated in order to provide domestic and irrigation water to each consumer within the Soboba Indian Reservation. Subject to the appropriation authorization limitation in section 5, construction or rehabilitation of facilities to provide water service to the Soboba Indian Reservation shall be undertaken by Eastern, shall be financed by the United States, with Eastern providing such funds as the Secretary of the Interior and Eastern jointly determine represent a prorated share of joint-use facilities constructed outside of the Soboba Reservation, and with the $30,000 paid pursuant to subsection 1 (a) being applied to the construction or rehabilitation. Facilities constructed within the Soboba Reservation shall be the property of the United States and facilities constructed outside of the Soboba Reservation shall be the property of Eastern.
(d) Eastern shall have the exclusive right, without charge, to use the supply and distribution facilities owned by the United States lying within the Soboba Indian Reservation, and Eastern shall assume the responsibility for maintaining and operating such facilities.
(e) Upon assumption of operation and maintenance of the system by Eastern following completion of the initial installation and rehabilitation work, any new service connections applied for by residents or consumers within the Soboba Indian Reservation, and any other additional water main extensions or facilities required for serving new development within the Soboba Indian Reservation, shall be financed by the applicants for such service, in accordance with the standard
Page 1213
rules and regulations of Eastern, except as indicated in the next sentence. As long as title to the lands involved is held in trust by the United States, such new service connections or additional water main extensions or facilities may be financed by the United States to the extent agreed upon by the Secretary of the Interior. All such new service connections, additional extensions, or facilities shall be constructed by Eastern. All such new service connections, additional extensions, or facilities financed by parties other than the United States shall be the property of Eastern. All such service connections, additional extensions, or facilities financed by the United States shall be the property of the United States subject to exclusive use by Eastern without charge.
(f) Subject to the limitations of capacity and location of the jointly agreed upon facilities, Eastern shall deliver domestic and irrigation water to each individual consumer within the Soboba Indian Reservation in accordance with the prevailing standard rules and regulations of Eastern and the provisions of the annexation and water service agreement.
(g) The retail rates applicable to water service within the Soboba Indian Reservation shall be mutually agreed upon by Eastern and the Secretary of the Interior, and shall be neither less than nor more than the estimated cost of such water service to Eastern, adjusted to reflect differences between estimated costs and actual costs in preceding rate periods. Eastern shall make collections for service in accordance with its prevailing rules and regulations and the Secretary of the Interior shall guarantee payment to Eastern of any delinquent bill for providing water service to lands held in trust within the Soboba Indian Reservation. Water service to a consumer shall be discontinued in accordance with the prevailing rules and regulations of Eastern when a bill for service becomes delinquent, and shall not be resumed as long as the bill is delinquent without prior approval of the Secretary of the Interior. The Secretary shall not approve a resumption of service to an Indian who is able to pay all or a portion of a delinquent bill and fails to do so.
(h) When title restrictions are removed from any part or all of the Soboba Indian Reservation land, the responsibility and duties of the United States under the annexation and water service agreement shall cease with respect to such land, except for the installation and rehabilitation obligations undertaken in subsections 2 (c) and (e) unless otherwise provided by Act of Congress. Title to the water distribution facilities serving such lands shall at that time become the property of Eastern and the obligation of Eastern to provide water service to such land at cost to the district shall likewise cease.
The Secretary is authorized to grant to Eastern without charge and subject to such conditions as he may prescribe (a) rights-of-way over Soboba Reservation lands necessary for the use, maintenance, and operation of supply and distribution facilities owned by the United States; (b) rights-of-way within which new service connections are installed after initial installation and rehabilitation work has been completed by Eastern; and (c) rights-of-way necessary for additional water main extensions and other waterworks facilities required for serving new development: Provided, That where title to the Soboba Reservation lands involved has been conveyed in fee simple by the United States the rights-of-way hereby authorized shall be subject to prior approval of the owner of record. Eastern shall construct, use, maintain, operate, or install the equipment or facilities for which the rights-of-way are granted in a manner that avoids damage to buildings, crops, or trees, or interference with growing of crops. Should such damage or interference occur, Eastern shall compensate the United States as trustee, or the fee owner of record. The rights-of-way
Page 1214
granted shall revert to the United States or the owner of record when no longer required for the purpose or purposes for which granted.
Nothing in this Act shall permit Metropolitan or Eastern, or their successors or assigns to alienate, encumber, or tax any property belonging to an Indian or Indian band which is held in trust by the United States of America, or which is subject to a restriction against alienation imposed by the United States of America, while such property is exempt therefrom under Federal case law or provisions of other Federal statutes.
There are authorized to be appropriated to carry out the provisions of subsection 2 (c) not to exceed $316,658, in addition to the unexpended balance of sums previously appropriated and available for a water supply to the Soboba Reservation and the $30,000 provided pursuant to subsection 2 (c), plus or minus such amounts, if any, as may be justified by reason of ordinary fluctuations in construction costs as indicated by engineering cost indices applicable to the types of construction involved. There are also authorized to be appropriated such sums as may be necessary to make any payments guaranteed pursuant to subsection 2 (g). No funds shall be appropriated pursuant to the authorization contained in this section until sixty calendar days (not counting days on which either the House of Representatives or the Senate is not in session because of an adjournment of more than three calendar days to a day certain) after the Secretary has submitted to the Congress a plan for the construction and use of the water supply and distribution facilities under subsection 2 (c), and for the repayment of costs as provided in section 6, and then only if within said sixty days neither the House nor the Senate Committee on Interior and Insular Affairs disapproves by committee resolution the plan submitted.
Nothing in this Act shall affect the right of the Soboba Indians to pursue their claim against the United States under the Act of August 13, 1946 (60 Stat. 1049), now pending in docket numbered 80A before the Indian Claims Commission, but any expenditures under subsections 2 (c), (e), and (g), and the $30,000 paid by the Metropolitan and used pursuant to subsection 2 (c), may be used by the Commission either in mitigation of damages or as an offset against any award which the Indians may receive. If such amount exceeds the award, the excess, and all expenditures by the United States under subsections 2 (c), (e), and (g) after the date of the award, shall be repaid to the United States, without interest, by deductions from revenues received by the Soboba Band or its members from the sale, lease, or rental of the lands, such deductions to be in amounts that will reimburse the United States within fifty years, or as soon thereafter as possible, according to estimates of the Secretary of the Interior, which estimates may be revised from time to time: Provided, That deductions in any one year shall not exceed 50 per centum of the revenues received in that year.
Notwithstanding any other provision of law, any assignment of land on the Soboba Reservation shall be modified, reduced in size, revoked, or otherwise limited by the governing body of the Soboba Band, or by the Secretary of the Interior if in his judgment the governing body fails to act effectively, in order to assure that the benefits from the development of the land with water provided pursuant to this Act, other than for subsistence purposes, will accrue to the Band rather than to the assignee.
The second sentence of section 1 of the Act of August 9, 1955 (69 Stat. 539), as amended (25 U. S. C. 415), is hereby amended by inserting after "Gila River, Reservation," the words "the Soboba Indian Reservation,".
Approved, December 17, 1970.


text:
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text:
Drug Treatment Guidelines
Rheumatoid arthritis is best treated with disease-modifying anti-rheumatic drugs (DMARDS), which include both nonbiologic and biologic medications. Current guidelines for drug treatment recommend:
Drug Approvals
In 2011, the U.S. Food and Drug Administration (FDA) approved as treatments for rheumatoid arthritis:
Drug Warnings
The FDA is continuing to collect data to determine associations between tumor necrosis factors (TNF) blocker drugs and cancer risks. Also in 2011, the FDA added Legionionella and Listeria to the list of serious infections that pose a risk to patients who take TNF blockers. Anti-TNF drugs approved for treatment of rheumatoid arthritis include:
Rheumatoid arthritis (RA) is a chronic disease in which various joints in the body are inflamed, leading to swelling, pain, stiffness, and the possible loss of function.
The process may develop in the following way:
This inflammatory process not only affects cartilage and bones but can also harm organs in other parts of the body.
The exact causes of rheumatoid arthritis are unknown. Rheumatoid arthritis is most likely triggered by a combination of factors, including an abnormal autoimmune response, genetic susceptibility, and some environmental or biologic trigger, such as a viral infection or hormonal changes.
Rheumatoid arthritis is considered an autoimmune disease. In autoimmune disorders, the body's immune system mistakenly attacks and destroys healthy cells and tissue.
The immune system determines the body's responses to foreign substances (antigens) such as viruses and toxins. The immune response helps the body to fight infection and heal wounds and injuries. The inflammatory process is a byproduct of the immune response.
Two important components of the immune system that play a role in the inflammation associated with rheumatoid arthritis are B cells and T cells, both of which belong to a family of immune cells called lymphocytes. Lymphocytes are a type of white blood cell
If the T cell recognizes an antigen as "non-self," it will produce chemicals (cytokines) that cause B cells to multiply and release many immune proteins (antibodies). These antibodies circulate widely in the bloodstream, recognizing the foreign particles and triggering inflammation in order to rid the body of the invasion.
For reasons that are still not completely understood, both the T cells and the B cells become overactive in patients with RA.
Genetic factors may play some role in RA either in terms of increasing susceptibility to developing the condition or by worsening the disease process. The main genetic marker identified with rheumatoid arthritis is HLA (human leukocyte antigen).
A number of HLA genetic forms called HLA-DRB1 and HLA-DR4 alleles are referred to as the RA-shared epitope because of their association with rheumatoid arthritis. These genetic factors do not cause RA, but they may make the disease more severe once it has developed. Genetic variations in the HLA region may also predict drug treatment response to etanercept and the disease-modifying anti-rheumatic drug methotrexate.
Infections. Although many bacteria and viruses have been studied, no single organism has been definitively identified as a trigger for RA. Higher than average levels of antibodies that react with the common intestinal bacteria E. coli have appeared in the synovial fluid of people with RA. Some researchers think they may stimulate the immune system to prolong RA once the disease has been triggered by some other initial infection. Other potential triggers include Mycoplasma, parvovirus B19, retroviruses, mycobacteria, and Epstein-Barr virus.
According to the U.S. Arthritis Foundation, rheumatoid arthritis (RA) affects about 1.3 million Americans.
Although rheumatoid arthritis can occur at any age from childhood to old age, onset usually begins between the ages of 30 - 50 years.
Juvenile rheumatoid arthritis is the term used for arthritis that affects children. Juvenile rheumatoid arthritis often resolves before adulthood. Patients who experience arthritis in only a few joints do better than those with more widespread (systemic) disease, which is very difficult to treat. (Note: This report primarily discusses rheumatoid arthritis in adults.)
Women are more likely to develop RA than men.
Some people may inherit genes that make them more susceptible to developing RA, but a family history of RA does not appear to increase an individual's risk.
Heavy long-term smoking is a very strong risk factor for RA, particularly in patients without a family history of the disease.
The course of rheumatoid arthritis differs from person to person. For some patients, they disease becomes less aggressive over time and symptoms may improve. Other people develop a more severe form of the disease, which can lead to serious complications that affect not only the joints but other areas of the body including organs. Fortunately, for many patients newer treatments are helping slow the progression of the disease and preventing severe disability.
Complications of rheumatoid arthritis, many of which are the result of chronic inflammation, can include:
Affected joints can become deformed, and for some patients the performance of even ordinary tasks can become very difficult or impossible. In addition to pain, patients may also experience muscle weakness.
This condition affects the nerves, most often those in the hands and feet. It can result in tingling, numbness, or burning.
People with RA may develop anemia, which involves a decrease in the number of red blood cells.
Scleritis and episcleritis are inflammations of the blood vessels in the eye that can result in corneal damage. Symptoms include redness of the eye and a gritty sensation.
Patients with RA have a higher risk for infections, particularly if they are treated with immune-suppressing drugs (such as corticosteroids, anti-tumor necrosis factors, and disease modifying drugs).
Skin problems are common, particularly on the fingers and under the nails. Some patients develop severe skin complications that include rash, ulcers, blisters (which may bleed in some cases), lumps or nodules under the skin, and other problems. In general, severe skin involvement reflects a more serious form of RA.
Osteoporosis, loss of bone density, is more common than average in postmenopausal women with RA. The hip is particularly affected. The risk for osteoporosis also appears to be higher than average in men with RA who are over 60 years old.
Patients with RA are susceptible to chronic lung diseases, including interstitial fibrosis, pulmonary hypertension, and other problems. Both rheumatoid arthritis itself and some of the drugs used to treat it may cause this damage.
Vasculitis involves inflammation in small blood vessels and can affect many organs in the body. Manifestations of vasculitis include mouth ulcers, nerve disorders, rapid worsening of the lungs, inflammation of coronary arteries, and inflammation of the arteries supplying blood to the intestines.
Patients with RA have increased risk for death from coronary artery disease. Research suggests that the chronic inflammation associated with RA may be a factor.
Patients with RA are more likely than healthy patients to develop non-Hodgkin's lymphoma. RA's chronic inflammatory process may play a role in the development of this cancer. Anti-TNF drugs used for RA treatment may also increase the risk for lymphoma (particularly in children and adolescents) as well as leukemia and other malignancies.
People with RA have a higher risk for developing periodontal disease, which damages the gum and bone around the teeth.
Although rheumatoid arthritis only rarely involves the kidney, some of the drugs used to treat the disease can damage kidneys and the liver.
Women with RA have an increased risk for premature delivery. They are also more likely than healthy women to develop high blood pressure during the last trimester of pregnancy. For many women with RA, the disease goes into remission during pregnancy but the condition recurs and symptoms can increase in severity after giving birth.
The hallmark symptom of rheumatoid arthritis is morning stiffness that lasts for at least an hour. (Stiffness from osteoarthritis, in contrast, usually clears up within half an hour.) Even after remaining motionless for a few moments, the body can stiffen. Movement becomes easier again after loosening up.
Most typically, the onset of symptoms takes place over the course of weeks or even months. However, rapid onset with more severe symptoms may also occur.
Swelling and pain in the joints must occur for at least 6 weeks before a diagnosis of rheumatoid arthritis is considered. The inflamed joints are usually swollen and often feel warm and "boggy" (spongy) when touched. The pain often occurs on both sides of the body (symmetrically) but may be more severe on one side of the body, depending on which hand the person uses more often.
Although rheumatoid arthritis almost always develops in the wrists and knuckles, the knees and joints of the ball of the foot are often affected as well. Many joints may eventually be involved, including those in the cervical spine, shoulders, elbows, tips, temporomandibular joint (jaw), and even joints between very small bones in the inner ear. Rheumatoid arthritis does not usually show up in the fingertips, where osteoarthritis is common, but joints at the base of the fingers are often painful.
In some patients with RA, inflammation of small blood vessels can cause nodules, or lumps, under the skin. They are about the size of a pea or slightly larger, and are often located near the elbow, although they can show up anywhere. Nodules can occur throughout the course of the disease, although they are usually a sign of more severe disease. Rarely, nodules may become sore and infected, particularly if they are in locations where stress occurs, such as the ankles.
Fluid may accumulate, particularly in the ankles. In some cases, the joint sac behind the knee accumulates fluid and forms what is known as a Baker's cyst. This cyst feels like a tumor and sometimes extends down the back of the calf causing pain. Baker's cysts can also develop in people who do not have RA.
Symptoms such as fatigue, weight loss, and low-grade fever may also be present.
In children, juvenile rheumatoid arthritis, also known as Still's disease, is usually preceded by high fever and shaking chills along with pain and swelling in many joints. A pink skin rash may be present.
Rheumatoid arthritis can be difficult to diagnose. Many other conditions resemble RA. Its symptoms can develop insidiously. Blood tests and x-rays may show normal results for months after the onset of joint pain.
Specific findings or presentation more likely to suggest the diagnosis of rheumatoid arthritis include morning stiffness, involvement of three joints at the same time, involvement of both sides of the body, subcutaneous nodules, positive rheumatoid factor, and changes in x-rays.
Various blood tests may be used to help diagnose RA, determine its severity, and detect complications of the disease.
Rheumatoid Factor. In RA, antibodies in the blood that collect in the synovium of the joint are known as rheumatoid factor. In about 80% of cases of RA, blood tests reveal rheumatoid factor. It can also show up in blood tests of people with other diseases. However, when it appears in patients with arthritic pain on both sides of the body, it is a strong indicator of RA. The presence of rheumatoid factor plus evidence of bone damage on x-rays also suggests a significant chance for progressive joint damage.
Erythrocyte Sedimentation Rate. An erythrocyte sedimentation rate (ESR or sed rate) measures how fast red blood cells (erythrocytes) fall to the bottom of a fine glass tube that is filled with the patient's blood. The higher the sed rate the greater the inflammation. Because the sed rate can be high in many conditions ranging from infection to inflammation to tumors, the ESR test is used not for diagnosis but to help determine how active the condition is.
C-Reactive Protein. High levels of C-reactive protein (CRP) are also indicators of active inflammation. Like the ESR, a high result does not indicate what part of the body is inflamed, or what is causing the inflammation.
Anti-CCP Antibody. The presence of antibodies to cyclic citrullinated peptides (CCP) can identify RA years before symptoms develop. In combination with the test for rheumatoid factor, the CCP antibody test is the best predictor of which patients will go on to develop severe RA.
Tests for Anemia. Anemia is a common complication. Blood tests determine the amount of red blood cells (hemoglobin and hematocrit) and iron (soluble transferrin receptor and serum ferritin) in the blood.
X-rays generally have not been helpful to detect the presence of early rheumatoid arthritis because they cannot show images of soft tissue. However, x-rays can help track the progression of joint damage over time. The doctor may also order other imaging tests, such as ultrasound, or magnetic resonance imaging (MRI). Dual energy x-ray absorptiometry (dexa scans), also called bone densitometry, may be used to check for signs of bone density loss associated with osteoporosis.
Symptoms of rheumatoid arthritis can be mimicked by things as benign as a bad mattress or as serious as cancer. Several rare genetic diseases attack the joints. Physical injuries, infections, and poor circulation are among the many problems that can cause aches and pains. Many conditions present with symptoms of joint aches and pains. A few that in particular may be confused with rheumatoid arthritis include:
Osteoarthritis. Osteoarthritis is the most common form of arthritis, but it differs from RA in several important respects:
Gout. Gout also causes swelling and severe pain in a joint. It most commonly starts in one joint. It is sometimes difficult to distinguish chronic gout in older people from rheumatoid arthritis, since gout in this population can occur in a number of joints. A proper diagnosis can be made with a detailed medical history, laboratory tests, and detection in the affected joint of crystals called monosodium urate (MSU), which identifies gout.
The treatment of rheumatoid arthritis involves medications and lifestyle changes.
Many drugs are used for managing the pain and slowing the progression of rheumatoid arthritis, but none completely cure the disease. The goals of drug treatment for rheumatoid arthritis include:
The drug classes used for RA include:
The question of how early and how aggressively to treat RA has been the subject of great debate. Among patients with RA, some will go into remission and remain in remission for the length of their lives even in the absence of treatment, while others will go on to develop active, sometimes severe RA.
In 2010, the American College of Rheumatology (ACR) updated its classification system for rheumatoid arthritis to help identify and treat patients in earlier stages of the disease. Under the old system, patients were not diagnosed with RA until joint damage was evident. The new classification system uses a 10-point analysis that includes factors such as symptom duration, and number and size of inflamed joints.
Current practice has moved towards treating the disease aggressively while it is in its early stages to help prevent it from reaching a more severe and chronic state. Studies have found less joint damage in patients with early, aggressive treatment, particularly with the use of DMARDs and TNF modifiers in combination with methotrexate. Intensive early dosing of methotrexate may help slow progression of rheumatoid arthritis. Early combination therapy with DMARDs and corticosteroids is also showing good results.
Patients who have not been helped by one drug often benefit from a combination of drugs. However, over a longer period of time, it is not clear whether a drug combination approach offers many advantages over single drugs. It is also not certain which combination of drugs works best. Depending on your particular health condition, and how you respond to the drugs prescribed, your doctor may try various treatment strategies.
Current DMARD guidelines from the American College of Rheumatology recommend:
[For more specific information on these drugs, see Medications section of this report.]
Disease-modifying anti-rheumatic drugs (DMARDs) are the standard treatments for RA. They are used either alone or in combination with newer biologic DMARDs.
DMARDs do not have any common properties other than their ability to slow down the progression of rheumatoid arthritis. Many were used for other diseases and were found accidentally to help RA. DMARDs include:
Unfortunately, all DMARDs tend to lose effectiveness over time, even methotrexate. Patients rarely use one drug for more than 2 years. Combining DMARDs with each other or with drugs in other categories offers the best approach for many patients. The addition of a corticosteroid to any combination may also be helpful.
All DMARDs may produce stomach and intestinal side effects, and, over the long term, each poses some risk for rare but serious reactions. (In some cases, however, they may be less harmful than long-term NSAID treatment.)
Methotrexate. Methotrexate (Rheumatrex, Trexall, generic) acts as an anti-inflammatory drug and is now the most frequently used DMARD, particularly for severe disease. Methotrexate starts working within 3 - 6 weeks, but its full effect may not occur until after 12 weeks of treatment.
Even this drug loses effectiveness, however, when used alone. For this reason, it is often used in combination with other DMARDs such as hydroxychloroquine, sulfasalzine, or leflunomide. It may also be combined with various biological response modifier drugs, especially for treatment of patients with early aggressive arthritis. The combination appears to work better than single drug therapy.
About 20% of patients withdraw from methotrexate because of its side effects. They include nausea and vomiting, rash, mild hair loss, headache, mouth sores, and muscle aches. Methotrexate reduces levels of folic acid (folate) in the body, which can lead to some of these side effects. Doctors may prescribe folic acid supplements to prevent side effects. However, some research suggests that folic acid may interfere with methotrexate's effectiveness.
Methotrexate is usually given as pills. Patients who need higher doses can take it as an injection. Methotrexate has fewer serious toxic effects than many DMARDs. Although these severe reactions are rare, they may include:
Leflunomide. Leflunomide (Arava, generic) blocks autoimmune antibodies and reduces inflammation. It also may inhibit metalloproteinases (MMP), which are involved in cartilage destruction. Leflunomide takes several weeks before improving joint pain or swelling. Full benefits may not occur until 6 - 12 weeks of treatment.
Leflunomide may be given alone or in combination with other DMARDs such as methotrexate. (This combination poses a risk for liver toxicity and requires monitoring.)
Side effects are similar to those of methotrexate, including nausea, diarrhea, hair loss, and rash. Potentially serious side effects include infections and severe liver injury. Everyone taking leflunomide should be monitored regularly, including blood tests for liver function, and anyone with liver problems should not take this drug. Leflunomide should not be taken by patients with active bacterial infections, active herpes-zoster viral infection, active or latent tuberculosis, or acute or chronic hepatitis B or C.
Hydroxychloroquine. Hydroxychloroquine (Plaquenil, generic) was originally used for preventing malaria and is now also used for mild, slowly progressive rheumatoid arthritis. Hydroxychloroquine starts to improve symptoms within 1 - 2 months, but it may take up to 6 months to achieve full benefit. It also does not appear to slow disease progression. Hydroxycholoroquine usually causes fewer side effects than other DMARDs. The most common side effects are nausea and diarrhea, which typically improve over time or when the drug is taken with food. Less common side effects include skin rash or bleaching or thinning of hair.
This drug used to be associated with eye and vision problems, but with current lower doses this side effect is rare. If vision problems occur, it is usually with people taking very high doses, those with kidney disease, or those over 60 years of age. Still, patients should have an eye exam (including retinal examination) within the first year of treatment. Patients with health risks (liver disease, retinal disease, over age 60) should have an annual eye exam. Patients should notify their doctors if they experience any sudden changes in vision.
Sulfasalazine. Sulfasalazine (Azulfidine, generic) works best when the disease is confined to the joints. Symptom relief occurs within 1 - 3 months.
Side effects are common, particularly stomach and intestinal distress, which usually occur early in the course of treatment. (However, serious gastrointestinal side effects, such as stomach ulcers, occur less frequently with sulfasalazine than with NSAIDs.) A coated-tablet form may help reduce side effects. Other side effects include skin rash and headache. Sulfasalazine increases sensitivity to sunlight. Be sure to wear sunscreen (SPF 15 or higher) while taking this drug. People with intestinal or urinary obstructions or who have allergies to sulfa drugs or salicylates should not take sulfasalazine.
Gold. Gold has been a time-honored DMARD for rheumatoid arthritis, although its use has decreased with the development of disease modifying and biologic drugs. Gold is usually administered in an injected form because the oral form, auranofin (Ridaura, generic), is much less effective. There are two injectable forms of gold: Gold sodium thiomalate (Myochrysine, generic) and aurothioglucose (Solganal, generic). It can take 3 - 6 months before injections have an effect on RA symptoms.
Gold injections cause mouth sores in about a third of patients. Skin side effects, including itching and rash, can be severe in some patients. The most serious side effects of gold injections, while rare, are kidney damage and decreased white blood cell count. Gold injections are usually not given to pregnant women. It is not definite that gold causes birth defects, but doctors generally recommend women use birth control while receiving this drug.
Minocycline. Minocycline (Minocin, generic) is a tetracycline antibiotic that is generally reserved for patients with mild RA. It can take 2 - 3 months before symptoms begin to improve and up to a year for full benefit. Side effects include upset stomach, dizziness, and skin rash. Long-term use of minocycline can cause changes in skin color, but this side effect usually disappears once the medication is stopped. Minocycline can cause yeast infections in women. It should not be used by women who are pregnant or planning on becoming pregnant. Minocycline increases sensitivity to sunlight and patients should be sure to wear sunscreen. In rare cases, minocycline can affect the kidneys and liver.
Azathioprine. Azathioprine (Imuran, generic) suppresses immune system activity. It takes 6 - 8 weeks for early symptom improvement and up to 12 weeks for full benefit. Azathioprine can cause serious problems with the gastrointestinal tract. About 10 - 15% of patients experience nausea and vomiting, often accompanied by stomach pain and diarrhea. (Taking the medication twice daily, instead of once daily, or taking it after eating may help avoid this problem.) Azathioprine can also cause problems with liver function and pancreas gland inflammation, and can reduce white blood cell count.
Cyclosporine. Like azathioprine, cyclosporine (Sandimmune, Neoral, generic) is an immunosuppressant. It is used for people with RA who have not responded to other drugs. It can take a week before symptoms improve and up to 3 months for full benefit. The most serious and common side effects of cyclosporine are high blood pressure and kidney function problems. While kidney function usually improves once the drug is stopped, mild-to-moderate high blood pressure may continue. Cyclosporine can also cause gout or worsen gout in people who have this condition.
Other common side effects include headache, nausea, vomiting, stomach pain and upset, and swelling of hands and feet. About 10% of patients who take cyclosporine develop tremors, increased hair growth, muscle cramps, and numbing or tingling in hands and feet (neuropathy). Swelling of the gums is also common. Patients should practice good dental hygiene, including regular brushing and flossing.
Biologic response modifiers are drugs made from living cells. These drugs target specific components of the immune system that contribute to the joint inflammation and damage that are part of the rheumatoid arthritis disease process.
Biologic DMARDs are generally used to treat moderate-to-severe rheumatoid arthritis. Some of these drugs are used as first-line treatments for RA. Others are used for patients who have not responded to DMARDs or other types of treatment. Depending on the specific drug, they may be used alone or in combination with the DMARD methotrexate. However, biologic response modifiers are not used in combination with each other, as this can lead to serious infections.
As with other rheumatoid arthritis drugs, these drugs do not cure the disease but can help slow progression and joint damage.
Anti-TNF Drugs. Most biologic DMARDs are anti-tumor necrosis factor (anti-TNF) drugs. They block TNF, which is a cytokine involved in the inflammatory process. Anti-TNF drugs approved for treatment of rheumatoid arthritis are:
Other Biologic DMARDs. Other biologic DMARDs approved for RA treatment are:
Side Effects and Complications. Etanercept, adalimumab, anakinra, golimumab, certolizumab, and abatacept come in pre-filled syringes and are given by injection under the skin (subcutaneous injection). This may cause pain at the injection site. To prevent injection reactions, patients are sometimes pretreated with betamethasone, a corticosteroid drug, but some research suggests that the steroid does little good.
Infliximab, tocilizumab, abatacept and rituximab are given by intravenous infusion in a doctor's office. Common infusion reactions include headache, nausea, and flu-like symptoms. Because biologic response modifiers affect the immune system, patients who take these drugs have an increased risk for infections.
Biologic DMARDs should not be taken by patients with active bacterial infections, active herpes-zoster viral infection, active or latent tuberculosis, or active or chronic hepatitis B or C. In addition, anti-TNF drugs should not be given to patients with a history of heart failure, a history of lymphoma, or who have multiple sclerosis or other demyelinating disorders.
Other risks associated with these drugs include:
Corticosteroids work rapidly to control inflammation and pain. Long-time use, however, can have severe adverse effects. Still, they are often used under the following conditions:
Side Effects of Oral Corticosteroids. Serious side effects are associated with long-term use of oral steroids. (Low doses may reduce these risks, but they do not eliminate them.) Osteoporosis is a common and particularly severe long-term side effect of prolonged steroid use. Other adverse effects include cataracts, glaucoma, diabetes, fluid retention, susceptibility to infections, weight gain, hypertension, capillary fragility, acne, excess hair growth, wasting of the muscles, menstrual irregularities, irritability, insomnia, and, rarely, psychosis. Recent research suggests that prednisone may increase the risk of developing non-melanoma skin cancer.
Withdrawal from Long-Term Use of Oral Corticosteroids. Long-term use of oral steroid medications suppresses secretion of natural steroid hormones by the adrenal glands. After withdrawal from these drugs, this adrenal suppression persists and it can take the body a while (sometimes up to a year) to regain its ability to produce natural steroids again. There have been a few cases of severe adrenal insufficiency that occurred when switching from oral to inhaled steroids, which, in rare cases, has resulted in death.
No one should stop taking any steroids without consulting a doctor first, and if steroids are withdrawn, regular follow-up monitoring is necessary. Patients should discuss with their doctor measures for preventing adrenal insufficiency during withdrawal, particularly during stressful times, when the risk increases.
Two-thirds of people with RA rank pain as their primary reason for seeking professional help. The most common pain relievers for RA are nonsteroidal anti-inflammatory drugs (NSAIDs). These drugs block prostaglandins, the substances that dilate blood vessels and cause inflammation and pain. There are dozens of NSAIDs:
Studies suggest that the best times for taking an NSAID may be after the evening meal and then again on awakening. RA symptoms increase gradually during the night, reaching their greatest severity at the time of awakening. Taking NSAIDs with food can reduce stomach discomfort, although it may slow the pain-relieving effect.
Long-term, regular use of NSAIDs (with the exception of aspirin) can increase the risk for heart attack, especially for people who have a heart condition. Long-term use of NSAIDs also increases the risk of ulcers and gastrointestinal bleeding. To reduce the risks associated with NSAIDs, take the lowest dose possible for pain relief.
Other possible side effects of NSAIDs may include:
COX-2 Inhibitors (Coxibs). Coxibs inhibit an inflammation-promoting enzyme called COX-2. This drug class was initially thought to provide benefits equal to NSAIDs but cause less gastrointestinal distress. However, following numerous reports of heart problems, skin rashes, and other adverse effects, the FDA re-evaluated the risks and benefits of COX-2 inhibitors. This led to the removal of rofecoxib (Vioxx) and valdecoxib (Bextra) from the United States market. Celecoxib (Celebrex) is still available, but patients should ask their doctor whether the drug is appropriate and safe for them.
Some people with RA benefit from joint surgery. Surgery can help relieve joint pain, correct deformities, and modestly improve joint function. There are several types of joint surgery techniques. [For more information on surgical procedures, see In-Depth Report #35: Osteoarthritis.]
Synovectomy is removal of the joint lining (synovium). It is used to remove inflamed tissue that causes pain. Synovectomy can help reduce swelling and slow the progression of joint damage.
Arthroscopy is performed to clean out bone and cartilage fragments (a process called debridement) that cause pain and inflammation. It is usually performed on the knee, but it also may be done on other joints:
In many cases, the procedure can be done using local anesthetic, and the patient can go home within a day. In the case of knee operations, patients can resume mild activity in a couple of days, but full recovery can take up to 3 months.
Eventually, even after these procedures, rheumatoid arthritis may progress to the point that normal functioning is impossible. In such cases, artificial (prosthetic) replacement joint implants may be considered for shoulders, knees, hips, ankles, wrists and hands, or other joints. Joint replacement (arthroplasty) is usually reserved for people over age 50 or those whose joint damage is rapidly progressing. The joint replacement typically lasts for 20 years or more.
If the affected joint cannot be replaced, surgeons can perform a procedure called arthrodesis that eliminates pain by fusing the bones together. However, fusing the bones makes movement of the joint impossible. Bone fusion is most often done in the spine and in the small joints of the hands (wrists, fingers) and feet (ankles, toes).
It is important for patients with RA to maintain a balance between rest (which will reduce inflammation) and moderate exercise (which will relieve stiffness and weakness). Studies have suggested that even as little as 3 hours of physical therapy over 6 weeks can help people with RA, and that these benefits are sustained.
The goal of exercise is to:
In general, doctors recommend the following approaches:
A common-sense approach to exercise is the best guide:
Many patients with RA try dietary approaches, such as fasting, vegan diets, or eliminating specific foods that seem to worsen RA symptoms. There is little scientific evidence to support these approaches but some patients report anecdotally that they are helpful.
In recent years, a number of studies have suggested that the omega-3 fatty acids contained in fish oil may have anti-inflammatory properties useful for RA joint pain relief. The best source of fish oil is through increased consumption of fatty fish such as salmon, mackerel, and herring. Fish oil supplements are another option, but they may interact with certain medications. If you are thinking of trying fish oil supplements, talk to your doctor first.
Various ointments, including Ben Gay and capsaicin (a cream that use the active ingredient in chili peppers), may help soothe painful joints.
Orthotic devices are specialized braces and splints that support and help align joints. Many such devices made from a variety of light materials are available and can be very helpful when worn properly.
Several specially designed appliances and devices are available to ease daily activities.
People often turn to alternative therapies or nontraditional remedies to relieve the pain of rheumatoid arthritis. Although there is no definitive evidence to support their efficacy, some alternative procedures -- such as acupuncture, massage, mineral baths (balneotherapy), relaxation techniques, biofeedback, and hypnosis -- are not harmful and may be a useful adjunct to standard treatments.
Herbal remedies used for RA include boswellia, equisetum arvense (horsetail), devil's claw, borage seed oil, and many others. To date, no evidence supports their efficacy.
Researchers are currently conducting studies to determine if supplements extracted from the turmeric spice can help prevent joint inflammation. The Chinese medicine herb Tripterygium wilfordii Hook F (TwHF) is also being investigated for its anti-inflammatory properties.
Generally, manufacturers of herbal remedies and dietary supplements do not need FDA approval to sell their products. Just like a drug, herbs and supplements can affect the body's chemistry, and therefore have the potential to produce side effects that may be harmful. There have been a number of reported cases of serious and even lethal side effects from herbal products. Always check with your doctor before using any herbal remedies or dietary supplements.
Deighton C, O'Mahony R, Tosh J, Turner C, Rudolf M; Guideline Development Group. Management of rheumatoid arthritis: summary of NICE guidance. BMJ. 2009 Mar 16;338:b702. doi: 10.1136/bmj.b702.
Donahue KE, Gartlehner G, Jonas DE, Lux LJ, Thieda P, Jonas BL, et al. Systematic review: comparative effectiveness and harms of disease-modifying medications for rheumatoid arthritis. Ann Intern Med. 2008 Jan 15;148(2):124-34. Epub 2007 Nov 19.
Firestein GS. Etiology and pathogenesis of rheumatoid arthritis. In: Harris ED, Budd RC, Genovese MC, Firestein GS, Sargent JS, Sledge CB, eds. Kelley's Textbook of Rheumatology. 7th ed. Philadelphia, Pa: Saunders Elsevier; 2005:chap 65.
Furst DE, Breedveld FC, Kalden JR, Smolen JS, Burmester GR, Sieper J, et al. Updated consensus statement on biological agents for the treatment of rheumatic diseases, 2007. Ann Rheum Dis. 2007 Nov;66 Suppl 3:iii2-22.
Goldberg RJ, Katz J. A meta-analysis of the analgesic effects of omega-3 polyunsaturated fatty acid supplementation for inflammatory joint pain. Pain. 2007 May;129(1-2):210-23. Epub 2007 Mar 1.
Harris ED Jr. Clinical features of rheumatoid arthritis. In: Harris ED, Budd RC, Genovese MC, Firestein GS, Sargent JS, Sledge CB, eds. Kelley's Textbook of Rheumatology. 7th ed. Philadelphia, Pa: Saunders Elsevier; 2005:chap 66.
Huizinga TW, Pincus T. In the clinic. Rheumatoid arthritis. Ann Intern Med. 2010 Jul 6;153(1):ITC1-1-ITC1-15.
Komano Y, Tanaka M, Nanki T, Koike R, Sakai R, Kameda H, et al. Incidence and risk factors for serious infection in patients with rheumatoid arthritis treated with tumor necrosis factor inhibitors: a report from the Registry of Japanese Rheumatoid Arthritis Patients for Longterm Safety. J Rheumatol. 2011 Jul;38(7):1258-64. Epub 2011 Apr 15.
Macfarlane GJ, El-Metwally A, De Silva V, Ernst E, Dowds GL, Moots RJ; Arthritis Research UK Working Group on Complementary and Alternative Medicines. Evidence for the efficacy of complementary and alternative medicines in the management of rheumatoid arthritis: a systematic review. Rheumatology (Oxford). 2011 Sep;50(9):1672-83. Epub 2011 Jun 6.
Mariette X, Matucci-Cerinic M, Pavelka K, Taylor P, van Vollenhoven R, Heatley R, et al. Malignancies associated with tumour necrosis factor inhibitors in registries and prospective observational studies: a systematic review and meta-analysis. Ann Rheum Dis. 2011 Nov;70(11):1895-904. Epub 2011 Sep 1.
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O'Dell JR. Rheumatoid arthritis. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 272.
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Smolen JS, Aletaha D, Bijlsma JW, Breedveld FC, Boumpas D, Burmester G, et al. Treating rheumatoid arthritis to target: recommendations of an international task force. Ann Rheum Dis. 2010 Apr;69(4):631-7. Epub 2010 Mar 9.
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Yazici Y. Treatment of rheumatoid arthritis: we are getting there. Lancet. 2009 Jul 18;374(9685):178-80. Epub 2009 Jun 26.


text: This week Ray and Patrick are joined by two of the best LW fighters in the UK. First up is Curt Warburton who is the No contender for both the BAMMA and KSW LW championships. He talks about his career so far and going 1 and 2 in the UFC. Are second guests is TUF Smashes standout Brendan Loughnane, after a great showing in Australia he talks about facing fellow Brit Mike Wilkinson and at 23 a very bright future in the UFC.


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Snowden to Brazil: I Need Permanent Asylum
(NEWSER) – Is Edward Snowden looking to decamp from Russia to Brazil? He strongly implies as much in an open letter today, published at Folha. "I have expressed my willingness to assist wherever appropriate and lawful," he writes, "but unfortunately the United States government has worked hard to limit my ability to do so. … Until a country grants permanent political asylum, the US government will continue to interfere with my ability to speak." The rest of the letter is spent decrying NSA activities, which he says is a "culture of indiscriminate worldwide surveillance" that is "collapsing."


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Sherry Schnake, Ph.D.
Professor of Psychology
- Email:
- Phone: (812) 535-5178
- Ph.D., M.S., Experimental Social Psychology, Tulane University
- B.A., Psychology, Butler University.
Research Activities
- Schnake, S. (2010) Increasing Students' Reflection on How Their Own Development Connects With Young Adulthood Theories in a Service Learning Project. Poster presentation at 2010 Midwestern Psychological Association Annual Meeting.
- Schnake, M., Dumler, M., Fredenberger, B., & Schnake, S. (2004). Surprising student choices of traditional vs. nontraditional learning approaches in an undergraduate organizational behavior course. Academy of Educational Leadership Journal, 8, 23-24.
- Beal, D. J., Ruscher, J.B., & Schnake, S. B. (2001). No benefit of the doubt: Intergroup bias in understanding causal explanation. British Journal of Social Psychology, 40, 531-543.
- Schnake, S. B., & Ruscher, J. B. (1998). Modern racism as a predictor of the linguistic intergroup bias. Journal of Language and Social Psychology, 17, 486-493.
- Schnake, S. B., Ruscher, J. B., Gratz, K. L., & O'Neal, E. C. (1997). Measure for measure? Male retaliation commensurate with anger depends on provocateur gender and aggression covertness. Journal of Social Behavior and Personality, 12, 937-954.
Professional Experiences
- 2011-present Professor of Psychology, Saint Mary-of-the-Woods College
- 2005-2011 Associate Professor of Psychology, Saint Mary-of-the-Woods College
- 1999-2005 Assistant Professor of Psychology, Saint Mary-of-the-Woods College
- 1991-1993 Victim Advocate at Marion County Prosecutor's Office
- 2005 Pomeroy Award for Excellence in Scholarship
Community Involvement
- Board of Directors, Woods Day Care/Preschool 2004-2009
- Member, Lost Creek PTO, 2008-present


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Artisan Leather iPad® Mini Envelope - Chestnut
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A handsome way to protect your iPad® mini from scratches and damage, our artisan-crafted envelope is tailored by hand from supple leather. The vegetable-tanned leather gets its chestnut hue from bark and leaf pigments, which infuse the hide with rich color while preserving the tones and textures that make each piece one of a kind.
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Reading Level: Grade 8+
He was the father of one of the younger kids on her gymnastics team. How was 16-year-old Lark supposed to know that he was a predator? Lark died of exposure after he assaulted her and left her tied to a tree in the winter woods.
Lark's ghost begins visiting Nyetta soon after. Lark needs Nyetta to do something for her, something Nyetta is afraid to do. If Nyetta does not do it, Lark will be condemned to a horrible fate for eternity.
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The Sledding Hill by Chris Crutcher
Elsewhere by Gabrielle by Zevin and
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Re: remote kernels
In article <47hgug$dcl at ralph.vnet.net>, jeff at econ.Berkeley.EDU (Jeffrey C.
Ely) wrote:
>I have a notebook interface on my PC at home and wish to access
>a remote kernel running on a machine on campus. Unfortunately
>the machine denies rsh connections. Is there some other way
>to start the connection with the remote kernel.
>What exactly happens when using mathematica remotely. Since the
>default is to use rsh, it must not be the case that mathematica
>just starts an interactive shell on the machine running the
There are two methods of connecting the frontend to a kernel: MathLink
(new/current) and MathTalk (old). As I understand it, the latter does
everything through the telnet connection (the same one that the kernel was
spawned in). The former actually opens a new connection between the
kernel's host and the frontend's host and communicates with its own
Getting to the point, the MathTalk protocol should work for you (it is an
option in the frontend's kernel configuration window). The downside is
that I found MathTalk to be somewhat slower and less stable than MathLink.
-- Brad Sawatzky <Brad.Sawatzky at usask.ca>


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January 23, 2013 at 18:39:39 Jan 23, 2013 @ 18:39
tl:dr If he don't sell 250,000 by december, hes getting dropped.
Originally posted by Inactive UserThe teenage rap star wonât be able to spend most of his big-money pay check until he turns 18 in August, DNAinfo.com has learned.
Chief Keef signed a three-album contract â and a separate deal to control his own record label â with Interscope Records that could pay the South Side gangster rapper more than $6 million over three years. A split of future royalties could make for an even bigger pay day, according to court papersâ¦
â¦Interscope agreed to pay Chief Keef a $440,000 advance â half up front and half after a judge signs off on the deal â that will be deposited in a court administered trust fund on his behalf, according to courtpapers. The so-called âblocked trustâ is controlled by Chief Keefâs legal guardian, his grandmother, Margaret Carter. Withdrawals typically are prohibited from block trusts until a minor turns 18.
Chief Keef â who is currently locked up in juvenile detention for 60 days â also received at least $300,000 to cover the cost of recording âFinally Rich,â which sold 50,000 copies during the first week it was released in December.
Chief Keefâs deals all depend on album sales. If âFinally Richâ doesnât sell at least 250,000 albums by December 2013, Interscope has the right to pull the plug on subsequent album releases â two albums and a compilation of hits, according to the deal.
In a separate three-year deal to establish Chief Keefâs record label âGlory Boyz Entertainmentâ â GBE for short â Interscope Records forked over another $440,000 advance. That agreement calls for both Chief Keef and his manager, Rovan Manuel, to each be paid $180,000. The deal calls for 15-percent of Chief Keefâs advance to be put in his trust fund, according to court papers.
tl:dr If he don't sell 250,000 by december, hes getting dropped.