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In this task, you are given a context, a subject, a relation, and many options. Based on the context, from the options select the object entity that has the given relation with the subject. Answer with text (not indexes).

Context: Rheumatoid arthritis (RA) is a long-term autoimmune disorder that primarily affects joints. It typically results in warm, swollen, and painful joints. Pain and stiffness often worsen following rest. Most commonly, the wrist and hands are involved, with the same joints typically involved on both sides of the body. The disease may also affect other parts of the body. This may result in a low red blood cell count, inflammation around the lungs, and inflammation around the heart. Fever and low energy may also be present. Often, symptoms come on gradually over weeks to months.
While the cause of rheumatoid arthritis is not clear, it is believed to involve a combination of genetic and environmental factors. The underlying mechanism involves the body's immune system attacking the joints. This results in inflammation and thickening of the joint capsule. It also affects the underlying bone and cartilage. The diagnosis is made mostly on the basis of a person's signs and symptoms. X-rays and laboratory testing may support a diagnosis or exclude other diseases with similar symptoms. Other diseases that may present similarly include systemic lupus erythematosus, psoriatic arthritis, and fibromyalgia among others.
The goal of treatment is to reduce pain, decrease inflammation, and improve a person's overall functioning. This may be helped by balancing rest and exercise, the use of splints and braces, or the use of assistive devices. Pain medications, steroids, and NSAIDs are frequently used to help with symptoms. A group of medications called disease-modifying antirheumatic drugs (DMARDs), such as hydroxychloroquine and methotrexate, may be used to try to slow the progression of disease. Biological DMARDs may be used when disease does not respond to other treatments. However, they may have a greater rate of adverse effects. Surgery to repair, replace, or fuse joints may help in certain situations. Most alternative medicine treatments are not supported by evidence.
RA affects between 0.5 and 1% of adults in the developed world with between 5 and 50 per 100,000 people newly developing the condition each year. Onset is most frequent during middle age and women are affected 2.5 times as frequently as men. In 2013, it resulted in 38,000 deaths up from 28,000 deaths in 1990. The first recognized description of RA was made in 1800 by Dr. Augustin Jacob Landre-Beauvais (17721840) of Paris. The term "rheumatoid arthritis" is based on the Greek for watery and inflamed joints.
Signs and symptoms.
RA primarily affects joints, but it also affects other organs in more than 1525% of individuals., Fibromyalgia (FM) is a medical condition characterised by chronic widespread pain and a heightened pain response to pressure. Other symptoms include feeling tired to a degree that normal activities are affected, sleep problems, and troubles with memory. Some people also report restless legs syndrome, bowel or bladder problems, numbness and tingling, and sensitivity to noise, lights or temperature. Fibromyalgia is frequently associated with depression, anxiety, and posttraumatic stress disorder. Other types of chronic pain are also frequently present.
The cause of fibromyalgia is unknown; however, it is believed to involve a combination of genetic and environmental factors with half the risk attributed to each. The condition runs in families and many genes are believed to be involved. Environmental factors may include psychological stress, trauma, and certain infections. The pain appears to result from processes in the central nervous system and the condition is referred to as a "central sensitization syndrome". Fibromyalgia is recognized as a disorder by the US National Institutes of Health and the American College of Rheumatology. There is no specific diagnostic test. Diagnosis involves first ruling out other potential causes and verifying that a set number of symptoms are present.
The treatment of fibromyalgia can be difficult. Recommendations often include getting enough sleep, exercising regularly, and eating a healthy diet. Cognitive behavioral therapy may also be helpful. The medications duloxetine, milnacipran, or pregabalin may be used. Use of opioid pain medication is controversial with some stating their use is poorly supported by evidence and others saying that weak opioids may be reasonable if other medications are not effective. Dietary supplements also lack evidence to support their use. While fibromyalgia can last a long time, it does not result in death or tissue damage.
Fibromyalgia is estimated to affect 28% of the population. Females are affected about twice as often as males. Rates appear similar in different areas of the world and among different cultures. Fibromyalgia was first defined in 1990 with updated criteria in 2011. There is controversy about the classification, diagnosis, and treatment of fibromyalgia. While some feel the diagnosis of fibromyalgia may negatively affect a person, other research finds it to be beneficial. The term "fibromyalgia" is from New Latin, "fibro-", meaning "fibrous tissues", Greek "myo-", "muscle", and Greek "algos", "pain"; thus the term literally means "muscle and fibrous connective tissue pain"., A burn is a type of injury to skin, or other tissues, caused by heat, cold, electricity, chemicals, friction, or radiation. Most burns are due to heat from hot liquids, solids, or fire. Females in many areas of the world have a higher risk related to the more frequent use of open cooking fires or unsafe cook stoves. Alcoholism and smoking are other risk factors. Burns can also occur as a result of self harm or violence between people.
Burns that affect only the superficial skin layers are known as superficial or first-degree burns. They appear red without blisters and pain typically lasts around three days. When the injury extends into some of the underlying skin layer, it is a partial-thickness or second-degree burn. Blisters are frequently present and they are often very painful. Healing can require up to eight weeks and scarring may occur. In a full-thickness or third-degree burn, the injury extends to all layers of the skin. Often there is no pain and the burn area is stiff. Healing typically does not occur on its own. A fourth-degree burn additionally involves injury to deeper tissues, such as muscle, tendons, or bone. The burn is often black and frequently leads to loss of the burned part.
Burns are generally preventable. Treatment depends on the severity of the burn. Superficial burns may be managed with little more than simple pain medication, while major burns may require prolonged treatment in specialized burn centers. Cooling with tap water may help pain and decrease damage; however, prolonged cooling may result in low body temperature. Partial-thickness burns may require cleaning with soap and water, followed by dressings. It is not clear how to manage blisters, but it is probably reasonable to leave them intact if small and drain them if large. Full-thickness burns usually require surgical treatments, such as skin grafting. Extensive burns often require large amounts of intravenous fluid, due to capillary fluid leakage and tissue swelling. The most common complications of burns involve infection. Tetanus toxoid should be given if not up to date.
In 2013, fire and heat resulted in 35 million injuries. This resulted in about 2.9 million hospitalizations and 238,000 dying. Most deaths due to burns occur in the developing world, particularly in Southeast Asia. While large burns can be fatal, treatments developed since 1960 have improved outcomes, especially in children and young adults. In the United States, approximately 96% of those admitted to a burn center survive their injuries. Burns occur at similar frequencies in men and women. The long-term outcome is related to the size of burn and the age of the person affected.
Signs and symptoms.
The characteristics of a burn depend upon its depth. Superficial burns cause pain lasting two or three days, followed by peeling of the skin over the next few days. Individuals suffering from more severe burns may indicate discomfort or complain of feeling pressure rather than pain. Full-thickness burns may be entirely insensitive to light touch or puncture. While superficial burns are typically red in color, severe burns may be pink, white or black. Burns around the mouth or singed hair inside the nose may indicate that burns to the airways have occurred, but these findings are not definitive. More worrisome signs include: shortness of breath, hoarseness, and stridor or wheezing. Itchiness is common during the healing process, occurring in up to 90% of adults and nearly all children. Numbness or tingling may persist for a prolonged period of time after an electrical injury. Burns may also produce emotional and psychological distress., Orthopedic surgery or orthopedics (alternatively spelled orthopaedic surgery and orthopaedics) is the branch of surgery concerned with conditions involving the musculoskeletal system. Orthopedic surgeons use both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors, and congenital disorders.
Etymology.
Nicholas Andry coined the word ""orthopdics"" in French as "orthopedie", derived from the Greek words "orthos" ("correct", "straight") and "paidion" ("child"), when he published "Orthopedie" (translated as "Orthopdia: or the Art of Correcting and Preventing Deformities in Children") in 1741. Though as the name implies it was initially developed with attention to children, the correction of spinal and bony deformities in all stages of life eventually became the cornerstone of orthopedic practice., Septic arthritis, also known as infectious arthritis or joint infection, is the purulent invasion of a joint by an infectious agent which produces arthritis. People with artificial joints are more at risk than the general population but have slightly different symptoms, are infected with different organisms and require different treatment. Septic arthritis is considered a medical emergency. If untreated, it may destroy the joint in a period of days. The infection may also spread to other parts of the body., Arthritis is a term often used to mean any disorder that affects joints. Symptoms generally include joint pain and stiffness. Other symptoms may include redness, warmth, swelling, and decreased range of motion of the affected joints. In some types other organs are also affected. Onset can be gradual or sudden.
There are over 100 types of arthritis. The most common forms are osteoarthritis (degenerative joint disease) and rheumatoid arthritis. Osteoarthritis usually occurs with age and affects the fingers, knees, and hips. Rheumatoid arthritis is an autoimmune disorder that often affects the hands and feet. Other types include gout, lupus, fibromyalgia, and septic arthritis. They are all types of rheumatic disease.
Treatment may include resting the joint and alternating between applying ice and heat. Weight loss and exercise may also be useful. Pain medications such as ibuprofen and paracetamol (acetaminophen) may be used. In some a joint replacement may be useful.
Osteoarthritis affects more than 3.8% of people while rheumatoid arthritis affects about 0.24% of people. Gout affects about 1 to 2% of the Western population at some point in their lives. In Australia about 15% of people are affected, while in the United States more than 20% of have a type of arthritis. Overall the disease becomes more common with age. Arthritis is a common reason that people miss work and can result in a decreased quality of life. The term is from Greek "arthro-" meaning joint and "-itis" meaning inflammation., A bone is a rigid organ that constitutes part of the vertebrate skeleton. Bones support and protect the various organs of the body, produce red and white blood cells, store minerals, provide structure and support for the body, and enable mobility. Bones come in a variety of shapes and sizes and have a complex internal and external structure. They are lightweight yet strong and hard, and serve multiple functions. , Pain is a distressing feeling often caused by intense or damaging stimuli, such as stubbing a toe, burning a finger, putting alcohol on a cut, or bumping the "funny bone". Because it is a complex, subjective phenomenon, defining pain has been a challenge. The International Association for the Study of Pain's widely used definition states: "Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage." In medical diagnosis, pain is regarded as a symptom of an underlying condition., A disease is a particular abnormal condition, a disorder of a structure or function, that affects part or all of an organism. The study of disease is called pathology which includes the causal study of etiology. Disease is often construed as a medical condition associated with specific symptoms and signs. It may be caused by external factors such as pathogens, or it may be caused by internal dysfunctions particularly of the immune system such as an immunodeficiency, or a hypersensitivity including allergies and autoimmunity., Replacement arthroplasty (from Greek "arthron", joint, limb, articulate, + "plassein", to form, mould, forge, feign, make an image of), or joint replacement surgery, is a procedure of orthopedic surgery in which an arthritic or dysfunctional joint surface is replaced with an orthopedic prosthesis. Joint replacement is considered as a treatment when severe joint pain or dysfunction is not alleviated by less-invasive therapies. During the latter half of the 20th century, rheumasurgery developed as a subspecialty focused on these and a few other procedures in patients with rheumatic diseases., White blood cells (WBCs), also called leukocytes or leucocytes, are the cells of the immune system that are involved in protecting the body against both infectious disease and foreign invaders. All white blood cells are produced and derived from multipotent cells in the bone marrow known as hematopoietic stem cells. Leukocytes are found throughout the body, including the blood and lymphatic system., Osteoarthritis ( OA ) is a type of joint disease that results from breakdown of joint cartilage and underlying bone . The most common symptoms are joint pain and stiffness . Initially , symptoms may occur only following exercise , but over time may become constant . Other symptoms may include joint swelling , decreased range of motion , and when the back is affected weakness or numbness of the arms and legs . The most commonly involved joints are those near the ends of the fingers , at the base of the thumb , neck , lower back , knees , and hips . Joints on one side of the body are often more affected than those on the other . Usually the problems come on over years . It can affect work and normal daily activities . Unlike other types of arthritis , only the joints are typically affected . Causes include previous joint injury , abnormal joint or limb development , and inherited factors . Risk is greater in those who are overweight , have one leg of a different length , and have jobs that result in high levels of joint stress . Osteoarthritis is believed to be caused by mechanical stress on the joint and low grade inflammatory processes . It develops as cartilage is lost with eventually the underlying bone becoming affected . As pain may make it difficult to exercise , muscle loss may occur . Diagnosis is typically based on signs and symptoms with medical imaging and other tests occasionally used to either support or rule out other problems . Unlike in rheumatoid arthritis , which is primarily an inflammatory condition , the joints do not typically become hot or red . Treatment includes exercise , efforts to decrease joint stress , support groups , and pain medications . Efforts to decrease joint stress include resting and the use of a cane . Weight loss may help in those who are overweight . Pain medications may include paracetamol ( acetaminophen ) . If this does not work NSAIDs such as naproxen may be used , but these medications are associated with greater side effects . Opioids if used are generally only recommended short term due to the risk of addiction . If pain interferes with normal life despite other treatments , joint replacement surgery may help . An artificial joint , however , only lasts a limited amount of time . Outcomes for most people with osteoarthritis are good . OA is the most common form of arthritis with disease of the knee and hip affecting about 3.8 % of people as of 2010 . Among those over 60 years old about 10 % of males and 18 % of females are affected . It is the cause of about 2 % of years lived with disability . In Australia about 1.9 million people are affected , and in the United States about 27 million people are affected . Before 45 years of age it is more common in men , while after 45 years of age it is more common in women . It becomes more common in both sexes as people become older ., Pathology (from the Greek roots of "pathos", meaning "experience" or "suffering", and "-logia", "study of") is a significant component of the causal study of disease and a major field in modern medicine and diagnosis., Medical imaging is the technique and process of creating visual representations of the interior of a body for clinical analysis and medical intervention, as well as visual representation of the function of some organs or tissues (physiology). Medical imaging seeks to reveal internal structures hidden by the skin and bones, as well as to diagnose and treat disease. Medical imaging also establishes a database of normal anatomy and physiology to make it possible to identify abnormalities. Although imaging of removed organs and tissues can be performed for medical reasons, such procedures are usually considered part of pathology instead of medical imaging., Subject: osteoarthritis, Relation: medical_specialty, Options: (A) infection (B) infectious disease (C) orthopedics (D) pathology (E) rheumatology (F) surgery
Output:
rheumatology