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).

Example input: Context: Joanne McLeod is a Canadian figure skating coach. She is the skating director at the Champs International Skating Centre of BC (formerly known as the BC Centre of Excellence). Here current and former students include Emanuel Sandhu, Mira Leung, Kevin Reynolds, Jeremy Ten, Nam Nguyen, and many others. In 2012, McLeod became the first level 5 certified figure skating coach in British Columbia., Victor Kraatz, MSC (born April 7, 1971) is a Canadian former ice dancer. In 2003, he and his partner, Shae-Lynn Bourne, became the first North American ice dancers to win a World Championship., Allie Hann-McCurdy (born May 23, 1987 in Nanaimo, British Columbia) is a Canadian ice dancer. McCurdy began skating at age eight and was a singles skater until age 12 when she switched to ice dancing. In 2003 she teamed up with Michael Coreno, with whom she was the 2010 Four Continents silver medalist and the 2008 Canadian bronze medalist. The pair retired in June 2010, to coach at the Gloucester Skating Club., Maikki Uotila - Kraatz ( born 25 February 1977 ) is a Finnish ice dancer . She is a former Finnish national champion with Toni Mattila . She married Victor Kraatz on June 19 , 2004 . The two coach in Vancouver , where they are the ice dancing directors at the BC Centre of Excellence . She and Kraatz have two sons , born September 14 , 2006 and July 10 , 2010 ., Burnaby is a city in British Columbia, Canada, located immediately to the east of Vancouver. It is the third-largest city in British Columbia by population, surpassed only by nearby Surrey and Vancouver., Canada (French: ) is a country in the northern half of North America. Its ten provinces and three territories extend from the Atlantic to the Pacific and northward into the Arctic Ocean, covering , making it the world's second-largest country by total area and the fourth-largest country by land area. Canada's border with the United States is the world's longest land border. The majority of the country has a cold or severely cold winter climate, but southerly areas are warm in summer. Canada is sparsely populated, the majority of its land territory being dominated by forest and tundra and the Rocky Mountains. About four-fifths of the country's population of 36 million people is urbanized and live near the southern border. Its capital is Ottawa, its largest city is Toronto; other major urban areas include Montreal, Vancouver, Calgary, Edmonton, Quebec City, Winnipeg and Hamilton., British Columbia (BC) is the westernmost province of Canada, with a population of more than four million people located between the Pacific Ocean and the Rocky Mountains. 
British Columbia is also a component of the Pacific Northwest and the Cascadia bioregion, along with the U.S. states of Idaho, Oregon, Washington and Alaska., The "Champs International Skating Centre of British Columbia" (formerly known as the 'BC Centre of Excellence') is one of two major figure skating training centers in Canada. Located in Burnaby, British Columbia, it is home to many great national and international skaters. The programs there are overseen by a staff, including Joanne McLeod, who coaches 3-time Canadian men's national champion Emanuel Sandhu; Bruno Marcotte, who competed at the 2002 Winter Olympics; Victor Kraatz, the 2003 World Champion in ice dancing, and Maikki Uotila, who was a national champion in Finland. The center operates out of Canlan Ice Sports Burnaby 8 Rinks. Notable skaters who train there include Emanuel Sandhu, Mira Leung, Allie Hann-McCurdy & Michael Coreno, Jessica Millar & Ian Moram, Jeremy Ten, and Kevin Reynolds. This skating school is sometimes known as a training site for international competitors to practice for competitions in Vancouver. Champs International hosts its annual competition known as the BC/YK SummerSkate Competition every August., Shae-Lynn Bourne, MSC (born January 24, 1976) is a Canadian ice dancer. In 2003, she and partner Victor Kraatz became the first North American ice dancers to win a World Championship. They competed at three Winter Olympic Games, placing 10th at the 1994 Winter Olympics, 4th at the 1998 Winter Olympics, and 4th at the 2002 Winter Olympics., Vancouver, officially the City of Vancouver, is a coastal seaport city on the mainland of British Columbia, Canada, and the most populous city in the province., Subject: maikki uotila, Relation: country_of_citizenship, Options: (A) american (B) british (C) canada (D) finland (E) montreal
Example output: finland
Example explanation: This is a good example, as maikki uotila is citizen of the finland.
Q: Context: Megacolon is an abnormal dilation of the colon (also called the large intestine). The dilation is often accompanied by a paralysis of the peristaltic movements of the bowel. In more extreme cases, the feces consolidate into hard masses inside the colon, called fecalomas (literally, "fecal tumor"), which can require surgery to be removed., An abscess is a collection of pus that has built up within the tissue of the body. Signs and symptoms of abscesses include redness, pain, warmth, and swelling. The swelling may feel fluid filled when pressed. The area of redness often extends beyond the swelling. Carbuncles and boils are types of abscess that often involve hair follicles with carbuncles being larger.
They are usually caused by a bacterial infection. Often many different types of bacteria are involved in a single infection. In the United States and many other areas of the world the most common bacteria present is "methicillin-resistant Staphylococcus aureus". Rarely, parasites can cause abscesses and this is more common in the developing world. Diagnosis of a skin abscess is usually made based on what it looks like and is confirmed by cutting it open. Ultrasound imaging may be useful in cases in which the diagnosis is not clear. In abscesses around the anus, computer tomography (CT) may be important to look for deeper infection.
Standard treatment for most skin or soft tissue abscesses is cutting it open and drainage. There does not appear to be any benefit from also using antibiotics for this type of abscess in most people who are otherwise healthy. A small amount of evidence supports not packing the cavity that remains with gauze after drainage. Closing this cavity right after draining it rather than leaving it open may speed healing without increasing the risk of the abscess returning. Sucking out the pus with a needle is often not sufficient.
Skin abscesses are common and have become more common in recent years. Risk factors include intravenous drug use with rates reported as high as 65% in this population. In 2005 in the United States 3.2 million people went to the emergency department for an abscess. In Australia around 13,000 people were hospitalized in 2008 with the condition., 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., 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., Reactive arthritis is a form of inflammatory arthritis that develops in response to an infection in another part of the body (cross-reactivity). Coming into contact with bacteria and developing an infection can trigger the disease. By the time the patient presents with symptoms, often the "trigger" infection has been cured or is in remission in chronic cases, thus making determination of the initial cause difficult., Bowel obstruction, also known as intestinal obstruction, is a mechanical or functional obstruction of the intestines which prevents the normal movement of the products of digestion. Either the small bowel or large bowel may be affected. Symptoms include abdominal pain, vomiting, bloating, and not passing gas. Mechanical obstruction is the cause of about 5 to 15% of cases of severe abdominal pain of sudden onset requiring admission to hospital.
Causes of bowel obstruction include adhesions, hernias, volvulus, endometriosis, inflammatory bowel disease, appendicitis, tumors, diverticulitis, ischemic bowel, tuberculosis, and intussusception. Small bowel obstructions are most often due to adhesions and hernias while large bowel obstructions are most often due to tumors and volvulus. The diagnosis may be made on plain X-rays; however, CT scan is more accurate. Ultrasound or MRI may help in the diagnosis of children or pregnant women.
The condition may be treated conservatively or with surgery. Typically intravenous fluids are given, a tube is placed through the nose into the stomach to decompress the intestines, and pain medications are given. Antibiotics are often given. In small bowel obstruction about 25% require surgery. Complications may include sepsis, bowel ischemia, and bowel perforation.
About 2.5 million cases of or bowel obstruction occurred in 2013 which resulted in 236,000 deaths. Both sexes are equally affected and the condition can occur at any age. Bowel obstruction has been documented throughout history with cases detailed in the Ebers Papyrus of 1550 BC and by Hippocrates., Immunodeficiency (or immune deficiency) is a state in which the immune system's ability to fight infectious disease and cancer is compromised or entirely absent. Most cases of immunodeficiency are acquired ("secondary") due to extrinsic factors that affect the patient's immune system. Examples of these extrinsic factors include HIV infection, extremes of age, and environmental factors, such as nutrition. In the clinical setting, the immunosuppression by some drugs, such as steroids, can be either an adverse effect or the intended purpose of the treatment. Examples of such use is in organ transplant surgery as an anti-rejection measure and in patients suffering from an overactive immune system, as in autoimmune diseases. Some people are born with intrinsic defects in their immune system, or primary immunodeficiency. A person who has an immunodeficiency of any kind is said to be immunocompromised. An immunocompromised person may be particularly vulnerable to opportunistic infections, in addition to normal infections that could affect everyone. Immunodeficiency also decreases cancer immunosurveillance, in which the immune system scans the body's cells and kills neoplastic ones., 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 Landré-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., Diarrhea, also spelled diarrhoea, is the condition of having at least three loose or liquid bowel movements each day. It often lasts for a few days and can result in dehydration due to fluid loss. Signs of dehydration often begin with loss of the normal stretchiness of the skin and irritable behaviour. This can progress to decreased urination, loss of skin color, a fast heart rate, and a decrease in responsiveness as it becomes more severe. Loose but non-watery stools in babies who are breastfed, however, may be normal.
The most common cause is an infection of the intestines due to either a virus, bacteria, or parasite; a condition known as gastroenteritis. These infections are often acquired from food or water that has been contaminated by stool, or directly from another person who is infected. It may be divided into three types: short duration watery diarrhea, short duration bloody diarrhea, and if it lasts for more than two weeks, persistent diarrhea. The short duration watery diarrhea may be due to an infection by cholera, although this is rare in the developed world. If blood is present it is also known as dysentery. A number of non-infectious causes may also result in diarrhea, including hyperthyroidism, lactose intolerance, inflammatory bowel disease, a number of medications, and irritable bowel syndrome. In most cases, stool cultures are not required to confirm the exact cause.
Prevention of infectious diarrhea is by improved sanitation, clean drinking water, and hand washing with soap. Breastfeeding for at least six months is also recommended as is vaccination against rotavirus. Oral rehydration solution (ORS), which is clean water with modest amounts of salts and sugar, is the treatment of choice. Zinc tablets are also recommended. These treatments have been estimated to have saved 50 million children in the past 25 years. When people have diarrhea it is recommended that they continue to eat healthy food and babies continue to be breastfed. If commercial ORS are not available, homemade solutions may be used. In those with severe dehydration, intravenous fluids may be required. Most cases; however, can be managed well with fluids by mouth. Antibiotics, while rarely used, may be recommended in a few cases such as those who have bloody diarrhea and a high fever, those with severe diarrhea following travelling, and those who grow specific bacteria or parasites in their stool. Loperamide may help decrease the number of bowel movements but is not recommended in those with severe disease.
About 1.7 to 5 billion cases of diarrhea occur per year. It is most common in developing countries, where young children get diarrhea on average three times a year. Total deaths from diarrhea are estimated at 1.26 million in 2013  down from 2.58 million in 1990. In 2012, it was the second most common cause of deaths in children younger than five (0.76 million or 11%). Frequent episodes of diarrhea are also a common cause of malnutrition and the most common cause in those younger than five years of age. Other long term problems that can result include stunted growth and poor intellectual development., Crohn's disease is a type of inflammatory bowel disease (IBD) that may affect any part of the gastrointestinal tract from mouth to anus. Signs and symptoms often include abdominal pain, diarrhea (which may be bloody if inflammation is severe), fever, and weight loss. Other complications may occur outside the gastrointestinal tract and include anemia, skin rashes, arthritis, inflammation of the eye, and feeling tired. The skin rashes may be due to infections as well as pyoderma gangrenosum or erythema nodosum. Bowel obstruction also commonly occurs and those with the disease are at greater risk of bowel cancer.
Crohn's disease is caused by a combination of environmental, immune and bacterial factors in genetically susceptible individuals. It results in a chronic inflammatory disorder, in which the body's immune system attacks the gastrointestinal tract possibly directed at microbial antigens. While Crohn's is an immune related disease, it does not appear to be an autoimmune disease (in that the immune system is not being triggered by the body itself). The exact underlying immune problem is not clear; however, it may be an immunodeficiency state. About half of the overall risk is related to genetics with more than 70 genes found to be involved. Tobacco smokers are two times more likely to develop Crohn's disease than nonsmokers. It also often begins after gastroenteritis. Diagnosis is based on a number of findings including biopsy and appearance of the bowel wall, medical imaging and description of the disease. Other conditions that can present similarly include irritable bowel syndrome and Behçet's disease.
There are no medications or surgical procedures that can cure Crohn's disease. Treatment options help with symptoms, maintain remission, and prevent relapse. In those newly diagnosed, a corticosteroid may be used for a brief period of time to quickly improve the disease with another medication such as either methotrexate or a thiopurine used to prevent recurrence. An important part of treatment is the stopping of smoking among those who do. One in five people with the disease are admitted to hospital each year, and half of those with the disease will require surgery for the disease at some point over a ten-year period. While surgery should be used as little as possible, it is necessary to address some abscesses, certain bowel obstructions, and cancers. Checking for bowel cancer via colonoscopy is recommended every few years, starting eight years after the disease has begun.
Crohn's disease affects about 3.2 per 1,000 people in Europe and North America. It is less common in Asia and Africa. It has historically been more common in the developed world. Rates have, however, been increasing, particularly in the developing world, since the 1970s. Inflammatory bowel disease resulted in 35,000 deaths in 2010 and those with Crohn's disease have a slightly reduced life expectancy. It tends to start in the teens and twenties, although it can occur at any age. Males and females are equally affected. The disease was named after gastroenterologist Burrill Bernard Crohn, who, in 1932, together with two other colleagues at Mount Sinai Hospital in New York, described a series of patients with inflammation of the terminal ileum of the small intestine, the area most commonly affected by the illness., Irritable bowel syndrome (IBS) is a group of symptomsincluding abdominal pain and changes in the pattern of bowel movements without any evidence of underlying damage. These symptoms occur over a long time, often years. It has been classified into four main types depending on if diarrhea is common, constipation is common, both are common, or neither occurs very often (IBS-D, IBS-C, IBS-M, or IBS-U respectively). IBS negatively affects quality of life and may result in missed school or work. Disorders such as anxiety, major depression, and chronic fatigue syndrome are common among people with IBS.
The causes of IBS are not clear. Theories include gutbrain axis problems, small intestinal bacterial overgrowth, genetic factors, food sensitivity, and gut motility problems. Onset may be triggered by an intestinal infection, or stressful life event. IBS is a functional gastrointestinal disorder. Diagnosis is based on signs and symptoms in the absence of worrisome features. Worrisome features include onset at greater than 50 years of age, weight loss, blood in the stool, or a family history of inflammatory bowel disease. Other conditions that may present similarly include celiac disease, microscopic colitis, inflammatory bowel disease, bile acid malabsorption, and colon cancer.
There is no cure for IBS. Treatment is carried out to improve symptoms. This may including dietary changes, medication, probiotics, and counseling. Dietary measures include increasing soluble fiber intake, a gluten free diet, or a diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP). The medication loperamide may be used to help with diarrhea while laxatives may be used to help with constipation. Antidepressants may improve overall symptoms and pain. Patient education and a good doctorpatient relationship are an important part of care.
About 10 to 15% of people in the developed world are believed to be affected by IBS. It is more common in South America and less common in Southeast Asia. It is twice as common in women as men and typically occurs before age 45. The condition appears to become less common with age. IBS does not affect life expectancy or lead to other serious diseases. The first description of the condition was in 1820 while the current term "irritable bowel syndrome" came into use in 1944.
Classification.
IBS can be classified as either diarrhea-predominant (IBS-D), constipation-predominant (IBS-C), or with alternating stool pattern (IBS-A) or pain-predominant. In some individuals, IBS may have an acute onset and develop after an infectious illness characterized by two or more of: fever, vomiting, diarrhea, or positive stool culture. This postinfective syndrome has consequently been termed "postinfectious IBS" (IBS-PI)., Infection is the invasion of an organism's body tissues by disease-causing agents, their multiplication, and the reaction of host tissues to these organisms and the toxins they produce. Infectious disease, also known as transmissible disease or communicable disease, is illness resulting from an infection.
Infections are caused by infectious agents including viruses, viroids, prions, bacteria, nematodes such as parasitic roundworms and pinworms, arthropods such as ticks, mites, fleas, and lice, fungi such as ringworm, and other macroparasites such as tapeworms and other helminths., In medicine , sacroiliitis is an inflammation of the sacroiliac joint . Sacroiliitis is a feature of spondylarthropathies , such as ankylosing spondylitis , psoriatic arthritis , reactive arthritis or arthritis related to inflammatory bowel diseases , including ulcerative colitis or Crohn 's disease . It is also the most common presentation of arthritis from Brucellosis ., 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., Surgery (from the "cheirourgik" (composed of , "hand", and , "work"), via , meaning "hand work") is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, to help improve bodily function or appearance or to repair unwanted ruptured areas (for example, a perforated ear drum)., 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, knee, and hips. Joints on one side of the body are often more affected than those on the other. Usually the symptoms 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 and the underlying bone becomes 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. In contrast to rheumatoid arthritis, which is primarily an inflammatory condition, in osteoarthritis, 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) as well as NSAIDs such as naproxen or ibuprofen. Long-term opioid use is generally discouraged due to lack of information on benefits as well as risks of addiction and other side effects. If pain interferes with normal life despite other treatments, joint replacement surgery may help. An artificial joint typically lasts 10 to 15 years.
Osteoarthritis 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, 30 to 52.5 million people are affected. It becomes more common in both sexes as people become older., Genetics is the study of genes, genetic variation, and heredity in living organisms. It is generally considered a field of biology, but intersects frequently with many other life sciences and is strongly linked with the study of information systems., 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., Burrill Bernard Crohn (June 13, 1884  July 29, 1983) was an American gastroenterologist and made the first major advance to identify the disease that now bears his name. Although the description of Crohn's disease is by far his most famous accomplishment, Crohn had a long career both as a clinician, and as a researcher who contributed to modern understanding of many gastrointestinal conditions.
Life and work.
Crohn received his bachelor's degree from City College of New York in 1902. He received a medical degree from Columbia University College of Physicians and Surgeons in 1907. Crohn first became an intern at Mount Sinai Hospital in 1907. He was promoted to head of gastroenterology in 1920, the same year he joined the staff of Columbia University., 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"., Ankylosing spondylitis (AS) is a type of arthritis in which there is long term inflammation of the joints of the spine. Typically the joints where the spine joins the pelvis are also affected. Occasionally other joints such as the shoulders or hips are involved. Eye and bowel problems may also occur. Back pain is a characteristic symptom of AS, and it often comes and goes. Stiffness of the affected joints generally worsens over time.
The cause of ankylosing spondylitis is unknown; however, it is believed to involve a combination of genetic and environmental factors. More than 90% of those effected have a specific human leukocyte antigen known as the HLA-B27 antigen. The underlying mechanism is believed to be autoimmune or autoinflammatory. Diagnosis is typically based on the symptoms with support from medical imaging and blood tests. AS is a type of seronegative spondyloarthropathy, meaning that tests show no presence of rheumatoid factor (RF) antibodies.
There is no cure for ankylosing spondylitis. Treatments may improve symptoms and prevent worsening. This may include medication, exercise, and surgery. Medications used include NSAIDs, steroids, DMARDs such as sulfasalazine, and biologic agents such as infliximab.
Between 0.1% and 1.8% of people are affected. Onset is typically in young adults. Males are more often affected than females. The condition was first fully described in the late 1600s by Bernard Connor; however, skeletons with ankylosing spondylitis are found in Egyptian mummies. The word is from Greek "ankylos" meaning stiffening, "spondylos" meaning vertebra, and "-itis" meaning inflammation., Ulcerative colitis (UC) is a long-term condition that results in inflammation and ulcers of the colon and rectum. The primary symptom of active disease is abdominal pain and diarrhea mixed with blood. Weight loss, fever, and anemia may also occur. Often symptoms come on slowly and can range from mild to severe. Symptoms typically occur intermittently with periods of no symptoms between flares. Complications may include megacolon, inflammation of the eye, joints, or liver, and colon cancer.
The cause of UC is unknown. Theories involve immune system dysfunction, genetics, changes in the normal gut bacteria, and environmental factors. Rates tend to be higher in the developed world with some proposing this to be the result of less exposure to intestinal infections, or a Western diet and lifestyle. The removal of the appendix at an early age may be protective. Diagnosis is typically by colonoscopy with tissue biopsies. It is a kind of inflammatory bowel disease (IBD) along with Crohn's disease and microscopic colitis.
Dietary changes may improve symptoms. A number of medications are used to treat symptoms and bring about and maintain remission. These include aminosalicylates such as sulfasalazine, steroids, immunosuppressants such as azathioprine, and biological therapy. Removal of the colon by surgery may be necessary if the disease is severe, does not respond to treatment, or if complications such as colon cancer develop. Removal of the colon and rectum can cure the disease.
The first description of ulcerative colitis occurred around the 1850s. Each year it newly occurs in 1 to 20 people per 100,000 and 5 to 500 per 100,000 individuals are affected. The disease is more common in North America and Europe. Often it begins between 15 and 30 years of age or among those over 60. Males and females appear to be affected equally. It has also become more common since the 1950s. Together, ulcerative colitis and Crohn's disease affect approximately 500,000 to 2 million people in the United States. With appropriate treatment the risk of death appears the same as that of the general population., Subject: sacroiliitis, Relation: medical_specialty, Options: (A) gastroenterology (B) genetics (C) infection (D) infectious disease (E) pathology (F) rheumatology (G) surgery
A:
rheumatology