Rheumatoid Arthritis:a look outside the joints

by Dr Nachiket Kulkarni

Rheumatoid Arthritis has been known to mankind since early time of medical descriptions. Disease with joint pains and crippling deformities is how it has been described. This description is pretty much spot on! But is it a complete one? Not really!
Rheumatoid Arthritis is not just a disease of joints. It’s a disease characterised by various systemic manifestations. These systemic features are receiving special importance in current research as these features have major impact on RA morbidity and mortality. These features are primarily of two types- extra-articular features and Co-morbidities. Extra-articular features of RA are those which occur as  a direct consequence of RA pathology. Eg Rheumatoid nodules, ulcers etc. They are discussed in other sections of this magazine. We would make ourselves familiar with ‘Co-morbidities’ in this articles. This term refers to diseases which occur commonly with RA but are not direct effect of RA pathology. More often than not the Co-morbidities decide the cause of death in patients of RA!
The list of Co-morbidities has been ever increasing in recent past. Their impact on treatment, costs and quality of life has been recognised. Its imperative hence to be aware of this problem to safeguard ourselves of the bad effects.
1. Cardiovascular Diseases : This may come as a surprise to many that patients of Rheumatoid Arthritis have double the risk of Heart Attack. It is believed that increased inflammation in RA makes a person susceptible to have atherosclerosis at a rate much higher than general population. This makes them prone to have heart attack, paralysis attacks or even limb ischemia at lesser age as compared to general population. Increased cardiovascular diseases are a major cause for decreased life span for a patient of RA. The treatment of these diseases is a costly affair. More ever the number of medicines increase. There is a risk of drug-drug interactions which can hamper treatment efficacy or worse cause complications.
There is increased occurrence of Hypertension in patients of RA. This further adds to burden of atherosclerosis, increased medication and drug related complications.Cardiovascular diseases hence have now been recognised as major co-mobidity with RA ‘BUT’ (here its used for a positive tense) this menace is under ambit of control. Your Rheumatologist makes assessment of this risk from the time of diagnosis itself – irrespective of your age. During your follow up visits monitoring is done for hypertension and lipid levels. Lifestyle measures of healthy eating habits and exercise are re-enforced by your Rheumatologist.
Please feel free and take up initiative for yourself to discuss diet and exercise with your doctor. In most cases these measures suffice and in others these go a long way to support general health. Some times specialists help is taken to either identify or treat these problems. Correct treatment of RA is also protective against these complication. It is a heartening thought that patients of RA on regular follow up and treatment are less prone to these problems as compared to those who don’t.
• Infections: RA is an autoimmune disorder. The immune system starts attacking our own body cells. Though the activity of immune system increases it is actually a defective one. This affects the primary function of immune system- to safeguard against foreign insults like microorganisms. Coupled to this the medicines which are advised for RA further can increase risk of infections. This is most associated with Biologics. The highest risk is for respiratory infections. risk of other infections like urinary infections, gastrointestinal infections, skin infections, etc also increase. Risk is similar for bacterial, viral or parasitic infections. Most concerning are chronic infections like Tuberculosis and Hepatitis B. These are of special importance while dealing with biologics. It needs to be noted that infections in setting of RA might require an aggressive antibiotic therapy as compared to non RA individuals. BUT(again a positive sense) this co morbidity is under a measure of control. During your first assessment a thorough clinical and laboratory review is done by the Rheumatologist. Any therapeutic decision which your doctor takes is weighed thoroughly in risk versus benefit ratio. Screening of diseases are sometimes done in special situation like before starting Biologics. Vaccinations have revolutionised this fields. Vaccines against specific diseases can be administered as per your doctor. This decreases the morbidity and mortality due to those infections significantly. With widespread research in this field more and more vaccines are developed against various diseases.
•Nutritional Deficiency : This comorbidity gets under recognised and hence becomes a reason for untackled but common problems. By virtue of severe inflammation persons appetite is affected. The disease process itself can affect the digestive tract from mouth to colon. This adversely affects digestion. Medicines react with food causing vital nutritional deficiency. Some patients have severe gastrointestinal problems due to drugs which further increases the problem. BUT!! Your Rheumatologist keeps a keen eye out for this problem. Clinical and laboratory parameters are followed to keep a look out. The dietary recommendation  is to eat healthy. Nutritional supplements are used regularly and in emergency in intravenous form to meet the need.
•Depression: RA is a painful chronic disease. It’s obvious to understand that if not rightly attended to a person can develop depression. It is being researched that depression is associated with RA  due to the pathophysiological mechanics. About 19% of patients of RA were found to have depression in a case series. This has a direct impact on treatment and medications. In view of taboo associated with the subject very few get identified. Many patients suffer for bereft of right treatment. Please feel free to talk with doctor on this issue. Your doctor can help you be happy.
•Others: As mentioned earlier apart from the main comorbidities associated with RA the list is ever-increasing. Prominent among them are Drug related side effects and cancer. Drugs are the best friend for a patient of RA. They are also a double edged sword with number of side-effects. The list sometimes is exhausting.BUT!! As may be the toxicities as efficient would be your Rheumatologists capacity to prevent them. The doctor decides the best suited medicine after analysing you and timely monitoring specific to the drug used are done to prevent them or identify early. Other major comorbidity is Cancer. Some cancer occur in higher frequency in RA like lung cancer and lymphoma while some have a lower risk like bowel and breast cancer. A timely diagnosis is key to successful treatment. Be aware and be regular.

Understanding of comorbidities have made management of RA more tougher. It requires anticipation and early diagnosis for able management. Anticipation comes from awareness. Hope this article has sensitised you to be aware of problems of RA outside the joint. The take home message is that effective treatment of RA and regular follow up will help probably prevent, identify early and adequately manage RA and comorbidities.

Join the Conversation

640 Comments

  1. We are a group of volunteers and starting a new scheme in our community. Your web site provided us with valuable information to work on. You have done an impressive job and our whole community will be grateful to you.

  2. My brother suggested I might like this blog. He used to be totally right. This publish actually made my day. You cann’t believe just how so much time I had spent for this information! Thank you!

  3. Woah! I’m really enjoying the template/theme of this website. It’s simple, yet effective. A lot of times it’s tough to get that “perfect balance” between user friendliness and visual appearance. I must say that you’ve done a awesome job with this. In addition, the blog loads very fast for me on Safari. Outstanding Blog!

  4. Hey there! I know this is kind of off-topic but I had to ask. Does operating a well-established blog like yours take a lot of work? I’m completely new to blogging but I do write in my diary on a daily basis. I’d like to start a blog so I will be able to share my experience and views online. Please let me know if you have any suggestions or tips for new aspiring bloggers. Appreciate it!

  5. Very good website you have here but I was curious if you knew of any message boards that cover the same topics talked about in this article? I’d really love to be a part of group where I can get suggestions from other knowledgeable individuals that share the same interest. If you have any recommendations, please let me know. Many thanks!

  6. This design is steller! You most certainly know how to keep a reader entertained. Between your wit and your videos, I was almost moved to start my own blog (well, almost…HaHa!) Fantastic job. I really enjoyed what you had to say, and more than that, how you presented it. Too cool!

  7. When I originally commented I seem to have clicked the -Notify me when new comments are added- checkbox and now every time a comment is added I get four emails with the same comment. Is there a means you can remove me from that service? Many thanks!

  8. Hey there just wanted to give you a quick heads up and let you know a few of the images aren’t loading correctly. I’m not sure why but I think its a linking issue. I’ve tried it in two different browsers and both show the same results.

  9. An interesting discussion is worth comment. I do think that you should write more on this topic, it might not be a taboo subject but generally people do not speak about such subjects. To the next! All the best!!

  10. Do you have a spam issue on this site; I also am a blogger, and I was curious about your situation; many of us have created some nice procedures and we are looking to trade solutions with other folks, why not shoot me an e-mail if interested.

  11. Write more, thats all I have to say. Literally, it seems as though you relied on the video to make your point. You definitely know what youre talking about, why waste your intelligence on just posting videos to your site when you could be giving us something enlightening to read?

  12. An impressive share! I have just forwarded this onto a colleague who had been doing a little research on this. And he in fact bought me lunch because I found it for him… lol. So let me reword this…. Thank YOU for the meal!! But yeah, thanx for spending the time to discuss this issue here on your internet site.

  13. Hello would you mind stating which blog platform you’re working with? I’m planning to start my own blog in the near future but I’m having a tough time selecting between BlogEngine/Wordpress/B2evolution and Drupal. The reason I ask is because your design seems different then most blogs and I’m looking for something completely unique. P.S My apologies for getting off-topic but I had to ask!

  14. I like the valuable information you provide in your articles. I will bookmark your weblog and check again here frequently. I am quite certain I will learn lots of new stuff right here! Good luck for the next!

  15. Its like you read my mind! You seem to understand so much approximately this, like you wrote the guide in it or something. I feel that you could do with some % to pressure the message house a bit, however other than that, this is fantastic blog. An excellent read. I’ll definitely be back.

  16. Thank you for any other informative website. Where else may just I am getting that kind of info written in such a perfect method? I have a challenge that I am simply now running on, and I have been at the glance out for such information.

  17. Yesterday, while I was at work, my sister stole my iPad and tested to see if it can survive a forty foot drop, just so she can be a youtube sensation. My iPad is now broken and she has 83 views. I know this is entirely off topic but I had to share it with someone!

  18. Thank you for some other informative website. Where else may I am getting that kind of info written in such a perfect means? I have a venture that I am simply now operating on, and I have been at the glance out for such information.

  19. Хотите получить идеально ровный пол без лишних затрат? Обратитесь к профессионалам на сайте styazhka-pola24.ru! Мы предоставляем услуги по стяжке пола м2 по доступной стоимости, а также устройству стяжки пола под ключ в Москве и области.

  20. Хотите получить идеально ровные стены в своем доме или офисе? Обратитесь к профессионалам на сайте mehanizirovannaya-shtukaturka-moscow.ru! Мы предлагаем услуги по механизированной штукатурке стен любой сложности и площади, а также гарантируем качество работ и доступные цены.

  21. Хотите получить идеально ровные стены в своем доме или офисе? Обратитесь к профессионалам на сайте mehanizirovannaya-shtukaturka-moscow.ru! Мы предлагаем услуги по механизированной штукатурке стен любой сложности и площади, а также гарантируем качество работ и доступные цены.

  22. Can I simply say what a relief to find an individual who really knows what they’re talking about on the internet. You definitely know how to bring an issue to light and make it important. More and more people must look at this and understand this side of the story. I can’t believe you’re not more popular because you certainly have the gift.

  23. I loved as much as you will receive carried out right here. The sketch is tasteful, your authored subject matter stylish. nonetheless, you command get bought an edginess over that you wish be delivering the following. unwell unquestionably come further formerly again since exactly the same nearly a lot often inside case you shield this increase.

  24. Terrific article! This is the type of information that are meant to be shared around the internet. Disgrace on the seek engines for not positioning this submit upper! Come on over and seek advice from my site . Thank you =)

  25. hey there and thank you for your information I’ve definitely picked up anything new from right here. I did however expertise a few technical issues using this site, since I experienced to reload the site many times previous to I could get it to load properly. I had been wondering if your hosting is OK? Not that I am complaining, but sluggish loading instances times will often affect your placement in google and can damage your quality score if advertising and marketing with Adwords. Anyway I’m adding this RSS to my e-mail and can look out for a lot more of your respective interesting content. Make sure you update this again soon.

  26. I am really loving the theme/design of your site. Do you ever run into any internet browser compatibility problems? A number of my blog visitors have complained about my blog not operating correctly in Explorer but looks great in Opera. Do you have any ideas to help fix this issue?

  27. Heya just wanted to give you a quick heads up and let you know a few of the images aren’t loading correctly. I’m not sure why but I think its a linking issue. I’ve tried it in two different internet browsers and both show the same results.

  28. I love your blog.. very nice colors & theme. Did you design this website yourself or did you hire someone to do it for you? Plz reply as I’m looking to design my own blog and would like to know where u got this from. cheers

  29. Pretty part of content. I simply stumbled upon your website and in accession capital to claim that I acquire in fact enjoyed account your blog posts. Any way I’ll be subscribing on your augment or even I fulfillment you get entry to persistently rapidly.

  30. I think this is one of the such a lot significant information for me. And i’m glad reading your article. However want to statement on few common things, The site taste is great, the articles is really nice : D. Just right activity, cheers

  31. I do agree with all the concepts you have introduced on your post. They are very convincing and will definitely work. Still, the posts are too brief for novices. May just you please extend them a bit from next time? Thank you for the post.

  32. Yesterday, while I was at work, my sister stole my iphone and tested to see if it can survive a forty foot drop, just so she can be a youtube sensation. My iPad is now broken and she has 83 views. I know this is completely off topic but I had to share it with someone!

  33. Fantastic beat ! I wish to apprentice while you amend your web site, how can i subscribe for a blog web site? The account aided me a acceptable deal. I had been tiny bit acquainted of this your broadcast provided bright clear concept

  34. Howdy! I realize this is somewhat off-topic but I had to ask. Does operating a well-established blog like yours take a massive amount work? I’m completely new to operating a blog but I do write in my diary daily. I’d like to start a blog so I can share my experience and views online. Please let me know if you have any suggestions or tips for new aspiring bloggers. Appreciate it!

  35. Can I simply say what a relief to find somebody that truly knows what they’re talking about online. You definitely understand how to bring an issue to light and make it important. More and more people must look at this and understand this side of the story. I was surprised that you’re not more popular since you surely have the gift.

  36. Nice post. I used to be checking continuously this blog and I am inspired! Very useful information specially the last part 🙂 I deal with such info a lot. I used to be seeking this particular info for a long timelong time. Thank you and good luck.

  37. Simply wish to say your article is as surprising. The clearness on your publish is simply excellent and i can think you are a professional in this subject. Well with your permission allow me to clutch your RSS feed to stay up to date with forthcoming post. Thank you a million and please keep up the rewarding work.

  38. Hey There. I found your blog using msn. This is a very well written article. I will be sure to bookmark it and come back to read more of your useful information. Thanks for the post. I will definitely comeback.

  39. Howdy! I know this is kinda off topic nevertheless I’d figured I’d ask. Would you be interested in exchanging links or maybe guest writing a blog article or vice-versa? My website goes over a lot of the same subjects as yours and I believe we could greatly benefit from each other. If you are interested feel free to send me an e-mail. I look forward to hearing from you! Wonderful blog by the way!

  40. Today, I went to the beachfront with my kids. I found a sea shell and gave it to my 4 year old daughter and said “You can hear the ocean if you put this to your ear.” She put the shell to her ear and screamed. There was a hermit crab inside and it pinched her ear. She never wants to go back! LoL I know this is entirely off topic but I had to tell someone!

  41. My spouse and I absolutely love your blog and find many of your post’s to be exactly what I’m looking for. Does one offer guest writers to write content for yourself? I wouldn’t mind publishing a post or elaborating on some of the subjects you write related to here. Again, awesome site!

  42. You really make it seem so easy with your presentation but I find this topic to be really something which I think I would never understand. It seems too complicated and very broad for me. I am looking forward for your next post, I will try to get the hang of it!

  43. Undeniably consider that that you stated. Your favourite justification appeared to be at the internet the simplest thing to bear in mind of. I say to you, I definitely get irked at the same time as folks consider worries that they plainly do not recognise about. You controlled to hit the nail upon the top as smartlyand also defined out the whole thing with no need side effect , other people can take a signal. Will likely be back to get more. Thank you

  44. I’ve been exploring for a little bit for any high-quality articles or blog posts in this kind of area . Exploring in Yahoo I at last stumbled upon this site. Reading this info So i’m glad to show that I have a very just right uncanny feeling I found out exactly what I needed. I such a lot undoubtedly will make certain to don?t disregard this web site and give it a look on a continuing basis.

  45. Hi there just wanted to give you a quick heads up. The text in your content seem to be running off the screen in Ie. I’m not sure if this is a format issue or something to do with internet browser compatibility but I thought I’d post to let you know. The layout look great though! Hope you get the problem solved soon. Many thanks

  46. An impressive share! I have just forwarded this onto a colleague who had been doing a little research on this. And he in fact bought me breakfast because I discovered it for him… lol. So let me reword this…. Thank YOU for the meal!! But yeah, thanx for spending the time to discuss this matter here on your internet site.

  47. The other day, while I was at work, my sister stole my iPad and tested to see if it can survive a 25 foot drop, just so she can be a youtube sensation. My iPad is now broken and she has 83 views. I know this is entirely off topic but I had to share it with someone!

  48. I have been surfing online more than three hours today, yet I never found any fascinating article like yours. It’s lovely value enough for me. Personally, if all webmasters and bloggers made good content as you did, the net will probably be much more useful than ever before.

  49. Simply wish to say your article is as amazing. The clearness for your submit is simply nice and i can think you are a professional in this subject. Well together with your permission allow me to seize your RSS feed to stay up to date with imminent post. Thank you a million and please continue the rewarding work.

  50. Howdy! I know this is kinda off topic however , I’d figured I’d ask. Would you be interested in exchanging links or maybe guest writing a blog article or vice-versa? My website addresses a lot of the same subjects as yours and I believe we could greatly benefit from each other. If you are interested feel free to send me an e-mail. I look forward to hearing from you! Fantastic blog by the way!

  51. Appreciating the hard work you put into your website and in depth information you present. It’s awesome to come across a blog every once in a while that isn’t the same outdated rehashed material. Fantastic read! I’ve saved your site and I’m including your RSS feeds to my Google account.

  52. Appreciating the dedication you put into your website and in depth information you provide. It’s great to come across a blog every once in a while that isn’t the same unwanted rehashed material. Excellent read! I’ve saved your site and I’m including your RSS feeds to my Google account.

  53. Its like you read my mind! You seem to know so much about this, like you wrote the book in it or something. I think that you could do with some pics to drive the message home a bit, but other than that, this is wonderful blog. An excellent read. I’ll definitely be back.

  54. I believe what you postedwrotesaidbelieve what you postedwrotethink what you postedtypedsaidthink what you postedwroteWhat you postedwrotesaid was very logicala lot of sense. But, what about this?consider this, what if you were to write a killer headlinetitle?content?wrote a catchier title? I ain’t saying your content isn’t good.ain’t saying your content isn’t gooddon’t want to tell you how to run your blog, but what if you added a titlesomethingheadlinetitle that grabbed a person’s attention?maybe get a person’s attention?want more? I mean %BLOG_TITLE% is a little plain. You could look at Yahoo’s home page and see how they createwrite post headlines to get viewers to click. You might add a video or a related picture or two to get readers interested about what you’ve written. Just my opinion, it might bring your postsblog a little livelier.

  55. Hello would you mind stating which blog platform you’re working with? I’m planning to start my own blog in the near future but I’m having a tough time making a decision between BlogEngine/Wordpress/B2evolution and Drupal. The reason I ask is because your design and style seems different then most blogs and I’m looking for something completely unique. P.S My apologies for getting off-topic but I had to ask!

  56. Woah! I’m really loving the template/theme of this website. It’s simple, yet effective. A lot of times it’s challenging to get that “perfect balance” between user friendliness and visual appearance. I must say you have done a amazing job with this. In addition, the blog loads very fast for me on Internet explorer. Exceptional Blog!

  57. I think what you postedwrotesaidthink what you postedtypedsaidthink what you postedwrotethink what you postedwroteWhat you postedtyped was very logicala lot of sense. But, what about this?consider this, what if you were to write a killer headlinetitle?content?typed a catchier title? I ain’t saying your content isn’t good.ain’t saying your content isn’t gooddon’t want to tell you how to run your blog, but what if you added a titleheadlinetitle that grabbed a person’s attention?maybe get a person’s attention?want more? I mean %BLOG_TITLE% is a little vanilla. You might peek at Yahoo’s home page and see how they createwrite news headlines to get viewers interested. You might add a video or a pic or two to get readers interested about what you’ve written. Just my opinion, it could bring your postsblog a little livelier.

  58. My coder is trying to persuade me to move to .net from PHP. I have always disliked the idea because of the expenses. But he’s tryiong none the less. I’ve been using Movable-type on numerous websites for about a year and am worried about switching to another platform. I have heard excellent things about blogengine.net. Is there a way I can transfer all my wordpress content into it? Any kind of help would be really appreciated!

  59. What i do not realize is in fact how you’re now not really a lot more smartly-favored than you may be right now. You are so intelligent. You realize therefore significantly when it comes to this matter, produced me personally believe it from so many numerous angles. Its like men and women don’t seem to be interested until it’s something to accomplish with Lady gaga! Your personal stuffs nice. Always maintain it up!

  60. I think what you postedtypedsaidbelieve what you postedtypedsaidthink what you postedtypedthink what you postedwrotesaidWhat you postedtypedsaid was very logicala bunch of sense. But, what about this?think about this, what if you were to write a killer headlinetitle?content?typed a catchier title? I ain’t saying your content isn’t good.ain’t saying your content isn’t gooddon’t want to tell you how to run your blog, but what if you added a titleheadlinetitle that grabbed people’s attention?maybe get a person’s attention?want more? I mean %BLOG_TITLE% is a little vanilla. You ought to look at Yahoo’s home page and watch how they createwrite post headlines to get viewers interested. You might add a related video or a related pic or two to get readers interested about what you’ve written. Just my opinion, it could bring your postsblog a little livelier.

  61. Greetings I am so glad I found your site, I really found you by mistake, while I was searching on Digg for something else, Anyhow I am here now and would just like to say thank you for a remarkable post and a all round exciting blog (I also love the theme/design), I don’t have time to read through it all at the minute but I have saved it and also added in your RSS feeds, so when I have time I will be back to read a lot more, Please do keep up the superb job.

  62. hey there and thank you for your information I’ve definitely picked up anything new from right here. I did however expertise some technical issues using this web site, since I experienced to reload the web site many times previous to I could get it to load properly. I had been wondering if your web hosting is OK? Not that I am complaining, but sluggish loading instances times will very frequently affect your placement in google and can damage your high quality score if advertising and marketing with Adwords. Anyway I’m adding this RSS to my e-mail and can look out for a lot more of your respective fascinating content. Make sure you update this again soon.

  63. hey there and thank you for your information I’ve definitely picked up anything new from right here. I did however expertise some technical issues using this web site, since I experienced to reload the web site many times previous to I could get it to load properly. I had been wondering if your web hosting is OK? Not that I am complaining, but sluggish loading instances times will often affect your placement in google and can damage your quality score if advertising and marketing with Adwords. Anyway I’m adding this RSS to my e-mail and can look out for a lot more of your respective intriguing content. Make sure you update this again soon.

  64. Today, I went to the beachfront with my kids. I found a sea shell and gave it to my 4 year old daughter and said “You can hear the ocean if you put this to your ear.” She put the shell to her ear and screamed. There was a hermit crab inside and it pinched her ear. She never wants to go back! LoL I know this is entirely off topic but I had to tell someone!

  65. Hi there, I believe your site might be having internet browser compatibility issues. When I look at your web site in Safari, it looks fine however when opening in Internet Explorer, it has some overlapping issues. I just wanted to give you a quick heads up! Other than that, fantastic blog!

  66. I’m impressed, I must say. Rarely do I encounter a blog that’s both educative and entertaining, and let me tell you, you have hit the nail on the head. The issue is something which not enough people are speaking intelligently about. I am very happy that I found this in my search for something concerning this.

  67. Howdy would you mind stating which blog platform you’re working with? I’m looking to start my own blog in the near future but I’m having a tough time making a decision between BlogEngine/Wordpress/B2evolution and Drupal. The reason I ask is because your design and style seems different then most blogs and I’m looking for something completely unique. P.S My apologies for getting off-topic but I had to ask!

  68. Please let me know if you’re looking for a article writer for your site. You have some really great posts and I believe I would be a good asset. If you ever want to take some of the load off, I’d absolutely love to write some articles for your blog in exchange for a link back to mine. Please send me an e-mail if interested. Kudos!

  69. With havin so much written content do you ever run into any problems of plagorism or copyright violation? My website has a lot of completely unique content I’ve either created myself or outsourced but it appears a lot of it is popping it up all over the web without my authorization. Do you know any techniques to help reduce content from being ripped off? I’d truly appreciate it.

  70. I am really loving the theme/design of your site. Do you ever run into any internet browser compatibility problems? A number of my blog visitors have complained about my website not operating correctly in Explorer but looks great in Chrome. Do you have any suggestions to help fix this issue?

  71. Unquestionably consider that that you stated. Your favourite justification appeared to be at the net the simplest thing to take note of. I say to you, I definitely get irked at the same time as other folks consider concerns that they plainly do not recognise about. You controlled to hit the nail upon the top as smartlyand also defined out the whole thing with no need side effect , other people can take a signal. Will likely be back to get more. Thank you

  72. First off I want to say great blog! I had a quick question that I’d like to ask if you don’t mind. I was curious to know how you center yourself and clear your mind before writing. I have had trouble clearing my mind in getting my thoughts out. I do enjoy writing but it just seems like the first 10 to 15 minutes are generally wasted just trying to figure out how to begin. Any suggestions or tips? Thank you!

  73. Hey! I realize this is somewhat off-topic but I had to ask. Does operating a well-established blog like yours take a lot of work? I’m completely new to operating a blog but I do write in my diary daily. I’d like to start a blog so I will be able to share my own experience and thoughts online. Please let me know if you have any suggestions or tips for new aspiring bloggers. Appreciate it!

  74. Hi I am so glad I found your webpage, I really found you by error, while I was searching on Digg for something else, Regardless I am here now and would just like to say kudos for a remarkable post and a all round exciting blog (I also love the theme/design), I dont have time to look over it all at the minute but I have saved it and also included your RSS feeds, so when I have time I will be back to read much more, Please do keep up the awesome b.

  75. Hmm it appears like your site ate my first comment (it was extremely long) so I guess I’ll just sum it up what I had written and say, I’m thoroughly enjoying your blog. I as well am an aspiring blog blogger but I’m still new to the whole thing. Do you have any recommendations for first-time blog writers? I’d genuinely appreciate it.

  76. Hey! This is kind of off topic but I need some advice from an established blog. Is it very difficult to set up your own blog? I’m not very techincal but I can figure things out pretty fast. I’m thinking about setting up my own but I’m not sure where to start. Do you have any points or suggestions? Cheers

  77. Hi! I know this is kinda off topic however I’d figured I’d ask. Would you be interested in exchanging links or maybe guest writing a blog article or vice-versa? My site addresses a lot of the same subjects as yours and I believe we could greatly benefit from each other. If you happen to be interested feel free to send me an e-mail. I look forward to hearing from you! Wonderful blog by the way!

  78. Unquestionably believe that that you stated. Your favourite justification appeared to be at the internet the simplest thing to have in mind of. I say to you, I definitely get irked even as other people consider concerns that they plainly do not recognise about. You controlled to hit the nail upon the top as well as defined out the whole thing with no need side effect , folks can take a signal. Will likely be back to get more. Thank you

  79. Hiya! I know this is kinda off topic however I’d figured I’d ask. Would you be interested in exchanging links or maybe guest writing a blog article or vice-versa? My site addresses a lot of the same subjects as yours and I feel we could greatly benefit from each other. If you might be interested feel free to send me an e-mail. I look forward to hearing from you! Excellent blog by the way!

  80. First off I want to say terrific blog! I had a quick question that I’d like to ask if you don’t mind. I was curious to know how you center yourself and clear your mind before writing. I have had a difficult time clearing my mind in getting my thoughts out. I do enjoy writing but it just seems like the first 10 to 15 minutes are usually wasted just trying to figure out how to begin. Any ideas or tips? Appreciate it!

  81. I know this if off topic but I’m looking into starting my own blog and was wondering what all is required to get set up? I’m assuming having a blog like yours would cost a pretty penny? I’m not very internet savvy so I’m not 100% sure. Any recommendations or advice would be greatly appreciated. Thanks

  82. Hmm it seems like your site ate my first comment (it was extremely long) so I guess I’ll just sum it up what I had written and say, I’m thoroughly enjoying your blog. I as well am an aspiring blog blogger but I’m still new to the whole thing. Do you have any tips and hints for first-time blog writers? I’d genuinely appreciate it.

  83. Have you ever considered about including a little bit more than just your articles? I mean, what you say is valuable and all. Nevertheless think about if you added some great graphics or video clips to give your posts more, “pop”! Your content is excellent but with images and video clips, this website could undeniably be one of the very best in its niche. Superb blog!

  84. Hmm it appears like your site ate my first comment (it was extremely long) so I guess I’ll just sum it up what I submitted and say, I’m thoroughly enjoying your blog. I as well am an aspiring blog blogger but I’m still new to the whole thing. Do you have any tips and hints for novice blog writers? I’d definitely appreciate it.

  85. Hi, I do believe your web site might be having browser compatibility issues. When I look at your site in Safari, it looks fine but when opening in Internet Explorer, it has some overlapping issues. I simply wanted to give you a quick heads up! Besides that, wonderful website!

  86. My coder is trying to persuade me to move to .net from PHP. I have always disliked the idea because of the expenses. But he’s tryiong none the less. I’ve been using Movable-type on a variety of websites for about a year and am nervous about switching to another platform. I have heard fantastic things about blogengine.net. Is there a way I can transfer all my wordpress content into it? Any kind of help would be really appreciated!

  87. Woah! I’m really loving the template/theme of this site. It’s simple, yet effective. A lot of times it’s very hard to get that “perfect balance” between user friendliness and visual appeal. I must say that you’ve done a amazing job with this. In addition, the blog loads very fast for me on Chrome. Exceptional Blog!

  88. Woah! I’m really loving the template/theme of this site. It’s simple, yet effective. A lot of times it’s challenging to get that “perfect balance” between user friendliness and visual appearance. I must say that you’ve done a excellent job with this. Additionally, the blog loads very fast for me on Internet explorer. Superb Blog!

  89. What i do not realize is in reality how you’re not really a lot more well-liked than you may be right now. You are so intelligent. You realize therefore significantly when it comes to this matter, produced me in my opinion believe it from numerous numerous angles. Its like men and women aren’t interested unless it’s something to accomplish with Woman gaga! Your personal stuffs nice. All the time care for it up!

Leave a comment

Your email address will not be published. Required fields are marked *