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Treatment of Arthritis
Treatment of Rheumatoid Arthritis
Treatment of Facioscapulohumeral Muscular Dystroph
Treatment of Rheumatic Arthritis
Treatment of Psoriatic Arthritis
Treatment of Polymyalgia Rheumatica and Giant Cell
Treatment of Myotonia Congenita
Treatment of Paget'S Disease of Bone
Treatment of CAPS Syndrome
Treatment of Spheroid Body Myopathy
Treatment of Potassium-aggravated Myotonias
Treatment of Paramyotonia Congenita
Treatment of Scapuloperoneal Myopathy
Treatment of Primary Angiitis
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The human spine has 33 vertebrae. However, some conditions can fuse these vertebrae. Ankylosing Spondylitis is one such condition. This disease may also be known as AS or Bechterew's disease. It is an inflammatory disease that can make the spine less flexible by fusing the vertebrae of the lower back together. In some cases, it can also affect the rib cage and make it difficult to breathe. This disease typically affects more men as compared to women. Most patients begin showing symptoms in early adulthood.
Ankylosing Spondylitis affects the sacroiliac joints. These joints are located just above the tailbone. It causes inflammation of the spinal bones that in turn cause pain and stiffness. With time, this inflammation spreads to the entire spine and the vertebrae begin fusing together. This can make movement difficult and painful. In severe cases, it can also lead to the development of a hunchback. This disease also affects the other tissues of the body. For example, it can affect other joints and aggravate arthritis or affect organs such as the kidney, heart, lungs, and eyes.
A specific cause has not yet been identified for Ankylosing Spondylitis. However, studies show that genetic factors can be a trigger. In particular, the presence of the HLA-B27 gene increases a person’s risk of developing symptoms pertaining to this condition. However, it is important to note that merely the presence of this gene does not make Ankylosing Spondylitis inevitable. Other genes that are associated with this disease are ARTS1 and IL23R. These genes influence the functioning of the immune system. While it can affect people of all ages, adults are at a higher risk of suffering from this condition.
In many cases, the initial inflammation of the spine is due to a bacterial infection of microbial infection. Though the infection itself may be treated and cured, it may cause the immune system to react and trigger inflammation. Once activated, if the immune system cannot be turned off, this inflammation will continue and can trigger Ankylosing Spondylitis. In each case, the disease presents a unique pattern of progression.
There is presently no cure for this condition, but with an early diagnosis and treatment, the symptoms can be managed and progression can be slowed. This treatment usually takes the form of medication to relieve pain, inflammation and discomfort and physical therapy. Surgery cannot be used to treat Ankylosing Spondylitis but in cases where it has caused severe joint damage, surgery may be advised to replace the damaged joint.
Rheumatoid arthritis is a chronic inflammatory arthritis with a prevalence of 0.5-1% in India. It is characterized by joint pain and swelling associated with morning stiffness lasting for more than 30 minutes. It generally has a slow onset - over weeks to months, though the onset can be acute also. Most common joints involved are small joints of hands and feet. Larger joints like knee and shoulder can also be involved. The incidence of RA increases with age. It is twice more common in females than in males. Early treatment is necessary to bring down the inflammation, avoid joint deformities and prevent other complications ( lung, heart, vasculitis).
Predisposition to RA is multifactorial. It has a genetic component (family history of RA increases the risk). Environmental factors like smoking also play a role.
Initial symptoms start with fatigue, malaise, generalised bodyaches, low-grade fever. The onset is generally slow and eventually patient develops joint pain and swelling. Though the joint involvement is symmetrical in most cases, asymmetric onset is common (involving joints predominantly on one side).
Diagnosis is made by a physician after detailed history, clinical examination and supportive lab tests. Rheumatoid factor and anti-CCP antibody are positive in 75-80% patients with RA. They have raised inflammatory markers (ESR, CRP) during active inflammation.
RA treatment options are wide and quite effective. It starts with patient education regarding nature of the disease and the risk of complications. The need of early aggressive therapy should be emphasized. The patient should put in efforts for physiotherapy which play a very important role in muscle strength and joint mobility. Pharmacotherapy options are wide and include disease-modifying antirheumatic drugs ( DMARDS). These can be conventional DMARDS like methotrexate ( usually the first line drug), sulfasalazine, hydroxychloroquine, leflunomide. Failure to adequately respond to these drugs should lead your Rheumatologist to consider Biologic DMARDS ( TNF antagonists, Rituximab, Abatacept, Tocilizumab). Your Rheumatologist is the best person to guide you about dose, indications, monitoring and side effects of the drugs used in RA. Treatment duration depends on patient's response but is generally long ( 5-10 years or lifelong).
COMPLICATIONS BEYOND JOINTS:
RA patients can have rheumatoid nodules in skin, lungs, heart and other sites. These patients are at risk of accelerated bone loss, so calcium and vitamin D intake should be optimized. Eye complications include dryness, redness ( scleritis and episcleritis) and certain eye threatening complications. Lung involvement can be seen in various forms ( fluid in lungs, nodules, interstitial lung disease).
These patients are at high risk of atherosclerosis ( heart and blood vessel disease). They also have a tendency to have frequent infections.
NEED OF THE HOUR:
All patients with joint pains should be seen early by Rheumatologist for diagnosis and treatment. With so many treatment options, no patient should suffer from joint deformities and other complications associated with long standing, untreated RA. LEAD A HEALTHY LIFE!
Fibromyalgia is a condition characterised by chronic widespread body pains and increased responsiveness to pressure. Women are at a higher risk of suffering from this disorder than men. Fibromyalgia can be treated with physiotherapy, pharmacotherapy and combined efforts of physician and the patient.
Some of the symptoms that characterize this disorder are:
- Pain: Fibromyalgia is characterized by pain that has no apparent reason. It can affect different parts of the body and presents itself in different ways. Some people may experience a stabbing pain while others complain of a persistent dull ache. This pain may be affected by climate changes or stressful situations. There is reduced threshold to pain, because of certain chemical ( neurotransmitters) abnormalities in brain. Pain is generalized, felt above and below the waist, right and left-side of body, arms, legs, neck and back.
- Abnormal Sensitivity: Fibromyalgia patients are extremely sensitive to environmental changes that involve sight, sound and smell. For example, cigarette smoke can make a fibromyalgia patient extremely nauseous while loud music can give the person an instant headache. Lights that are brighter than normal can also make such a person feel uncomfortable. Patients have an abnormal sensitivity to pain, which leads to generalized aching of the body and tender points.
- Muscle & Joint Stiffness: Fibromyalgia patients often experience stiff muscles and joints without any form of strenuous activity or other reason. This may be localised to one group of muscles or affect the whole body. For some patients, this pain is worse in the morning or when sitting for extended periods of time. However, moving around does not provide any significant relief.
- Chronic fatigue and exhaustion: There are two main reasons for a fibromyalgia patient to complain of tiredness. Firstly, the condition itself drains a person of energy even without overexerting themselves. Secondly, the pain and joint stiffness can hamper a person’s sleep and lead to sleep deprivation. Over time, this can become a vicious cycle of tiredness and insomnia. Chronic fatigue also affects a person’s immune system causing his or her energy levels to drop.
- Cognitive impairments: Fibromyalgia patients also complain of a compromised short term memory. They often face difficulties recalling names of people they have recently met or other newly acquired information. These people may also have trouble concentrating on tasks for extended periods of time and experience mental sluggishness also known as fibro-fog.
- Irritable bowel syndrome: Bowel disturbance is another common symptom of this disease. Passing stool may become difficult due to a combination of pain and muscle stiffness. With time, this problem can worsen unless addressed with laxatives. However, an over-dependence on laxatives can lead to further problems.
- Somatic Symptoms: Apart from pain, patient experiences unrefreshing sleep and fatigue throughout the day. Other associated features can be depression, abdominal cramps, chest pain, tingling.
- Lab Tests: Fibromyalgia is a clinical diagnosis. There are no definite laboratory tests. In fact, most conducted tests will turn out to be normal.
Treatment: Foremost important is an education of patient and caregivers, regarding nature of the disease. The patient needs to indulge in recreational activities and undergo supervised physiotherapy. There are potent medicines to correct the chemical imbalance in the body thereby increasing the pain threshold and leading to better quality of life.
Juvenile rheumatoid arthritis also known as juvenile idiopathic arthritis is a commonly occurring arthritis in children under the age of 15. Some common problems that are faced by patients with this disease include stiffness, joint pain, and swelling. While the symptoms might persist for a few months for some patients, for others it might continue for the rest of their lives. Patients might face serious complications such as inflammation of the eye, problems related to growth etc. The treatment of this condition focuses on preventing the bones from getting damaged, pain control and improving the function of the body.
What are some of the common symptoms of juvenile arthritis?
- Pain: A child suffering from juvenile rheumatoid arthritis might face extreme pain in the joints. They might limp after a nap or night sleep due to pain or stiff joints.
- Swelling: Larger joints such as the knee might swell frequently. The swelling might occur in smaller joints too.
- Stiffness: In addition to limping the child might appear rough and clumsy after waking from night sleep or a nap.
What are the causes of Juvenile Rheumatoid Arthritis?
Juvenile Rheumatoid Arthritis occurs when the immune system of the body attacks its own tissues and cells. It is still unclear as to why it happens, although, researchers believe that the environment and heredity have a role to play. Certain geneticmutations might make a childmore vulnerable and susceptible to microbes that can trigger this condition.
What are the complications involved?
There could be several complications that might arise due to this condition. It is, therefore, wise to keep a close watch on the child. Seeking immediate medical attention can go a long way in mitigating the risk of these complications.
- Problems related to the eye: Juvenile Rheumatoid arthritis can damage the eye by causing an inflammation known as uveitis. If this condition is not treated, it might result in other conditions such as glaucoma, cataracts, blindness etc.
- Growth problems: Juvenile rheumatoid arthritis could result in growth problems. To treat this, a child would require a dose of corticosteroid.
How to diagnose juvenile arthritis?
It is not very easy to diagnose juvenile arthritis. Doctors often prescribe blood tests to get an idea of erythrocyte sedimentation rate, rheumatoid factor, C-reactive protein, anti-nuclear antibody, cyclic citrullinated peptide etc. A doctor might also prescribe imaging tests such as X-rays, MRI etc to detect congenital defects, fractures, tumors etc.
What are the treatment options available?
Some of the medications that are prescribed for this condition include NSAID such as ibuprofen and naproxen, DMARD such as Trexall and Azulfidine, TNF blockers such as Humira and Enbrel, immune suppressants such as Kineret, Rituxin and Orencia. In addition to this doctors would also prescribe corticosteroids and therapies. In case you have a concern or query you can always consult an expert & get answers to your questions!
Rheumatoid arthritis is an autoimmune disorder. It affects the joints as well as the skin, lungs, heart, eyes and blood vessels. This condition is most notorious for the pain and discomfort it causes in the joints. Unlike osteoarthritis, it does not attack the cartilage but affects the lining of the joints.
This results in erosion of the bone tissue and can even cause deformities. There is no known cure for this condition and treatment is mostly focused on relieving the pain caused. Some of the ways to manage your pain are:
- Medication: Medication can help control the inflammation and pain caused by rheumatoid arthritis. Disease-modifying antirheumatic drugs or DMARDs are usually the first course of treatment. These may be accompanied by steroids and help reduce inflammation. The best medication to relieve pain is non-steroidal anti-inflammatory drugs or NSAIDs. In some cases, stronger pain relievers may be prescribed but these should be used cautiously. Excessive dependence on pain relievers can cause addiction.
- Change Your Diet: A diet rich in Omega 3 fatty acids can help control inflammation. In turn, this can help relieve discomfort and slow the progression of the disease. Cold water fish and fish oil supplements are rich sources of omega 3 fatty acids. In addition, it is important to have a well-balanced diet and to avoid excessive carbs and sugars that can lead to weight gain. It is important to note that heavier people suffer from more pain as their weight puts pressure on the joints.
- Exercise Regularly: Rheumatoid arthritis makes movements difficult and hence exercising may seem counterintuitive but this can help in the long run. Avoid high-intensity workouts and pick low-intensity activities like walking, cycling, swimming etc. Water aerobics is one of the best forms of exercise for rheumatoid arthritis. Yoga can also be very beneficial. Regular exercise is important but it is also important not to overdo it. Put exercising on hold during acute flare-ups and avoid doing anything that increases your pain. It is a good idea to consult a physical therapist to know what the best type of activity is for you.
- Hot and cold packs: Heat and cold therapy can help relieve pain immensely. A hot pack will help relax the muscles while the cold pack will numb the pain. Heat packs and cold packs can be used alternatively. Alternatively, you could soak the affected joint in hot water and cold water.