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B Abhinava Krishna
A professional young mind whose words are enough to soothe his consultants.
When should a patient consult a rheumatologist?
- If the patient is suffering from any of the below symptoms, he might be having rheumatic diseases.
- Joint pains and swellings
- Severe joint pains and stiffness in the morning
- Severe back pain and stiffness in the morning
- Unexplained generalized body pains
- Recurrent mouth ulcers/hair loss
- Dryness of mouth/eyes, red rashes on cheeks
- Recurrent heel pains
- Prolonged unexplained fevers after detailed work up by physicians
- Wounds on skin not healing over a period of time referred by a surgeon and physician
- Persistent problems regarding abortions referred after primary work up by a gynecologist
- Recurrent uvietis after primary work up by an ophthalmologist.
- Unexplained pulmonary renal syndromes at primary care level.
It is important to see a rheumatologist, who has the training and experience to diagnose various forms of inflammatory arthritis
When the initial diagnosis is in doubt
- To pick up and manage extraarticular manifestations like vasculitis, eye involvement, pleuropulmonary involvement, lymphadenopathy etc in rhematoid arthritis
- Arthritis not controlled by traditional dmards
- Connective tissue disorders like sle, sjogrens syndrome, systemic sclerosis, mixed and undifferentiated connective tissue disorders etc
- Vasculitidis and other rare autoimmune diseases.
I am a male 64 years age. 2 years ago I had developed knee pain which occurred quite suddenly while working at my computer in the office. Pain was initially on the right knee. After examination by an orthopedic doctor he advised me of arthroscopic surgery. I had undergone this surgery with subsequent physiotherapy for 6 months. During this time pain started in the left knee also. The doctor says it is arthritis. Now after the physiotherapy I am able to walk, but have lost the flexibility of both knees. (Cannot bend more than 90 degrees) I would like to know if there is any treatment to restore this flexibility other than knee replacement surgery.
Dear Dr, I am a 45 year old man 5' 8" tall and 76 Kg weight with healthy structure, my mother and my elder sister are suffering from arthritis problems and last 3 months I also started getting some pain in my right knee and I doubt it may be an initial stages of Arthritis, kindly suggest how to find it is an Arthritis or other pain and how to be safe or avoid these problems.
Different foods have different properties. Here are some foods to have and a few you must refrain from if you are suffering from arthritis and inflammatory pain:
Include these foods in your diet.
1) cherries - these contain anthocyanocides which assist in lowering uric acids, thus reducing the level of pain.
2) ginger - eating fresh ginger of drinking ginger root tea is advisable if suffering from arthritis and inflammatory pain. The gingerols present in it include anti-inflammatory compounds which are extremely helpful.
3) pineapple - there exists in pineapples, an element called bromelain which is a very effective anti-inflammatory.
4) raw apple cider vinegar - anti-inflammatory properties of raw apple cider vinegar are also very beneficial. It can be consumed by drinking a tablespoon of the vinegar mixed in about 250ml water or as salad dressing.
5) turmeric - turmeric or as we call it haldi, has anti-oxidant as well as anti-inflammatory properties.
6) omega 3 fatty acids - omega 3 fatty acids also have anthocyanocides. Which lower the levels of uric acids. Eating more of chia seeds, flax seeds and fish is also encouraged.
And the foods to avoid are,
1) sugary foods - sugary foods are like toxins which cause inflammations and lead to more pains in the body. Hence, avoid foods with excessive sugar when suffering from arthritis and inflammatory pain.
2) omega 6 oils - these oils, if consumed in high amounts, cause inflammations. It is advisable to replace these foods with healthier foods.
3) fried foods: deep fried foods are cooked at high temperatures and thus induce inflammation.
4) salt - this happens to some people where excess intake of sodium increases the pain in the joints. Hence, lowering consumption is not a bad idea.
WHAT IS LUPUS?
SLE (or simply "lupus") is a treatable, chronic, autoimmune, inflammatory disease that can affect any organ in the body. Lupus is an autoimmune disease where the body's immune system becomes hyperactive and attacks normal, healthy tissue. This results in symptoms such as inflammation, swelling, and damage to joints, skin, kidneys, blood, the heart, and lungs.
The word LUPUS in greek means a wolf. It seems the face of an untreated SLE patient sometimes resembles a wolf. With the availability of modern drugs to treat SLE nothing of that sort ever happens.
Under normal function, the immune system makes proteins called antibodies in order to protect and fight against antigens such as viruses and bacteria. Lupus makes the immune system unable to differentiate between antigens and healthy tissue. This leads the immune system to direct antibodies against the healthy tissue - not just antigens - causing swelling, pain and tissue damage.
Women of child-bearing age (15 to 45) are most often affected. It can affect males very rarely. Children and the elderly can also be rarely affected. Lupus is not an infection.
There are several forms of lupus. Discoid or cutaneous lupus is limited to the skin. Systemic lupus can involve any system of the body, including the joints and other connective tissue, as well as major organs, including the heart, lungs, kidneys and brain. Drug-induced lupus is caused by extensive use of certain medications. Its symptoms are similar to systemic lupus but usually go away when the medications are discontinued. Neonatal lupus is an additional form of lupus that can affect the fetus or newborn involving the skin, blood, and vital organs, such as the heart and liver.
Systemic lupus accounts for approximately 70 percent of all cases of lupus. In approximately half of these cases, a major organ, such as the heart, lungs, kidneys or brain, will be affected. Cutaneous lupus (affecting only the skin) accounts for approximately 10 percent of all lupus cases. Drug-induced lupus accounts for about
10 percent of all lupus cases and is caused by high doses of certain medications.
SLE is often called a disease with a thousand faces because the symptoms from person to person can vary a lot. All of the symptoms described can occur either at the onset (beginning) of SLE or at any time during the course of the disease.
? Fatigue is the commonest symptom that affects patients with SLE.
? Prolonged unexplained fever with recurrent low platelet counts, low WBCs, Anemia can be the presenting manifestations of SLE.
? The butterfly rash happens in 50% of all SLE patients is a red rash that occurs over the cheeks and often over the bridge of the nose. This is a very characteristic feature of the disease.
? Photo sensitivity is an excessive skin reaction to sunlight (causing rash) that occurs in at least 50% of patients.
? Mucosal ulcers are small sores that occur on the mucous lining of the mouth or nose in as many as 40% of SLE patients.
? Arthritis is very common in SLE. It causes pain in the joints of the hands, wrists, elbows, knees or other joints in the arms and legs. The pain may be migratory, meaning that it goes from one joint to another, and it may occur in the same joint on both sides of the body.
? In 50% of patients, kidney damage may occur. SLE kidney involvement tends to remain silent until damage has already occurred. Then the patient will complain of weight gain and swelling, particularly in the feet and legs.
? Seizures (epilepsy) and psychosis are serious problems caused by central nervous system (CNS) involvement in SLE, and occur in 15-25% of patients. Psychosis is a serious mental condition where thinking and behavior are disturbed, often including hallucinations (seeing or hearing things that aren't there) and delusions (false notions or ideas, for instance the belief that one is being poisoned).
? A persistent increase in hair loss involving the whole scalp may be due to SLE. Headaches, persistent high blood pressure (hypertension), anemia, thrombocytopenia, skin rash and ulcers, repeated abortions, unexplained weight loss, low-grade fever that lasts a long time or sudden, high fevers are the other symptoms of SLE.
The diagnosis of SLE is made based on a combination of symptoms, signs and test results and after other illnesses have been ruled out. There is no single disease symptom, sign or test which, alone, will give a diagnosis of SLE.
? Detection of autoantibodies like ANA, dsDNA, Sm can aid in the diagnosis of SLE.
? Urine analysis and tests of kidney function are performed to detect renal involvement. A kidney biopsy provides valuable information on the type, the degree and the age of lupus lesions and is very helpful in choosing the right treatment.
? A skin biopsy may help to make a diagnosis of skin vasculitis, of discoid or sub acute lupus or of the lupus nature of various skin rashes.
? In some cases the time to diagnose SLE may take years.
The vast majority of SLE patients can be treated successfully. Various forms of treatments are available. Treatment regimens are based on the type of presentation.
? NSAIDS, METHOTRXATE, are often used for controlling moderate to severe forms of arthritis.
? Sunscreen lotions are advised for photosensitivity. Hydroxychloroquine is used to treat fatigue, arthritis and other milder symptoms of SLE. Hydroxychloroquine also helps to prevent flares in patients who have taken this medication continuously over a six month period.
? Major organ involvement like lupus nephritis, CNS lupus requires usage of drugs like AZATHIOPRINE,MYCOPHENOLATE MOFETIL , CYCLOPHOSPHAMIDE, which are immunosuppresants for certain period of time along with steroids.
? Newer drugs called Biologics, like RITUXIMAB, BELIMUMAB offer hope for patients whose disease is resistant to traditional drugs.
Unfortunately there is neither a cure nor a way to prevent it. However lupus patients can keep their disease under control by avoiding certain things.
? Protection from the sun exposure by using Sunscreen lotion with a minimum SPF of at least 25 and which blocks both UV-A and UV-B rays. It is generally
? Advised to avoid sun exposure between 10 am to 4 pm or to minimize direct sun exposure below 20 minutes maximum,avoid halogen or fluorescent lights indoors/at places of work,use sunshades when travelling in a car, wear clothes covering maximum portions of your body, Hats etc. To limit sun exposure.
? Avoiding tobacco in all forms.
There is no special diet that can cure lupus. Any advertisement that claims otherwise is quackery. Say NO to quackery and to miracle cures.
Planning for pregnancy is a critical decision that has to be taken in consultation with the treating Rheumatologist as a flare up of lupus during pregnancy can be life threatening for both mother and fetus. The ideal time would be when the disease has remained in remission without any medication other than a small dose of prednisone or no prednisone at all (other medications may be harmful to the baby). SLE is also associated with a higher risk of miscarriage, premature delivery and other serious problems. These can be controlled by appropriate medication and achieving remission prior to conception.
All patients need not suffer from all of the manifestations. It is all about regular follow up as advised,to check clinically and lab wise, catch any manifestations at the beginning and manage them aggressively.Lupus is a little like a freight train; it is much easier to stop if the brakes are applied before the train has gained too much speed. With regular follow up, medications and proper care morbidity and mortality with SLE can be considerably reduced.
I am suffering from arthritis since 3 years due to it there' s pain in my backbone. So I can' t do my work easily so please suggest me. How to solve this problem?
Hi I am 62 year old. I was diagnosed with rheumatoid arthritis almost 6 yrs backand I had been taking lefra and folvite since then. Also last year I was diagnosed of shingles and for that I was given some wrong medication which reacted and I was hospitalized for 15 days. I have become quite weak after this. Since then I am not taking any other medicene other than lefra and folvite. From almost last one month I am again feeling that arthiritis pain in my hand. Can you please give any suggestion?
My husband is a ra patient past 2 years. he is 35 yr old .he taking medetion only at the paining time is that correct and what should do next?
If the patient is suffering from any of the below symptoms, he might be having Rheumatic Diseases.
• Joint pains and swellings
• Severe joint pains and stiffness in the morning
• Severe back pain and stiffness in the morning
• Unexplained generalized body pains
• Recurrent mouth ulcers/hair loss
• Dryness of mouth/eyes,red rashes on cheeks
• Recurrent heel pains
• Prolonged unexplained fevers after detailed work up by physicians
• Wounds on skin not healing over a period of time referred by a surgeon and physician,Persistent problems regarding abortions referred after primary work up by a gynaecologist,Recurrent uvietis after primary work up by an ophthalmologist,Unexplained pulmonary renal syndromes at primary care level.
It is important to see a Rheumatologist, who has the training and experience to diagnose various forms of inflammatory arthritis
• when the initial diagnosis is in doubt
• to pick up and manage extraarticular manifestations like vasculitis, eye involvement, pleuropulmonary involvement, lymphadenopathy etc in rhematoid arthritis
• arthritis not controlled by traditional DMARDS
• connective tissue disorders like SLE, sjogrens syndrome, systemic sclerosis, mixed and undifferentiated connective tissue disorders etc
• Vasculitidis and other rare autoimmune diseases.