Dr. Bharat Singh

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.

Arthritis is a disease usually associated with elderly people, but it can also affect children. When arthritis affects children, it is known as juvenile rheumatoid arthritis. This disorder affects the musculoskeletal structure of a child and can cause pain, stiffness and swelling in the muscles, joints, ligaments and bones. In some cases, it can also affect the internal organs. With medication and therapy, the symptoms of this disorder can be managed and the quality of the child’s life can be improved.

Hence, it is important to recognise the signs and symptoms of this disease. Some of the symptoms to look out for are:

1. Pain - Complaints of pain in the joints or muscles on waking up from bed can be a sign of juvenile arthritis. This may affect a child’s jaw, neck, hands, knees and feet. For most children, moving around helps relieve some of the pain. Unlike the pain triggered by an injury, this kind of pain develops slowly and affects both symmetrical joints.
2. Joint stiffness - Children affected by this disorder may complain of stiff joints which hamper normal movement and activities. As with pain, this stiffness is usually worst in the morning and improves with movement.
3. Swelling - Redness and inflammation of painful joints is another symptom of this disorder. The joint may also feel warm to touch. This swelling may come and go or persist for several days. The joints of the hands, feet and knees are most susceptible to swelling.
4. Fever - Frequent fever accompanied by fatigue can indicate juvenile arthritis. These fevers usually com on suddenly and are relieved after a short time. Also, they do not exhibit any signs of respiratory or stomach infections.
5. Rashes - Rashes that are symptomatic of this disorder appear commonly over the knuckles, nose bridge or on the trunk, arms and legs. This often takes the form of a faint, pink rash that persists for weeks but unlike other rashes, it does not itch or ooze.
6. Weight loss - Drastic weight loss and an unexplained loss of appetite can also signal this disorder. In such cases, the child may also appear fatigued and showcase symptoms of associated malnutrition disorders.
7. Eye problems - Persistent troubles with eye sight such as pain, blurred vision and redness of the eye can be a sign of juvenile arthritis. In some cases, this disorder also causes the iris and uveitis as well as the middle layer of the eye to appear inflamed.

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). 

CAUSE: 

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. 

SYMPTOMS: 

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: 

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. 

TREATMENT:

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 as below :

1. 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. 
2. 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. 
3. 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.
4. 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.
5. 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.
6. 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.
7. 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.
8. Lab Tests - Fibromyalgia is a clinical diagnosis. There are no definite laboratory tests. In fact, most conducted tests will turn out to be normal. 
9. 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.

Rheumatoid Arthritis is a degenerative disease that progresses over time. It generally affects the fingers, feet, wrists, and ankles. It causes immobility due to inflammation and stiffness as well as severe pain. This is an autoimmune disease where the body mistakenly ends up attacking the joints instead of attacking bacteria and other substances as it normally should. Severe cartilage damage can be caused if this condition is not treated on time, which can make the spacing between the bones even smaller than usual.

Let us find out how one can tackle this condition :

1. Rest: While there is still no cure for this condition, one can take a number of measures in order to tackle it. One of the foremost ways of managing this condition is with the help of rest and relaxation. It is important to get plenty of sleep so that you can keep the condition from getting worse. There are a number of relaxation exercises that will help you in sleeping better, especially if you have been having trouble sleeping due to the aches and pains. 
2. Exercise: Depending on the doctor’s recommendations, you will need to exercise on a regular basis so as to keep the motion in your joints intact for as long as possible. Muscle and joint strengthening exercises include swimming, walking, and even gentle stretching that can help in reducing muscle fatigue. This can make your muscles stronger and increase the range of motions as well. 
3. Ointments and Lotions: One can turn to gels and lotions which can be topically applied. These can be prescribed by the doctor as well, so that the pain is soothed and temporary relief from pain and stiffness may be experienced. These are also available in the form of sprays. These ointments, gels or lotions usually contain camphor, menthol, capsaicin and salicylates. 
4. Fish Oil Supplements: Pain and stiffness can be significantly reduced with the help of fish oil, as per many medical studies. Before adding fish oil supplements to your food, you will need to talk to your orthopaedic specialist to find out if it may interfere with any medication that you may be taking for the condition or any other related disorder.
5. Plant Oils: Plant oils are also known to contain fatty acids known as gamma linolenic acid, which can give much relief when it comes to pain and stiffness, especially in the morning. One must remember, though, that excessive use of this oil can lead to liver damage. So it is imperative to speak with your doctor or therapist before taking any plant oils. 
6. Medications: Aspirin and other non-steroidal anti-inflammatory drugs can help in containing the pain and inflammation for severe cases.

Osteogenesis Imperfecta or brittle bone disease weakens bones and causes them to break easily. This condition is frequently seen in children at birth, but it only develops in children who have a history of brittle bone disease in their family. Depending on the severity of the development of the disease, children can face anything from a couple of bone fractures to hearing loss, problems in the spinal cord, permanent deformation of bone structure, and heart failure. About one in every 20,000 babies develops brittle bone disease and it is equally spread out throughout different ethnic groups and genders.

Causes

It is caused due to a defect in the gene that helps in the production of type 1 collagen, which is a protein used in the creation of bones. This defect of gene is hereditary and is thought to be caused due to certain genetic mutations.

Types

There are four main types of brittle bone disease, namely Type 1 OI, Type 2 OI, Type 3 OI, and Type 4 OI.

• Type 1 is the most common and mild with development of fragile bones that are prone to fracture, and teeth problems such as cavities and dental cracks. It is not common among adults.
• Type 2 is the most severe form of the disease and potentially fatal. The body is unable to produce needed collagen resulting in formation of narrow chest, underdeveloped lungs and ill structured ribs in babies.
• Type 3 OI results in fracture in bones in children even before birth and may result in worsening of bone structure deformities as the child grows up.
• Lastly, Type 4 has symptoms both severe and mild. It is similar to Type 3 as it is caused due to production of lower quality collagen. Children suffering from this type of brittle bone disease are born bow legged, but the condition reduces over time.

Symptoms

The symptoms experienced by patients suffering from this condition vary from type to type. It is common knowledge that the most glaring symptom is fragility in bones, but there are many other symptoms that may appear as the cases grow more severe. Some patients report development of deformities, while others experience fractured bones without apt injuries. Loose joints, bowed arms and legs, week teeth, abnormal curving of the upper section of the spine, scoliosis, loss of hearing, heart defects, blue sclera (thinning in the collagen fibers), and respiratory issues are also frequently documented symptoms.

Back pain is a common problem that most of us have suffered from. A pain anywhere in the spine- upper, middle or lower back – are all classed under the category of back pain. It’s a large category but it’s important to note that back pain can be caused due to a number of factors.

Causes
The causes of back pain can be varied because the human vertebra is composed of a complex structure of muscles, ligaments, tendons, disks and bones. Disks are cartilage-like pads that cushion the vertebrae, and problems with any of these can lead to back pain. Some of the common causes of back pain are:

1. Changes in the bony lumbar spine
2. Problems in discs between the vertebrae like hernias, bulges etc.
3. Problems in ligaments around the spine and discs
4. Due to changes in spinal cord and nerves
5. Weakened lower back muscles
6. Problems in abdomen and pelvic internal organs
7. Osteoporosis
8. Posture and lifestyle

Some of the other factors that can cause back pain are:

• Age: You can suffer from back pain at any age but the older you get, the more your chances of getting back pain. It is significantly more common among adults aged 35 or above. Strain is the most common cause of back pain. It can be due to strained muscles, ligaments or a muscle spasm caused due to lifting something too heavy or not using the correct posture when lifting something. It can also be caused due to an abrupt and awkward movement Arthritis can also cause back pain as it may cause a narrowing of the space around the spinal cord known as stenosis. Abnormal curvature of the spine can also cause back pain.
• Other reasons: Issues such as Cauda equina syndrome which affects the bundle of spinal nerve roots that arise from the lower end of the spinal cord and cancer of the spine or a tumour located on the spine which presses against a nerve can result in back pain. Infections of the spine or other infections such as pelvic inflammatory disease in women, bladder, or kidney infections may also lead to back pain.

Symptoms
Pain in the spine is the most common symptom of back pain. Other symptoms can be tenderness, numbness, inflammation, and pain in legs or hands. The nerves of the back could be affected by structural problems in the spine such as a bulge in the disc or herniation or disc rupture. This can press against a vital nerve which controls muscles in arms and legs, causing pain.

Treatment

• Back pain can usually be managed with over-the-counter (OTC) painkillers and by applying a hot compress or an ice pack to the area to relieve pain.
• Resting also helps.
• A change in lifestyle especially by improving body posture while using the computer at work, will be effective.

If the first line of treatment doesn’t work, doctors would prescribe

1. NSAID Medication: These are non steroidal anti-inflammatory drugs such as Codeine or hydrocodone which are prescribed for short periods
2. Physical therapy: This therapy uses the application of heat, ice, ultrasound and electrical stimulation to the back muscles and soft tissues to help alleviate pain. A physical therapist would suggest flexibility and strength exercises for the back and abdominal muscles. They would also suggest ways to improve posture and hence reduce back pain.
3. Cortisone injections: In severe cases, back pain sufferers would be given cortisone injections in the epidural space, which is the space around the spinal cord, to reduce pain by reducing inflammation.
4. Surgery: This is useful for treating herniated discs, ruptured discs or a bulge. Tumours are also removed surgically to treat back pain.

In case you have a concern or query you can always consult an expert & get answers to your questions!

Bones and muscles, together known as the musculoskeletal system, are responsible for all bodily movements. The bones and muscles move in unison, as they are connected by what are known as tendons, which are thin fibrous tissue. These tendons are prone to damage and inflammation known as tendinitis (this can cause inflammation in any organ). It can occur in any bone/joint but most common in areas which are prone for repetitive use including the wrists, arms, elbows, shoulder, knees, and ankles.

Read on to understand how it happens and how it can be managed.

Causes: Depending on the onset, tendinitis can be acute or chronic. Though it can occur in any individual, the risk increases with age, as bones lose their elasticity and can tear.

• Acute is caused by a sudden injury like a fall or accident or infections
• Chronic is caused by repetitive movements, poor posture, poor stretching, overuse, etc. Some common movements include carpentry, painting, golfing, tennis, gardening, lawn mowing, badminton, etc.

Symptoms: As with any inflammation, the symptoms of tendinitis would include swelling, pain, redness, and warmth. There is also a reduced range of motion of the affected joint, producing what is known as adhesive capsulitis.

Prevention: Tendinitis is preventable to some extent by avoiding repetitive work and overuse of the joint. Those who are used to a lazy week and an active weekend should definitely watch out. Sudden, excessive stress can cause tendinitis. The tendons should be subjected to limited stress and activity. With any kind of activity, if there is even a slight hint of pain or any issue, get it checked with the doctor. Continuing to do the same activity will only make it worse. Symptoms to watch for include fever, swollen and painful joints, and limited movement of the affected joint.

Management: If identified and arrested in the early stages, tendinitis can be managed conservatively. Progressive measures of treatment would include the following.

• As soon as there is discomfort identified, rest the joint and stop any activity, which you think could have caused the problem. Usually, this should help the condition to subside on its own. Ice and heat therapy can also help.
• If it is the ankle or the knee, keep it elevated.
• Pain killers may be taken if the pain cannot be tolerated or is affecting daily routine.
• After the initial week, mild exercises to strengthen the tendon can be started.
• Steroid injections may be required in cases where the joint pain and swelling is significant.
• As a last resort, if the above measures do not work, surgery may be recommended. This will again be followed by rest, medications, and physical therapy.

In case you have a concern or query you can always consult an expert & get answers to your questions!

Osteoporosis in very simple terms is a condition that causes spongy bones. The bones develop pores and become fragile with an increased susceptibility to fractures. In average, all our bones get weak after the age of 35 years which means that the bone mass decreases. Women after menopause are especially susceptible to this condition and also osteoporotic fractures. What are the other risk factors for osteoporosis? Knowing this is important for your bone health as it will help to prevent fractures. But before we discuss the causes of osteoporosis, it’ is important to point out that osteoporosis has no symptoms and it can only be diagnosed when you have a fracture for no reason at all, or you get a bone density test to diagnose osteoporosis.

Some of the factors that can lead to osteoporosis are:

• Genetics
• Lack of exercise
• Low calcium and low vitamin D levels
• A personal history of fracture as an adult
• Smoking
• Excessive alcohol consumption
• Rheumatoid arthritis
• Low body weight
• Family history of osteoporosis which means having a mother with an osteoporotic hip fracture doubles your risk of a hip fracture as well
• Chemotherapy for treating cancer also increases the risk for osteoporosis as it causes early menopause.
• In men low testosterone levels known as hypogonadism can cause this condition.
• The absence of menstrual periods known as amenorrhea in younger women also predisposes them to osteoporosis as it causes low estrogen levels. Amenorrhea can occur in women who undergo extremely vigorous physical training or those that practice extreme dieting. As their body fat goes down they experience amenorrhoea.
• Chronic inflammation, due to chronic inflammatory arthritis and also liver disease can cause osteoporosis.
• Any condition that interferes with walking such as stroke can cause spongy bones.
• Hyperthyroidism, a condition that causes an increase in production of the thyroid hormone can cause spongy bones too.

Some other factors that can lead to it

• Hyperparathyroidism a disease where there is an increased parathyroid hormone production by the parathyroid gland. This hormone maintains blood calcium levels by absorbing calcium from the bones. This can cause osteoporosis.
• Low vitamin D causes low absorption of calcium from diet and hence you are at a risk of developing osteoporosis. Conditions such as celiac sprue or biliary cirrhosis which hamper the absorption of vitamin D can also cause osteoporosis.
• Medications such as heparin, a blood thinner, anti-seizure medicines such as Dilantin and phenobarbital, and long-term use of oral corticosteroids- can all up osteoporosis risks.

The diagnosis of osteoporosis is simple and it is advisable that older people especially women get periodic X- rays and bone density tests to rule out this bone condition.

In case you have a concern or query you can always consult an expert & get answers to your questions!

Rheumatoid arthritis (RA) is an auto-immune disorder which induces inflammation in the joints. What causes the condition is not exactly clear, but a lot of studies have been done to establish a connection between various factors such as, diet, exercise, etc., with this condition. These studies have come up with correlation between foods and rheumatoid arthritis. There are some foods which should be a part of your diet, and some that should definitely be avoided if you have to keep the joint inflammation under control. Read on to know the top 5 foods to eat and to avoid.

What to eat?

1. Soy: Being rich in protein and fiber and low in fat, soy is a great food for RA. It also contains omega-3 fatty acids and vegetarians especially should ensure they get enough soy in their diet.
2. Fish: Salmon and tuna are fish that are rich in omega-3 fatty acids and these are proven to be natural anti-inflammatory agents. Therefore, it is highly recommended that people with RA eat fish about 3 to 4 times per week.
3. Oils: While an oily diet is definitely to be avoided, some healthy oils should be included. These include sunflower oil, walnut oil, olive oil, and avocado oil. These are known for their anti-inflammatory properties and are beneficial in people with RA.
4. Green tea: Known for their polyphenols and antioxidants, green tea reduces damage caused by inflammation in RA. People with RA are recommended to have at least 2 servings of green tea daily.
5. Beans and legumes: The high content of fiber, protein, folic acid, zinc, iron, potassium, and other minerals makes beans a must-have for RA patients. The red and kidney variety of beans are the preferred ones.

What to avoid?

1. Grilled foods: Grilled chicken or red meat have high levels of advanced glycation end products (AGEs) which are known to worsen inflammation. So, while they are good for weight watchers, not so if you have RA. These also contain higher levels of saturated fat, which is again not advisable for RA.
2. Fried foods: These contain 6-omega fatty acids, which have been proven to worsen inflammation. They are also high in saturated fats, which is a strict no-no for inflammation.
3. MSG: Monosodium glutamate which is used generously in various Oriental dishes including soups, salad dressings, etc. should be avoided as it affects liver health and worsens inflammation.
4. Salt: Reduce overall salt intake. Limiting the intake of pickles, salad dressings and processed foods, etc., which contain high amounts of sodium.
5. Alcohol: This again increases inflammation and should be avoided in RA.

A healthy lifestyle improves not just the overall quality of life, but also reduces the severity of symptoms of RA.

In case you have a concern or query you can always consult an expert & get answers to your questions!