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Sulfasalazine

Prescription vs.OTC: Prescription by Doctor required

Sulfasalazine is highly effective in the treatment of ulcerative colitis. The drug acts as a salicylate, thus it reduces inflammation. You doctor may prescribe this medicine for the treatment of other medical conditions as per his discretion.

Take the drug along with some water, after food. Make sure that your increase your fluid intake when seeking treatment with Sulfasalazine. Doses should be taken within 8 hours and should not be missed.

Dizziness as well as drowsiness may occur in patient taking Sulfasalazine. Thus, it is advised that driving and unsafe activities should be avoided. Also avoid consuming alcohol as it can make you dizzy. The drug will also make your skin more sensitive to light, thus protect your skin when you go out in the sun. It can also cause discoloration of the urine.

Other side effects of Sulfasalazine include nausea, headache, gastric problems, vomiting and anorexia.

Some medical problems may hinder the effectiveness of the drug, thus inform you medical practitioner if you have asthma, kidney problems, blood problems, thyroid problems and any allergies.

Also give him a list of all the medicines that you are taking presently. Make sure to include prescription drugs as well as over the counter medicines that you take.

Information given here is based on the salt and content of the medicine. Effect and uses of medicine may vary from person to person. It is advicable to consult a Gastroenterologist before using this medicine.

In addition to its intended effect, Sulfasalazine may cause some unwanted effects too. In such cases, you must seek medical attention immediately. This is not an exhaustive list of side effects. Please inform your doctor if you experience any adverse reaction to the medication.

Headache

Loss of appetite

Increased body temperature.

Is It safe with alcohol?

Interaction with alcohol is unknown. Please consult your doctor.

Are there any pregnancy warnings?

Ssn - ds 1000mg tablet dr is probably safe to use during pregnancy.
Animal studies have shown low or no adverse effect on the foetus, however, there are limited human studies. Please consult your doctor.

Are there any breast-feeding warnings?

Unknown. Human and animal studies are not available. Please consult your doctor.

Is it safe to drive while on this medicine?

There is no interaction between driving and consuming this drug. So dose alteration is not needed.

Does this affect kidney function?

Caution to be advised in patients with impaired renal function.

Does this affect liver function?

There is no data available. Please consult doctor before consuming the drug.

Are there any missed dose instructions?

If you miss a dose of Sulfasalazine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular schedule. Do not double the dose.
Below is the list of medicines, which contains Sulfasalazine as ingredient
Zydus Cadila
Ipca Laboratories Ltd
Rhumasafe Pharmaceutical
Rhumasafe Pharmaceutical
Cadila Pharmaceuticals Ltd
Medley Pharmaceuticals
Wallace Pharmaceuticals Pvt Ltd
Wallace Pharmaceuticals Pvt Ltd
Ipca Laboratories Ltd
Sulfasalazine which comprises of sulfapyridine and aspirin (5-aminosalicyclic acid) acts as an antimetabolite. It interferes with the production of immune system cells, and inhibits TNF or Tumor Necrosis Factor that plays a vital part in the immune response.
Whenever you take more than one medicine, or mix it with certain foods or beverages, you"re at risk of a drug interaction.

Interaction with Medicine

Dixin 3Mg/5Ml Syrup

Purinetone 50Mg Tablet

Azap 50Mg Tablet

What are you using Sulfasalazine for?
Rheumatoid Arthritis
Ankylosing Spondylitis
Ulcerative Colitis
Other
Crohn's Disease
Fever
How much was the improvement?
Average
Poor
Excellent
How long did it take before seeing improvement?
More than 2 days
Within a day
Within 6 hours
Within 2 hours
How frequently did you take this medicine?
Twice a day
Once a day
Thrice a day
Not taking on daily level
Four times A Day
How did you take this medicine?
With Food
With or without food
What were the side effects of this medicine?
Other
Nausea
Headache
Skin Rash
Loss of appetite
Increased body temperature
Disclaimer: The information produced here is best of our knowledge and experience and we have tried our best to make it as accurate and up-to-date as possible, but we would like to request that it should not be treated as a substitute for professional advice, diagnosis or treatment.

Lybrate is a medium to provide our audience with the common information on medicines and does not guarantee its accuracy or exhaustiveness. Even if there is no mention of a warning for any drug or combination, it never means that we are claiming that the drug or combination is safe for consumption without any proper consultation with an expert.

Lybrate does not take responsibility for any aspect of medicines or treatments. If you have any doubts about your medication, we strongly recommend you to see a doctor immediately.

Popular Questions & Answers

Hullo Doc! My wife was recently diagnosed with Rheumatoid arthritis (ra factor less than 10.4,crp 24.5,hb 9.7,esr 40, anti ccp antibodies 61.70). The pain becomes acute after evening. I consulted 2 docs - an orthopaedic surgeon and a physician- both senior specialists. The former gave 1. hydroxychloroquine 400 mg od, 2. Celecoxib 200 mg bd. The latter gave 1.Methotrexate 5 mg/week, 2.Sulfasalazine 500 mg od. Both have prescribed Iron capsules. Am very worried and confused about which course is better to take. PLEASE GUIDE. Can I give her aceclofenac 100/200 mg at night and for how long, along with either course to relieve pain? THANKS SO MUCH.

MPT - Orthopedic Physiotherapy, Fellowship in Orthopaedic Rehabilitation (FOR) Advanced Diploma in Nutrition and Diet
Physiotherapist, Kolkata
Hullo Doc! My wife was recently diagnosed with Rheumatoid arthritis (ra factor less than 10.4,crp 24.5,hb 9.7,esr 40,...
Rheumatoid arthritis is an autoimmune disease where the body starts attacking it's own self mistaking it as harmful foreign body. Immune system gets weak here, so the formula to get help from this is to STRENGTHEN your immune system , never to suppress. The medications which Doctors Bhavesh prescribed are to be taken religiously , they are immunomodulators , they will help your wife. along with medications, life style modifications and diet modification is equally important and vital in reversing your Arthritis. Adopt Plant based diet to heal your gut and IMMUNITY. Take Vitamin C on daily divided doses of around 2g . ( consult with your doctor before taking this ) Evening Primrose oil/capsules around 500mg twice daily ( Gamma Linolenic acid ) helps immensely. For diets and Nutraceuticals, consult with me in person for detailed information. Remember, Hippocrates had said, " Let Food be thy Medicine and Medicine be thy food " he also said , whenever one is afflicted with disease, first heal the "GUT" Hope it helps. Thanks. Thanks.
1 person found this helpful

Why in my both legs Pain in standing more than 5 to 10 minutes. I have RA and I have COPD also all these problems due to RA Is there is a cure. I am taking regularly SULFASALAZINE .FISH OIL CAPSULES AND supplemental CALCIUM TABLETS 650 MG Twice a day I also drink Green Tea I want a cure for my leg Pain Please help me.

BPTh/BPT
Physiotherapist, Delhi
Why in my both legs Pain in standing more than 5 to 10 minutes. I have RA and I have COPD also all these problems due...
You do yoga it is best in fitness & lose wait you wear shoes either shilper light wait & comfortable you teke hot water then deep your leg in hot water when you feel cold then outside your leg you can also some exercise some days OK either you can also take 10-15 days physiotherapy you feel batter then time after physiotherapy.
2 people found this helpful

Hi. I have spondyloarthropathy and I've consulted a doctor 3-4 months ago and wasn't given sazo 500 x3 with dolonex x2. And after the dose was over my pain is back. I was stretching and did physio too but I'm starting to fall back to the same pain despite all that. I have booked an appointment with you. Please advice me briefly. I'm am coming from Tanzania. Thanks.

MD - General Medicine, DM - Rheumatology
Rheumatologist, Delhi
Hi. I have spondyloarthropathy and I've consulted a doctor 3-4 months ago and wasn't given sazo 500 x3 with dolonex x...
If your disease activity is high in terms of pain intensity and you are not responding adequately to pain killers and sulfasalazine ( saazo) then you need to take biologic drugs ( injections ) for spondyloarthritis. The final decision is made after detailed history and examination and certain investigations.
1 person found this helpful

I am a rheumatoid arthritis patient I take sulfasalazine 2 tablet twice a day. Instead can I take 2 in the morning and 1 in the evening. Plus ii am taking hcqs 200 mg each day 1. Please advice me.

MBBS, MS - Orthopaedics
Orthopedist, Delhi
I am a rheumatoid arthritis patient I take sulfasalazine 2 tablet twice a day. Instead can I take 2 in the morning an...
You can reduce the doe &see, If The symptoms don't reappear, continue. You have to adjust on minimum required dose.

Popular Health Tips

Spondyloarthritis

MD
General Physician, Secunderabad
Spondyloarthritis

Spondyloarthritis (also known as spondyloarthropathy) is the term which describes the connective tissue diseases. It is the group of inflammatory diseases, including arthritis of the peripheral joints and spine (sacroiliitis or spondylitis); including the area where ligaments and tendons attach to bones (enthesitis or enthesopathy). These diseases cause pain or stiffness in the leg or arm joints, spine, ligaments and tendons become inflamed. Skin rashes, eye, and intestinal problems may also be able to occur.

Epidemiology

  • Spondyloarthritis is a pathology that specifically strikes young people. The symptoms most frequently start before the age of 45. It affects more males than females.
  • Predisposition to spondyloarthritis, especially spa, is determined largely by genetic factors.
  • The incidence rate is higher in populations with a higher prevalence of hla-b27.
  • Psoriatic skin lesions and colitis due to inflammatory bowel disease (ibd) have been considered as both basic, subtype-defining entities with their own genetic background (distinct from hla-b27 genotype), and as manifestations of spondyloarthritis.
  • There is a strong need to diagnose patients with spa in an earlier stage; currently, there is a delay of 5–10 years between onset of the first symptoms and diagnosis.

Types

There are five types of spondyloarthritis

Ankylosing spondylitis or bechterew disease: it is the type of arthritis that affects the spine. Symptoms include pain and stiffness in the lower back and in the neck. Spine bones fuse together and it will become rigid spine and it leads to stoope over posture.

Psoriatic arthritis: psoriatic arthritis is the form of arthritis that affects the people who have psoriasis. Most people diagnosed with psoriasis and later diagnosed with psoriatic arthritis. It may affect any part of the body such as fingertips and spine. The main symptoms are joint pain, stiffness, and swelling.

Psoriatic arthritis

Reactive arthritis: it occurs due to the infection by certain bacteria. Often the bacteria’s from genitals (chlamydia trachomatis) or bowel (campylobacter, salmonella, shigella, and yersinia). It usually targets your knees and joints of ankles or feet.

Reactive arthritis

Undifferentiated arthritis: undifferentiated inflammatory arthritis does not conform to any of the recognized inflammatory arthritis types. It may include monoarthritis of a single joint; oligoarthritis, which is usually when four or fewer joints are involved; or polyarthritis, which usually involves many small joints.

Risk factors

Risk factors may be higher due to following reasons:

  • Family member having the gene which causes spondyloarthritis
  • Positive results for the hla-b27 gene
  • Recurring bacterial infection in your gut
  • Have other inflammatory conditions such as psoriasis or inflammatory bowel disease

Causes

  • The main cause is not known, but researchers pointed out that the hereditary genetics playing an important role in this disease. Since this disease occurs often in family members of patients who have spondyloarthritis.
  • Many genes cause it. Up to 30 genes have been found. But the major gene that causes spondyloarthritis is hla-b27.
  • Bacterial infections can also cause reactive spondyloarthritis known to be triggered by a bacteria chlamydia or food borne infections.

Symptoms and complications of spondyloarthritis

The first and major symptoms of all types of spondyloarthritis are severe low back pain, swelling of arms, stiffness, and fatigue. The different types of spondyloarthritis can be manifested by the following signs and symptoms.

  • Alternative or unilateral buttock pain
  • Arthritis in small joints
  • Arthritis in large joints such as knee joint, ankle joint and elbow joint (peripheral arthritis)
  • Numbness and tingling sensation in arms and legs
  • Spinal fusion may occur in ankylosing spondylitis
  • Inflammation at the interfaces between bone and tendon or ligament of limbs (enthesitis)
  • Inflammation of intestine, urinary tract and aortic heart valves. These can lead to spinal joints inflammation.
  • Inflammation of joints in pelvis and spine (sacroiliitis)
  • Enteropathic arthritis shows symptoms such as diarrhea and abdominal pain
  • Digestive problems
  • Skin disease like psoriasis
  • Osteoporosis
  • Redness of eye (iritis)
  • Swollen fingers and
  • Pain in the heels cause difficult to walk, stand even for small duration

Diagnosis and testing

First a doctor may ask for patient’s medical history, physical exam and may suspects for symptoms of spondyloarthritis. To confirm doctor may perform the following diagnosis and tests.

  • X-rays: x-ray images shows the change of the sacroiliac joints in the pelvis and fusion of spine. If these changes not observed, but symptoms shows spondyloarthritis doctor will suggest mri scan. Mri shows these changes more promptly than the x-ray.
  • Mri scans: it can show a very clear image of enthesitis and also the changes of sacroiliac joints.
  • Ct scans: ct also used for the imaging of bone joints.
  • Hla-b27: most patients with spondyloarthritis have hla-b27 gene, but some people don’t have this gene. So it is necessary to go for a hla-b27 test if the symptoms suspects spondyloarthritis.
  • Complete blood count (cbc): cbc can be useful to find the inflammation.
  • Musculoskeletal ultrasound scanning: ultrasound imaging uses sound waves to produce the images of inflammatory conditions of muscles, ligaments, and tendons.
  • Dual-energy x-ray absorptiometry (dexa) scans: used for measuring the bone mineral density usually the bones of the lower spine and hips. Bone loss is measured through this technique.

Treatment of spondyloarthritis.

  • There is no way to cure this disease condition, but there are treatments to counterparts the symptoms.
  • Nonsteroidal anti-inflammatory drugs: certain nsaid’s like naproxen, ibuprofen, meloxicam, or indomethacin are prescribed by doctors to relief from the pain due to symptoms.
  • Corticosteroid medication: inflammation around the tendons and in the joints can be overcome by taking some corticosteroid drugs. This helps to reduce the swelling in the joints.
  • Antibiotics: antibiotics can be used in the case of reactive spondyloarthritis in which bacteria cause the major problems.
  • Disease-modifying antirheumatic drugs (dmard’s): sulfasalazine (azulfidine) and methotrexate are the best dmard’s to be used for the joint damages in limbs affected by arthritis.
  • Tumor necrosis alpha (tnf-alpha) blockers: fda approved tnab are adalimumab (humira), adalimumab-atto (amjevita), a biosimilar to humira, certolizumab pegol (cimzia), etanercept (enbrel), etanercept-szzs (ereizi), a biosimilar to enbrel, golimumab (simponi), infliximab (remicade), infliximab-dyyb (inflectra), a biosimilar to remicade, and secukinimab (cosentyx). These are biosimilars used to treat arthritis in spine joints.
  • Surgery: patients with over inflammation of pelvis joints needs hip replacement. In the case of heavy damage in the cartilage of joints needs surgery to repair. In some rare cases, spinal surgery also needed.

Prevention and control measures

  • Prevention from spondyloarthritis needed some lifestyle changes as follows.
  • Quit smoking: smoking speeds up the spinal fusion in addition to other bad health effects.
  • Follow good posture: practicing a proper sitting and posture makes your spine to escape from growing into slumped-over position and strain.
  • Daily physical exercise: frequent home exercise and physiotherapy is essential to reduce the stiffening of spine and other joint problems. It also helps to have your heart healthy.
  • Good diet: follow the diets that are rich in calcium. Dairy products are preferred foe calcium rich foods.
Psoriatic arthritis
4 people found this helpful

Options Other Than Knee Replacement

MBBS, M. S., SR (AIIMS),FIJRS (SOUTH KOREA)
Orthopedist, Delhi
Options Other Than Knee Replacement

There is no cure for arthritis but there are a number of treatments that may help relieve the pain and disability it can cause.

  • As with other arthritic conditions, initial treatment of arthritis of the knee is nonsurgical. Your doctor may recommend a range of treatment options.
  • Lifestyle modifications. Some changes in your daily life can protect your knee joint and slow the progress of arthritis.
  • Minimize activities that aggravate the condition, such as climbing stairs.
  • Switching from high impact activities (like jogging or tennis) to lower impact activities (like swimming or cycling) will put less stress on your knee.
  • Losing weight can reduce stress on the knee joint, resulting in less pain and increased function.
  • Physical therapy. Specific exercises can help increase range of motion and flexibility, as well as help strengthen the muscles in your leg. Your doctor or a physical therapist can help develop an individualized exercise program that meets your needs and lifestyle.
  • Assistive devices. Using devices such as a cane, wearing shock-absorbing shoes or inserts, or wearing a brace or knee sleeve can be helpful. A brace assists with stability and function, and may be especially helpful if the arthritis is centered on one side of the knee. There are two types of braces that are often used for knee arthritis: an" unloader" brace shifts weight away from the affected portion of the knee, while a" support" brace helps support the entire knee load.
  • Other remedies. Applying heat or ice, using pain-relieving ointments or creams, or wearing elastic bandages to provide support to the knee may provide some relief from pain.
  • Medications. Several types of drugs are useful in treating arthritis of the knee. Because people respond differently to medications, your doctor will work closely with you to determine the medications and dosages that are safe and effective for you.
  • Over-the-counter, non-narcotic pain relievers and anti-inflammatory medications are usually the first choice of therapy for arthritis of the knee. Acetaminophen is a simple, over-the-counter pain reliever that can be effective in reducing arthritis pain.
  • Like all medications, over-the-counter pain relievers can cause side effects and interact with other medications you are taking. Be sure to discuss potential side effects with your doctor.
  • Another type of pain reliever is a nonsteroidal anti-inflammatory drug, or nsaid (pronounced" en-said"). Nsaids, such as ibuprofen and naproxen, are available both over-the-counter and by prescription. A cox-2 inhibitor is a special type of nsaid that may cause fewer gastrointestinal side effects. Common brand names of cox-2 inhibitors include celebrex (celecoxib) and mobic (meloxicam, which is a partial cox-2 inhibitor). A cox-2 inhibitor reduces pain and inflammation so that you can function better. If you are taking a cox-2 inhibitor, you should not use a traditional nsaid (prescription or over-the-counter). Be sure to tell your doctor if you have had a heart attack, stroke, angina, blood clot, hypertension, or if you are sensitive to aspirin, sulfa drugs or other nsaids.
  • Corticosteroids (also known as cortisone) are powerful anti-inflammatory agents that can be injected into the joint these injections provide pain relief and reduce inflammation; however, the effects do not last indefinitely. Your doctor may recommend limiting the number of injections to three or four per year, per joint, due to possible side effects.
  • In some cases, pain and swelling may" flare" immediately after the injection, and the potential exists for long-term joint damage or infection. With frequent repeated injections, or injections over an extended period of time, joint damage can actually increase rather than decrease.
  • Disease-modifying anti-rheumatic drugs (dmards) are used to slow the progression of rheumatoid arthritis. Drugs like methotrexate, sulfasalazine, and hydroxychloroquine are commonly prescribed.
  • In addition, biologic dmards like etanercept (embril) and adalimumab (humira) may reduce the body's overactive immune response. Because there are many different drugs today for rheumatoid arthritis, a rheumatology specialist is often required to effectively manage medications.
  • Viscosupplementation involves injecting substances into the joint to improve the quality of the joint fluid.
  •  Glucosamine and chondroitin sulfate, substances found naturally in joint cartilage, can be taken as dietary supplements. Although patient reports indicate that these supplements may relieve pain, there is no evidence to support the use of glucosamine and chondroitin sulfate to decrease or reverse the progression of arthritis.
5 people found this helpful

Tips On Preconception Health For Men

MBBS, DGO, MD, Fellowship in Gynae Oncology
IVF Specialist, Delhi
Tips On Preconception Health For Men

As couples prepare for pregnancy, it is easy to focus only on the woman's health. However, there are several habits men need to be forming during these critical months of preparation too. Issues of fertility do not rest solely on the female.

'agents that may cause birth defects do not reach the developing fetus through the father as they do from the pregnant mother,' but we do know that male exposure to certain substances can lead to some preliminary problems with fertility and also slightly elevate the risk of certain birth defects.

Male infertility alone accounts for approximately 1/3 of all infertility cases. Should fertility issues arise, you should plan ahead to be in the best physical condition to conceive.

Clean out the medicine cabinet

Eliminate as many medications from your routine as possible. Talk with your physician about your prescription medications. You may need to discontinue use or try something new.

The following medications have been known to impact male fertility:
 

  • Tagamet (cimetidine), sulfasalazine, and nitrofurantoin are used to treat ulcers, gastrointestinal problems, and urinary tract infections. These medications may impact sperm production and sperm count.
  • Steroids, such as prednisone and cortisone, which are used to treat asthma, arthritis and skin conditions, impact male fertility.
  • Chemotherapy and radiation could cause sterility or a significant change in sperm quality and quantity.



Take a good look at your work environment

Your work environment may be a contributing factor to your fertility. Ongoing exposure to certain agents such as pesticides, chemical fertilizers, lead, nickel, mercury, chromium, ethylene glycol ethers, petrochemicals, benzene, perchloroethylene, and radiation can lower sperm quality, quantity and possibly lead to infertility or miscarriage.


Eat and sleep

What you eat can make a difference. Find out what your proper weight range should be and make the necessary dietary and exercise changes to get there. Studies suggest that some men with low sperm count also have a zinc deficiency.

The following foods are high in zinc and could increase your fertility:
 



Adding more vitamin e may also help the process along. There are male fertility supplements available containing vitamins, minerals and other ingredients designed to help improve overall reproductive health.

Also, keep in mind getting plenty of rest is good for everything that ails you, even low sperm count and sperm quality.

Avoid alcohol and other substances

Eliminate alcohol, tobacco, marijuana and any illicit drugs. Too much alcohol may reduce zinc levels, and drugs decrease sperm quality. There is some research that may link smoking and certain rare heart defects, but further studies must be done to make an accurate conclusion. Marijuana has been proven to affect sperm quality and sperm count, but there is no evidence that shows that marijuana causes birth defects.

Keep your testicles cool

Heat from hot tubs, saunas, long showers (more than 30 minutes), heating pads, electric blankets, and tight clothing like briefs and spandex could cause your testicles to become too hot, which decreases sperm quantity.

Stay away from cycling

Cycling can cause a lot of friction and jostling, which increases the temperature of your testicles. The rise in temperature and possibility of injury may cause a low sperm count.

 

7 people found this helpful

What is Infertility?

DHMS (Diploma in Homeopathic Medicine and Surgery)
Homeopath, Jhansi
What is Infertility?

1. What is infertility?
Infertility is a term that is used to describe the inability of an individual to successfully contribute to the process of conception. In females, it refers to their lack of ability to conceive post having regular, unprotected intercourse. In some cases, it also refers to their inability to carry a pregnancy to its full term. A normal fertility helps conception in the first 12 months of trying for almost 86% of couples, with around 7-8% couples conceiving in their second year, depending on their age. Hence, many practitioners also treat an inability to conceive within the first 12 months as infertility. 

2. Is infertility a global problem?
Sub-fertility as well as infertility are a global public health issue affecting approx. 8-12% couples, worldwide. It is prevalent in both males and females. While over 10% of women world-wide, who have been in stable relationships for over 5 years yet been unsuccessful in conceiving, have been estimated to be inflicted with this problem; the count is much smaller in the case of men, primarily because of non-acknowledgement, even though it contributes to almost 50% of reported cases.

3. Do infertility problems occur only among women?
No, infertility problems are as common in men as they are in women. Almost 50% of cases of infertility are attributable to male infertility related issues. However, due to the social structure prevalent, most of such male infertility related issues go unacknowledged.

4. What could be the probable symptoms that suggest a possibility of infertility related problems?
Though the process of conception and the possibility of infertility related problems could be time-driven factors, some symptoms could indicate a bent towards infertility and could be medically examined and addressed in time to curb the problem at the very onset. Some of these indications include:

Indications in Females:
Infertility symptoms in females can be related to either one of multiple of these problems:
Changes in menstrual cycle: Irregular or infrequent periods mean that the number of days between two cycles varies each month. This is a common indication of infertility as it reflects that the ovulation cycle is not stable, i.e. the body is not producing ovules (egg) regularly or at times not at all. 
Abnormalities in periods: Sudden changes in the bleeding pattern – heavier periods, no period or cramping and pelvic pain associated with periods – could also be indicative of an underlying fertility related problem.
Hormonal Disturbances: Sudden changes in skin like more than usual acne, changes in sexual drive, unexplained and sudden growth of facial hair, excessive weight gain/loss, etc. 
Other Symptoms: Other symptoms such as pain during sex, milky-white discharge from breast/nipples (unrelated to lactation) can also be indicative of infertility and one should seek medical advice at the earliest.
Age-related: As one advances in age, the egg count decreases rapidly along with a related deterioration in the egg quality. Hence, if a woman is in her early 30s and is failing to conceive, it could be related to a fertility problem. 

Indications in Males:
Infertility symptoms in men can be quite elusive as they are very closely related to the cause of infertility. These often go unnoticed until the point that the couple start trying for a baby. Some of these are: 
• Sudden changes in sexual drive.
Pain, inflammation or lump in the testicles or if the testicles are small and firm.
• Problems related to ejaculation and erection
• Sudden, unexplained changes in hair growth patterns.
• Known semen abnormalities

5. Who are at risk of infertility problems?
Age is one of the most crucial risk involved in fertility related matters. For couples who start trying for a baby later in age, the chances of infertility increases manifolds. Couples where either partner is in their mid-30s or into 40s are at higher risk of infertility problems. While a man’s overall lifestyle, health and other factors can affect his chances of contributing to a successful conception, in a woman age and chronic health conditions play a major role.

6. What increases infertility risk in men?
While health and lifestyle are the most important factors that contribute to their fertility levels, including their sperm quality and count, there are many other factors that affect fertility and push towards higher infertility risk among men. Some of these include:
• Age
• Alcohol and tobacco consumption
• Excessive physical exercise, especially excessive cycling
• Weight related issues 
• Exposure to toxins at workplace or as part of a medical treatment like chemotherapy/radiation
• Surgical procedures like vasectomy or its reversal
• Family history of infertility or fertility related disorders or other genetic medical conditions like cystic fibrosis
• Medical history of sexually transmitted infections (STIs)
• Certain chronic problems like high blood pressure, diabetes, renal or hormonal problems 


7. What can increase the risk of infertility among women?
Ovulation related issues contribute to over 25% of female infertility cases, with tubal blockage and uterine problems coming in as the other infertility causes in women. However, some other factors like the ones enlisted below also put females at risk of infertility:
• Advanced age
• Frequent or heavy alcohol or caffeine consumption
• Cigarette smoking
• Weight-related issues
Eating disorders and lack of balanced healthy diet
• Intense and extended athletics or no exercise at all
• History of STIs, endometriosis, polycystic ovarian syndrome (PCOS) or fibroids
• Chronic health issues like high blood pressure or diabetes. 
• Hormonal problems like thyroid etc. 
• Mental stress and fatigue

8. How is age related to a woman’s ability to conceive or infertility aspects?
A woman’s fertility rate begins to recede with her age. As a woman nears her mid-30s, her natural fertility starts to fall and many experience difficulties in conception as well as multiple pregnancy failures. The reason for this is that the ovarian reserve in women is fixed since birth and as they age it starts to fall drastically as the follicles keep leaving the reserve in a continuous flow (menstrual cycle). This follicular depletion accelerated as she approaches 40s and decreases not just her egg count but its quality too, as she ages. For men, this progressive drop in fertility rate hits after the age of 40. 

9. What are common causes of infertility in men?
One of the most common causes of infertility in men are semen disorders. The semen comprises a milky white fluid and sperms that are ejaculated during orgasm. Abnormal semen contributes to over 75% cases of male infertility. The common semen related disorders include:
i. No sperm presence in semen
ii. Low sperm mobility
iii. Abnormal sperm shape/size
iv. Low sperm concentration (under 10 million/milliliter) in the semen (Ideal: 20 million/milliliter of semen)
 

The major causes of these abnormalities and a consequent infertility in men are:
1. Ejaculation Disorders
2. Frequent use of saunas, hot baths etc. that lead to overheating of testicles.
3. Testicular infections
4. Testosterone deficiency
5. Deformed or undescended testicles that usually happens as a birth defect or abnormal fetal development.
6. Genetic disorders like Klinefelter's syndrome that lead to abnormally developed testicles.
7. Very frequent intake of medications like Sulfasalazine, Anabolic steroids (frequently taken by athletes), etc. or exposure to chemotherapy/radiation.
8. Conditions like hypospadias (a condition where the urethral opening is not at the tip of the penis but at its underside) or cystic fibrosis.

10. What are common causes infertility in women?
There are a number of conditions that lead to fertility among women, such as:

1. Ovarian Disorders: The most commonly reported reason for infertility among women is a disorder in the ovulation process. 
Ovulation involves the production and release of egg. This cycle happens on a monthly basis. However, certain situations lead to a malfunctioned ovulation. These causes include:
i. Polycystic ovary syndrome (PCOS) which lead to mal function of ovaries
ii. Very high prolactin levels in non-lactating females
iii. Damaged or abnormal eggs – Poor egg quality is common in older women
iv. Thyroid disorders
v. Medical conditions like cancer, diabetes, AIDS, etc. 
vi. Premature (before the age of 40) ovarian failure 

2. Uterine Disorders: Once fertilized, the egg travels from the ovary to the uterus and it is important that the uterus be healthy to receive and nurture the fertilized egg. However, at times, disorders of the uterus lead to infertility problems in women. Uterine disorders can be attributed to one or more of these reasons:
i. Pelvic or cervical surgery that may cause scarring or damage of the uterus or fallopian tubes or at times shortening of the cervix which serves as the mouth of the uterus.
ii. Endometriosis – a condition where the cells that line the uterus start growing outside the uterus.
iii. Sterilization treatments like tying of tubes, etc.
iv. Uterine fibroids or endometrial polyps

3. Medications: Certain medications like those used in chemotherapy or certain NSAIDS like aspirin and ibuprofen lower fertility rates in females.

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Rheumatoid Arthritis - Why It Is Important To Treat It On Time?

MD - General Medicine, DM - Rheumatology
Rheumatologist, Delhi
Rheumatoid Arthritis - Why It Is Important To Treat It On Time?

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! If you wish to discuss about any specific problem, you can consult a rheumatologist.

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