"Ooohhh... My Aching Knee!!!"
Insider Secrets on How You Can Get Relief Quickly and
Easily!
By
Nathan
Wei
When your knee hurts, getting relief is all that’s on your mind. Getting the right relief, though, depends on knowing what’s wrong. The correct diagnosis will lead to the correct treatment.
Know Your Knee!
The knee is the largest joint in the body. It’s also one of the most complicated. The knee joint is made up of four bones that are connected by muscles, ligaments, and tendons. The femur (large thigh bone) interacts with the two shin bones, the tibia (the larger one) located towards the inside and the fibula (the smaller one) located towards the outside. Where the femur meets the tibia is termed the joint line. The patella, (the knee cap) is the bone that sits in the front of the knee. It slides up and down in a groove in the lower part of the femur (the femoral groove) as the knee bends and straightens.
Ligaments are the strong rope-like structures that help connect bones and provide stability. In the knee, there are four major ligaments. On the inner (medial) aspect of the knee is the medial collateral ligament (MCL) and on the outer (lateral) aspect of the knee is the lateral collateral ligament (LCL). The other two main ligaments are found in the center of the knee. These ligaments are called the anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL). They are called cruciate ligaments because the ACL crosses in front of the PCL. Other smaller ligaments help hold the patella in place in the center of the femoral groove.
Two structures called menisci sit between the femur and the tibia. These structures act as cushions or shock absorbers. They also help provide stability for the knee. The menisci are made of a tough material called fibrocartilage. There is a medial meniscus and a lateral meniscus. When either meniscus is damaged it is called a "torn cartilage".
There is another type of cartilage in the knee called hyaline cartilage. This cartilage is a smooth shiny material that covers the bones in the knee joint. In the knee, hyaline cartilage covers the ends of the femur, the femoral groove, the top of the tibia and the underside of the patella. Hyaline cartilage allows the knee bones to move easily as the knee bends and straightens.
Tendons connect muscles to bone. The large quadriceps muscles on the front of the thigh attach to the top of the patella via the quadriceps tendon. This tendon inserts on the patella and then continues down to form the rope-like patellar tendon. The patellar tendon in turn, attaches to the front of the tibia. The hamstring muscles on the back of the thigh attach to the tibia at the back of the knee. The quadriceps muscles are the muscles that straighten the knee. The hamstring muscles are the main muscles that bend the knee.
Bursae are small fluid filled sacs that decrease the friction between two tissues. Bursae also protect bony structures. There are many different bursae around the knee but the ones that are most important are the prepatellar bursa in front of the knee cap, the infrapatellar bursa just below the kneecap, the anserine bursa, just below the joint line and to the inner side of the tibia, and the semimembranous bursa in the back of the knee. Normally, a bursa has very little fluid in it but if it becomes irritated it can fill with fluid and become very large.
Is it bursitis... or tendonitis...or arthritis?
Tendonitis generally affects either the quadriceps tendon or patellar tendon. Repetitive jumping or trauma may set off tendonitis. The pain is felt in the front of the knee and there is tenderness as well as swelling involving the tendon. With patellar tendonitis, the infrapatellar bursa will often be inflamed also. Treatment involves rest, ice, and anti-inflammatory medication. Injections are rarely used. Physical therapy with ultrasound and iontopheresis may help.
Bursitis pain is common. The prepatellar bursa may become inflamed particularly in patients who spend a lot of time on their knees (carpet layers). The bursa will become swollen. The major concern here is to make sure the bursa is not infected. The bursa should be aspirated (fluid withdrawn by needle) by a specialist. The fluid should be cultured. If there is no infection, the bursitis may be treated with anti-jnflammatory medicines, ice, and physical therapy. Knee pads should be worn to prevent a recurrence once the initial bursitis is cleared up.
Anserine bursitis often occurs in overweight people who also have osteoarthritis of the knee. Pain and some swelling is noted in the anserine bursa. Treatment consists of steroid injection, ice, physical therapy, and weight loss.
The semimembranous bursa can be affected when a patient has fluid in the knee (a knee effusion). The fluid will push backwards and the bursa will become filled with fluid and cause a sensation of fullness and tightness in the back of the knee. This is called a Baker’s cyst. If the bursa ruptures, the fluid will dissect down into the calf. The danger here is that it may look like a blood clot in the calf. A venogram and ultrasound test will help differentiate a ruptured Baker’s cyst from a blood clot. The Baker’s cyst is treated with aspiration of the fluid from the knee along with steroid injection, ice, and elevation of the leg.
Knock out knee arthritis... simple steps you can take! Younger people who have pain in the front of the knee have what is called patellofemoral syndrome (PFS). Two major conditions cause PFS. The first is chondromalacia patella. This is a condition where the cartilage on the underside of the knee cap softens and is particularly common in young women. Another cause of pain behind the knee cap in younger people may be a patella that doesn’t track normally in the femoral groove. For both chondromalacia as well as a poorly tracking patella, special exercises, taping, and anti-inflammatory medicines may be helpful. If the patellar tracking becomes a significant problem despite conservative measures, surgery is need.
While many types of arthritis may affect the knee, osteoarthritis is the most common. Osteoarthritis usually affects the joint between the femur and tibia in the medial (inner) compartment of the knee. Osteoarthritis may also involve the joint between the femur and tibia on the outer side of the knee as well as the joint between the femur and patella. Why osteoarthritis develops is still being scrutinized carefully. It seems to consist of a complex interaction of genetics, mechanical factors, and immune system involvement. The immune system attacks the joint through a combination of degradative enzymes and inflammatory chemical messengers called cytokines.
Patients will sometimes feel a sensation of rubbing or grinding. The knee will become stiff if the patient sits for any length of time. With local inflammation, the patient may experience pain at night and get relief from sleeping with a pillow between the knees. Occasionally, locking and clicking may be noticed. Patients with osteoarthritis may also tear the fibrocartilage cushions (menisci) in the knee more easily than people without osteoarthritis.
So how is the arthritis treated? An obvious place to start is weight reduction for patients who carry around too many pounds.
Strengthening exercises for the knee are also useful for many people. These should be done under the supervision of a physician or physical therapist.
Other therapies include ice, anti inflammatory medicines, and occasionally steroid injections. Glucosamine and chondroitin supplements may be helpful. A word of caution... make sure the preparation you buy is pure and contains what the label says it does. The supplement industry is unregulated... so buyer beware!
Injections of the knee with viscosupplements – lubricants- are particularly useful for many patients. Special braces may help to unload the part of the joint that is affected.
Arthroscopic techniques may be beneficial in special circumstances. Occasionally, a surgical procedure called an osteotomy, where a wedge of bone is removed from the tibia to “even things out,” may be recommended. Joint replacement surgery is required for end stage knee arthritis.
Research is being done to develop medicines that will slow down the rate of cartilage loss. Targets for these new therapies include the destructive enzymes and/or cytokines that degrade cartilage. It is hoped that by inhibiting these enzymes and cytokines and by boosting the ability of cartilage to repair itself, that therapies designed to actually reverse osteoarthritis may be created. These are referred to as disease-modifying osteoarthritis drugs or “DMOADs.” Genetic markers may identify high risk patients who need more aggressive therapies.
Newer compounds that are injected into the knee and provide healing as well as lubrication are also being developed. And finally, less invasive surgical techniques are also being looked at. Recent technological advances in “mini” knee replacement look very promising.
Dr. Wei (pronounced “way”) is a board-certified rheumatologist and Clinical Director of the nationally respected Arthritis and Osteoporosis Center of Maryland. He is a Clinical Assistant Professor of Medicine at the University of Maryland School of Medicine and has served as a consultant to the Arthritis Branch of the National Institutes of Health. He is a Fellow of the American College of Rheumatology and the American College of Physicians. For more information go to: Arthritis Treatment
Easy Steps You Can Take Today
to Erase Hip Pain
By
Nathan
Wei
“More than 100,000 Americans are unable to get from their bed to the bathroom without assistance because of problems related to their hip or knee.” So says Dr. Nathan Wei, Clinical Director of the Arthritis and Osteoporosis Center of Maryland. He adds, “Too many people put up with pain when there are so many treatments available.”
The hip joint plays a major role in weight-bearing and walking.
It’s a ball-and-socket joint that combines great stability and a wide range of motion. This joint is comprised of the head of the thigh bone (femur) which is shaped like a ball. This sits inside a cup-like area of the pelvis called the acetabulum (“socket”). It is surrounded by powerful muscles that help maintain the body in an upright posture and also help with walking. Many ligaments also help support the structure of the hip.
The most common symptom with hip problems is pain
Pain due to hip problems may be felt in the groin, on the outside of the hip region, the buttock, inner part of the thigh, the front of the thigh, and even the knee. In fact, there have been patients who’ve had knee surgery... when the problem was really in the hip. NOT a good thing! Pain coming from the hip joint also needs to be distinguished from low back disorders as well as knee disorders. Activities of daily living that are affected by hip pain include going up and down stairs, getting out of chairs, getting out of bed, getting shoes and socks off and on, and sexual intercourse.
Hip pain is often aggravated by weight-bearing.
Besides arthritis, hip pain can be due to bursitis. The most common is trochanteric bursitis. Trochanteric bursitis is inflammation of the large bursa that sits on the side of the hip. It tends to come on in middle-aged people. The major symptom is a deep aching pain over the upper outer thigh. It is made worse by walking. It is often bad at night and is aggravated by lying on the affected side. The treatment consists of anti-inflammatory medication, physical therapy, steroid injection, and stretching exercises.
Another potentially serious condition is avascular necrosis of the hip.
Here, a patient will have severe pain- usually in the groin. Weight-bearing is excruciating and the pain may also be present at night. Avascular necrosis is a condition where the blood supply to the head of the femur (”the ball”) is interrupted... ...and the head of the femur actually dies! The bone collapses. Remember the great athlete, Bo Jackson... he had avascular necrosis. The diagnosis is confirmed by MRI scanning and the treatment involves surgical procedures. In patient with an arthritis condition, treatment modalities should include anti-inflammatory medication, physical therapy, exercises, and weight reduction, if necessary.
Specific stretching exercises are helpful.
Dr. Wei says, “One of my favorite is called thread-the-needle. You cross one leg across the thigh of the other. Reach down through the hole formed by this crossing over maneuver with the same side hand as the leg you’re using to cross over. Clasp fingers with the other hand behind the thigh and gently pull. You’ll feel the stretch! Hold for 10 seconds. Repeat with the other side.”
Joint replacement- known as hip arthroplasty- is still the resort of choice in patients with end-stage arthritis.
Indications for arthroplasty include:
•loss of function in the hip.
In the past, the limiting problem was that the replaced hip was only good for 10 to 15 years with “normal” use.
Problems that limit the lifespan of hip replacements are
•wear and...
•inflammatory response to particles that eventually cause loosening in some patients.
Dr. Wei (pronounced “way”) is a board-certified rheumatologist and Clinical Director of the nationally respected Arthritis and Osteoporosis Center of Maryland. He is a Clinical Assistant Professor of Medicine at the University of Maryland School of Medicine and has served as a consultant to the Arthritis Branch of the National Institutes of Health. He is a Fellow of the American College of Rheumatology and the American College of Physicians. For more information on arthritis and related conditions, go to: Arthritis Treatment
My Arthritis is Killing Me - It Must be
Springtime
By
Nathan Wei
It turns out that patients with rheumatoid arthritis appear to have higher disease activity during the spring season relative to the fall season, based on subjective and objective disease measures.
To determine whether a seasonal fluctuation in disease severity exists among patients with rheumatoid arthritis (RA), researchers examined data from 1,665 patients with RA who participated in a large, observational cohort study conducted in Japan from October 2000 to April 2005. The majority of the patients (81.7%) were female, the mean age of the patients was 57.2 years, and the mean disease duration was 9.9 years.
Ten criteria were used to assess disease activity, including objective, subjective, patient-assessed, and physician-assessed measures. Evaluations were made each spring and fall during the study period.
The results showed higher disease activity in the spring for almost all measures.
In addition to clinical measures of disease, laboratory measures of disease activity including the erythrocyte sedimentation rate (sed rate), C-reactive protein, and rheumatoid factor were also significantly elevated in the spring compared with the fall.
The implications of the research are difficult to fully establish. However, it is clear that examining patients during different times of the year may lead to different results. Seasonal variations in symptoms should be taken into account when planning changes in treatment. Patients with RA should be warned about the possible seasonal variations that can occur.
(N. Iikuni, A. Nakajima, E. Inoue, E. Tanaka, H. Okamoto, M. Hara, T. Tomatsu, N. Kamatani and H. Yamanaka. What's in season for rheumatoid arthritis patients? Seasonal fluctuations in disease activity. Rheumatology. January 2007).
Nathan Wei, MD, FACP, FACR is a rheumatologist and Director of the Arthritis and Osteoporosis Center of Maryland (http://www.aocm.org). He is a Clinical Assistant Professor of Medicine at the University of Maryland School of Medicine and consultant to the National Institutes of Health. For more info: http://www.arthritis-treatment-and-relief.com/arthritis-treatment.html Arthritis Treatment
Green Tea for Rheumatoid
Arthritis?
By
Nathan Wei
A new study from the University of Michigan Health System and the University of Michigan School of Medicine was presented at the national Experimental Biology meeting in Washington, D.C.
Lead researcher, Salah-uddin Ahmed, stated that "it's too early" to fully recommend green tea to ease rheumatoid arthritis (RA), but the “study is a starting point."
In the study, Ahmed isolated cells called synovial fibroblasts from the joints of patients with rheumatoid arthritis. These cells form the inside lining of tissue inside the capsule of a joint. This synovial lining becomes inflamed in patients with rheumatoid arthritis. The inflammation leads to joint destruction and crippling deformity.
The researchers cultured these cells and exposed them to the active ingredient in green tea, a compound named epigallocatechin-3-gallate (EGCG). Next, the cells were stimulated with a protein called interleukin-1B. Interleukin -1B is a cytokine. Cytokines are chemical messengers that promote joint inflammation and destruction through the production of damaging proteins and enzymes.
In an earlier study, Ahmed's team found that fibroblasts pretreated with EGCG and then stimulated with cytokine IL-1B were better able to block IL-1B's ability to produce the damaging proteins and enzymes that cause the cartilage breakdown seen in people with rheumatoid arthritis.
In the current study, the researchers also looked at whether EGCG had the ability to block the activity of two potent molecules, IL-6 and cyclooxygenase-2 (Cox-2), which also play a role in joint inflammation in RA.
The two molecules were suppressed by the EGCG significantly, Ahmed reported.
EGCG also blocked the production of prostaglandin E2, another compound that can promote joint inflammation.
The new research by Ahmed is one of the first to focus on rheumatoid arthritis and green tea. Ahmed cautioned that while it's too soon to advise rheumatoid arthritis patients to drink green tea, drinking green tea certainly wouldn't hurt, he said. Green tea is known to have many health benefits and no known side effects.
Nathan Wei, MD, FACP, FACR is a rheumatologist and Director of the Arthritis and Osteoporosis Center of Maryland (http://www.aocm.org/). He is a Clinical Assistant Professor of Medicine at the University of Maryland School of Medicine and consultant to the National Institutes of Health. For more info: http://www.arthritis-treatment-and-relief.com/
Eliminate
Agonizing Hand Pain Quickly and Easily!
By
Nathan Wei
According to Dr. Nathan Wei, “The hand and wrist are the mirrors of disease.” While the cause of hand pain can be a localized problem, hand pain can also be the presenting sign for other diseases.
The wrist and hand are capable of power and precision. As a result, pain and swelling are often accompanied by weakness of grip in hand disorders. A careful history and a complete physical examination are important. The presence of symptoms elsewhere in the body is important to establish.
Two serious hand problems are:
• Reflex sympathetic dystrophy (RSD). This is caused by a disorder of the sympathetic nervous system. Typically, it is described as a burning pain. The precipitating factor may be trauma Color changes including purplish discoloration of the fingers may occur. The treatment involves a special procedure called stellate ganglion block. Usually performed by an anesthesiologist, this procedure is often very effective.
• Hypertrophic osteoarthropathy. The hand becomes swollen and painful. This picture occasionally occurs in patients with underlying cancers.
Other hand problems that point to other diseases:
• Psoriasis may also cause pitting or lifting up (onycholysis) of the fingernails.
• Abnormal blood vessel patterns near the fingernails may signify auto-immune diseases like lupus.
• Raynaud's phenomenon... When fingers blanch (turn white) this may be a sign of an underlying autoimmune problem such as systemic lupus erythematosus or scleroderma.
• Bumps, called “nodules” can develop as a result of osteoarthritis, gout, and rheumatoid arthritis.
• Depuytren’s contracture is a problem where the skin in the palm may become thickened and shortened. A cord of tissue develops and causes fingers to bend into the palm. Treatment for this problem may be steroid injection, splinting, and physical therapy. Surgery is often needed. This condition occurs with other medical diseases.
Virtually all types of arthritis can affect the wrist and hand.
Arthritis when untreated or poorly treated will lead to deformity. Tendonitis is another common problem in the wrist and hand. In the wrist, tendonitis usually causes pain and localized swelling. Tendonitis can be confused with arthritis.
Tendonitis in the hand is most common in the palm. This causes locking or triggering of the fingers. Steroid injection and physical therapy are usually effective treatments. Treatment consists of anti-inflammatory medication, steroid injection, splinting, and occasionally physical therapy.
Tips to make your hand pain better...
• Wear splints if you’re going to be doing a lot of repetitive motions
• Use your whole arm instead of just your hand and wrist
• Enlarge the handles on your tools. You can get kitchen utensils and writing implements with enlarges handles. They’re worth it.
• Make sure to take rest breaks.
• Avoid repetitive movements when possible.
• Carry objects with the palms open and flat. This will take the pressure off your wrists and fingers.
A common cause of hand pain is carpal tunnel syndrome
... pinching of the median nerve in the wrist. Carpal tunnel syndrome is a symptom- much like fever... it is not a disease! It is the most common cause of tingling in the hands. Besides tingling, burning pain may also occur. Patients often have discomfort at night that is relieved by hanging the affected hand over the side of the bed or vigorously shaking the hands. The discomfort of carpal tunnel syndrome can also be brought on by holding up the newspaper while reading, or by driving. Causes of carpal tunnel syndrome include arthritis, endocrine problems, pregnancy, trauma, infection, tumors, and overuse. Treatment of carpal tunnel syndrome depends on the severity. Mild to moderate carpal tunnel syndrome is treated with splinting, sometimes steroid injection, and avoidance of overuse. For patients with carpal tunnel syndrome that doesn’t respond to conservative measures or where the carpal tunnel syndrome is severe, surgery is indicated.
Radial nerve damage leads to wrist drop. Radial nerve pressure in the wrist can occur as a result of repetitive motion, tight pressure (handcuffs, watchbands, bracelets), diabetes, and trauma. Ulnar nerve damage and compression in the wrist can cause a "claw hand." Treatment consists of anti-inflammatory medication, rest, splinting, injection, and sometimes surgery.
Treatment of hand disorders is entirely dependent on making an accurate and specific diagnosis.
Doctor - How
Serious Are The Risks Of Arthritis Pain Relievers To My Stomach?
By
Nathan Wei
Non-steroidal-anti-inflammatory drugs (NSAIDS) are anti-inflammatory pain relievers. Approximately twenty different NSAIDS are available by prescription. Three NSAIDS (ibuprofen, naproxen, and ketoprofen) are also available over-the-counter as Advil, Motrin IB, Aleve, and Orudis. Aspirin is also an NSAID. NSAIDS are also found in many common cold preparations such as Advil Cold and Sinus, Dimetapp Sinus, and Aleve Cold and Sinus.
The most common side effect associated with these drugs is stomach problems. These problems can range from mild stomach upset to ulcers and bleeding. NSAIDS cause this situation because the same mechanism that allows them to block inflammation also causes them to block the secretion of substances that protect the stomach lining.
The magnitude of this problem is enormous. Significant stomach side-effects from NSAIDS result in 103,000 hospitalizations and 16,500 deaths each year in the United States.
While anyone who takes an NSAID can be at risk for stomach problems, there are some high risk factors that significantly increase the chance of problems developing. These include:
• Age greater than
60
• History of previous ulcers
• Taking steroid medicines such as prednisone
• Using blood thinners like coumadin, Plavix, or heparin
• Regular alcohol consumption
• Taking higher than the recommended dosage of NSAID
• Taking more than one NSAID at the same time (such as taking an NSAID along
with aspirin)
• Taking NSAID for a prolonged period of time
A 2003 survey revealed that about half of all Americans who took over-the-counter NSAIDS took more than the recommended dose. This can happen when the dose is taken before the recommended time for dosing, taking more than the recommended number of tablets, taking more than the recommended dosage per day, and taking more than one NSAID at a time.
Small amounts of over-the-counter NSAID including low-dose aspirin to prevent stroke, heart attack, and colon cancer also increase risk.
Warning signs that a
significant problem may be occurring include:
• Stomach pain
• Tarry black stool or blood in the stool
• Vomiting up material that looks like coffee grounds
One unfortunate issue is that more than 80 per cent of people who have a life-threatening stomach problem have no warning symptoms. Symptoms can occur quickly also. Serious medical events have occurred in people taking NSAIDS for less than one week.
To reduce your
risk:
• Check to see if you have risk factors.
• Discuss potential side-effects with your prescribing physician.
• Read the warning label and follow dosing instructions.
• Don’t use prescription NSAID and over-the-counter NSAID at the same time.
• When you see your doctor let him or her know about all the medicines,
including nutritional supplements, you are taking.
• Limit your alcohol intake while on these medicines.
• Recognize that low dose aspirin is an NSAID.
• Let your physician know if you’re experiencing any symptoms that suggest a
stomach problem.
• Ask about other medicines that might reduce your risk of a stomach
side-effect. Medicines called proton pump inhibitors (PPIS) can reduce the risk
of stomach side-effects. Examples of PPIS include Nexium, Protonix, Prilosec,
and Axid.
Another medicine, Cytotec, may also protect your stomach. Sometimes using an analgesic that is not an NSAID can relieve arthritis symptoms sufficiently. Analgesics include Tylenol or Ultram (tramadol).
Cox-2 medicines such as Celebrex may also reduce your stomach risk. However, adding low dose aspirin to Celebrex apparently removes the protective effect of the Celebrex.
Viscosupplements for My Knee Arthritis - What are They?
By
Nathan Wei
In osteoarthritis, the cartilage in the joint gradually wears away. During the course of cartilage degeneration, there is inflammation and resultant stiffness and pain. Osteoarthritis may be caused by or aggravated by excess stress on the joint from deformity, repeated trauma, or excess weight. It most often affects middle-aged and older people.
A younger person who develops osteoarthritis may have an inherited form of the disease or may have experienced problems as a result of injury.
In rheumatoid arthritis, the joint becomes inflamed and cartilage may be destroyed as well. Arthritis not only affects joints, it can also affect supporting structures such as:
• muscles
• tendons
• ligaments
Rheumatoid arthritis often affects people at an earlier age than osteoarthritis. Regardless of the type of arthritis causing knee symptoms, the end result is often the same. A person who has arthritis in the knee may experience pain, swelling, and a decrease in knee motion. A common symptom is morning stiffness that gets better as the person moves around. Sometimes the joint locks or clicks when the knee is bent and straightened, but these signs may occur in other knee disorders as well. The doctor may confirm the diagnosis by performing a physical examination and examining magnetic resonance (MR) scans, which reveal the inner architecture of the knee.
Most often arthritis in the knee is treated initially with pain-reducing medicines, such as analgesics and anti-inflammatory medicines.
Exercise is essential to restore joint movement and strengthen the knee. Losing excess weight can also help people with osteoarthritis.
Glucocorticoid injections are helpful when there is evidence of inflammation.
The normal knee joint produces synovial fluid, a thick slippery substance that nourishes cartilage and allows smooth gliding of the cartilage surfaces. With arthritis, the amount of synovial fluid made by the joint is reduced.
In instances when other therapies do not provide the desired relief, viscosupplements are sometimes used. These are gel-like substances (hyaluronates) that mimic the properties of naturally occurring joint fluid.
These hyaluronates actually supplement the viscous properties of synovial fluid. Injection of hyaluronates is done using either fluoroscopic or ultrasound needle guidance.
Currently, hyaluronate injections are approved for the treatment of osteoarthritis of the knee in those who have failed to respond to more conservative therapy. The number of injections performed varies with the type of viscosupplement used. Usually 5 injections are required for the best response.
Currently, there are five FDA approved hyaluronates:
• Hyalgan
• Synvisc
• Euflexa
• Supartz
• Orthovisc
Sometimes, a physician will perform an arthroscopy before providing viscosupplement. Also, a special type of brace to help unload the narrowed part of the knee may be used to help the viscosupplement work better.
Use for other joints is being studied. Studies have shown effectiveness for the shoulder, hip, and ankle. We published a study a few years ago showing these viscosupplements are effective for osteoarthritis affecting the base of the thumb.
How You Can Erase Low Back
Pain Using the Latest Medical Techniques!
By
Nathan Wei
“If you’re one of the nine out of ten adults in the United States who suffers from low back pain, I have good news for you!” states Dr. Nathan Wei, a board-certified rheumatologist and Clinical Director of the Arthritis and Osteoporosis Center of Maryland.
“Low back pain is the most expensive work-related injury as well as the third most common reason for a surgical procedure,” Dr. Wei adds.
The spine is a complex collection...
It consists of bones, called vertebrae, and the joints that allow them to
interact; discs that separate the vertebrae from each other; the spinal cord and
nerves; the soft tissues such as muscles and ligaments that help hold the spine
together. Your spine has 3 major functions including protecting the spinal cord,
supporting the body in an upright position, and allowing the body to move
freely.
The four major categories of low back pain are:
• Mechanical- arising from either trauma or repetitive motion
• Degenerative- usually from arthritic causes
• Systemic- arising from medical illnesses
• Stress-induced
Mechanical causes are responsible for more than 90% of back pain and the most common cause of back pain is probably muscle injury due to strain or sprain. Other common causes include disc herniation, spondylolisthesis (a condition where the vertebra slips on the one below it), spinal stenoiss (narrowing of the canal that carries the spinal cord), scoliosis (curvature of the spine), osteoporosis (a disease where the bones become fragile and break), and arthritis. Bone tumors are another potential cause.
“Treatment is entirely dependent on
diagnosis!”
Dr. Wei says, “There are simple ways to help your back. For instance use the log
roll technique to get into and out of bed. Think of your body as a log, and make
sure you move it as a unit... rolling into and out of bed.”...He says, “use the
same idea when getting into and out of your car. Don’t twist or stick one leg
one way and the other leg a different way. Move your body as a unit...”
Check your work area
Make sure your computer, chair, and other parts of your work environment are
“friendly” to your back. Good support for your low back as well as your legs is
important.
Exercise regularly
Dr. Wei reminds us, “...Stretching is important for your spine…Since rotation is
a key movement and the upright position is part of our daily routine, we need to
incorporate exercises that stretch and strengthen those muscles that are
important for twisting and for posture.”
Space Age Treatment
“A new addition to our low back pain tool kit is a procedure device called
intervertebral disc decompression or IDD. It helps decompress the vertebrae
non-surgically, and non-invasively. Studies to date have shown a response rate
of up to 86%,” adds Dr. Wei
Dr. Wei concludes, “Surgical procedures are a last ditch effort...and should be reserved for patients who have pain unresponsive to conservative treatment or who have a progressive neurologic problem.”
My Son Has A Stiff Back When
He Gets Up in the Morning - Is It Ankylosing Spondylitis?
By
Nathan Wei
Ankylosing Spondylitis is one of the more common forms of arthritis affecting about 0.5% of the population. It affects men more often than women in a ratio of about 2.4-5:1. The disease is categorized as a "spondyloarthropathy"... a type of arthritis that preferentially affects the spine. It usually starts in the sacroiliac joints- the joints that join the pelvis to the low back- and spreads upwards to involve the rest of the spine. Peak age of onset is between 15 and 30 years.
Typically, a patient will complain of stiffness in the low back or neck or both that is worse with rest and better with activity. Often, a young person will pursue sports as a way to relieve the pain they have! Stiffness during the day after inactivity is also common. Other joints affected include the hip, knee, wrists, shoulders, elbows, and ankles. Typically, patients will have not only joint symptoms but they will also have enthesopathy... meaning inflammation at points where tendons connect to bones. Fatigue is a very common symptom. Occasionally low grade fever, appetite loss, and weight loss may be seen.
Patients will sometimes present with the extra-articular (outside of the joint) symptoms. Examples include inflammation of the eye, lungs, and rarely, the heart. The most common extra-articular symptom is eye inflammation which occurs in about 40% of patients and must be diagnosed and treated aggressively. Blindness is a dreaded complication.
The physical exam will show limitation of range of motion in the low back. Chest expansion is also restricted since many patients with AS will have limited ability to expand their lungs due to involvement of the thoracic spine.
Occasionally, women with AS will have more symptoms in the neck than the low back.
Laboratory testing will show abnormalities that indicate the presence of inflammation. Patients with AS will also have the genetic marker HLA B27 in about 90% of cases.
Imaging studies such as magnetic resonance imaging will show the presence of inflammation in the sacroiliac joints. Inflammation of the tendon insertions at different affected joints will also be evident.
Treatment goals consist of relieving pain and stiffness as well as maintaining function.
A comprehensive program consists of a combination of anti-inflammatory medicines to help with symptoms as well as disease-modifying therapy to slow down the rate of progression. Examples of anti-inflammatory drugs are drugs such as ibuprofen (Motrin), naproxen (Naprosys), nabumetone (Relafen), etodolac (Lodine), meloxicam (Mobic), and celecoxib (Celebrex). Disease-modifying drugs that are used extensively for this condition are sulfasalazine (Azulfidine) and methotrexate. Biologic therapies like etanercept (Enbrel), adalimumab (Humnira), and infliximab (Remcade) are considered important for inducing remission. A solid program of physical therapy to help with range of motion is also mandatory.
For patients with suspected eye disease, close supervision by an experienced ophthalmologist is also recommended.
Patients with far-advanced disease may suffer complications including compression of the spinal cord (cauda equina syndrome), and fractures of the neck. In particular, care should be exercised in preparing patients with AS for surgery. Intubation (placing a breathing tube into the airways) for general anesthesia carries the risk of inadvertent spine fracture.
Surgery is reserved for far advanced cases that have not responded to medical therapy.
The clinical course and prognosis is highly variable and also highly dependent on the rapidity of diagnosis and the effectiveness of therapy.
Do You Suffer from
Osteoarthritis? Here's How to Tell!
By
Nathan Wei
The most common type of arthritis is osteoarthritis (OA). This type of arthritis is commonly referred to as wear and tear arthritis or degenerative arthritis.”
While this condition probably begins in the early teen years, it does not become symptomatic until a person reaches their 40’s.
Osteoarthritis affects cartilage, the slippery elastic tissue that covers the ends of long bones. Cartilage functions to absorb shock from movement and also to provide a gliding surface for the joints. With OA, the cartilage begins to wear away and the underlying bones begin to rub against each other. This leads to pain. As OS progresses, it causes swelling and loss of motion. Bone spurs develop and the joint starts to deform. Microscopic particles of cartilage and bone flake off and cause irritation of the joint lining leading to more inflammation which leads to pain and more damage.
Symptoms of OA include pain or stiffness in a joint particularly after getting out of bed or after sitting for a prolonged period of time. Some people have “flares” of their symptoms with weather changes. Stiffness and pain in the joints with movement may occur as may “crunchiness”.
Some people report no symptoms. One study done at the National Institutes of Health showed that one third of patients with osteoarthritis on x-ray had no symptoms.
While any joint may be affected, the most common areas of involvement are weight-bearing parts of the skeleton such as the neck, low back, hips, and knees. The great toe and the base of the thumb are also common locations. In older women the last row of finger joints and the next to last row of finger joints may be affected. Less common sites are the shoulders, elbows, ankles, and jaws.
Many factors including the way people use their joints. Occupational experiences also play a role. For instance, miners and dockworkers may develop knee OA while farmers have a higher incidence of OA of the hip. Ballet dancers can also develop OA in the feet, ankles, and hips. Athletes also fall into a high risk category with women soccer players being more likely to develop knee OA as a result of prior injury. Other athletic activities which cause joint trauma also can be a trigger for the development of OA.
Obesity is a major risk factor for OA of the hips and knees. The famous Framingham study showed that obese women had the most severe OA.
People with other types of arthritis such as rheumatoid arthritis or gout are at increased risk for developing OA also.
Probably the most significant risk factor is genetic. Patients with a strong family history of OA are at high risk themselves for developing OA. This is most likely a result of defects in cartilage metabolism which hastens wear and tear.
A Fresh Start Plan for People
With Neck Pain!
By
Nathan Wei
If you have to deal with chronic neck pain, it can be a real struggle. I know… because I’ve had to do it myself,” states Dr. Nathan Wei, a board-certified rheumatologist and Clinical Director of The Arthritis and Osteoporosis Center of Maryland.
How arthritis causes neck pain...
The neck is an interesting structure. It's made up of 7 bones stacked on top of
each other. Each is separated from each other in the front by fibrous cushions
called discs, and from each other in the back by special joints called facet
joints. “The maximum movement of the neck occurs between the 4th and 6th
cervical vertebrae...and this is where the most wear and tear in arthritis is
seen,” says Dr. Wei
Pain can come from anywhere!
Dr Wei adds, “… anything in the rear part of the brain can cause referred pain
to the neck….This includes aneurysms, infections, and tumors….
Also, neck pain can be referred from the shoulder, the upper chest, or even the heart! …Problems in the soft tissues of the neck such as growths or tumors affecting the thyroid gland, esophagus (food pipe) or trachea (wind pipe) can also lead to neck pain
Injury to the muscles and ligaments (example= whiplash auto accident) can cause neck pain. Dr. Wei declares, “This is the type of problem I have had for many years. I’ve been rear-ended a few times and I have degenerative arthritis in the neck at the C5-6 level. Patients I have talked with agree with me when I report popping or grinding in the neck with movement. Other patients say it “feels like sand back there” when they move their head…”
Pain from whiplash can radiate up the back of the head and cause headache. It may also radiate into the shoulders or between the shoulder blades.
Dr. Wei also adds, “Some types of neck pain are dangerous. When neck problems are associated with pressure on the spinal cord, this is called myelopathy and is a neurosurgical emergency!”
What are the most effective treatments?
Treatment obviously depends on making the correct diagnosis. According to Dr.
Wei, the goals of treatment are to relieve pain, improve range of motion,
prevent weakening of muscles, and restore function. Among the common treatments
are non-steroidal-anti-inflammatory medicines or NSAIDS, topical agents such as
Myorx, soft neck collars, neck support pillows, and exercises. Dr. Wei firmly
reminds us, “… evidence of instability or cord compression is a ticket to see
the neurosurgeon stat…”
22 Inside Tips on How You Can
Make Your Arthritis Medicines Work Twice as Effectively
By
Nathan Wei
This report will give you 22 important tips to make sure that you’re getting the very best out of your arthritis treatment program.
1. Make absolutely sure that the nurse or doctor knows what allergies you have. Also, make sure that they know what other medicines you’re taking and ask specifically about drug interactions and side effects.
2. Ask how the arthritis medicine should be taken. Sometimes arthritis medicines are taken best on an empty stomach and sometimes they’re taken best on a full stomach. Also ask what time of day is best to take the medication. Some arthritis medicines should be taken in the morning and some should be taken in the evening.
3. If you have other medical illnesses, let the doctor or nurse know about that. If you have a previous history of ulcers, they should be informed.
4. Ask whether there is literature such as an Arthritis Foundation pamphlet available on the kind of medicine that you’re going to be receiving. If not, ask if there are any other printed handouts. At the very least, the nurse should go over the medication with you.
5. Ask if the medicine comes as a generic. If it does not, at the very least, ask for a two-week supply of free samples.
6. If you have a common arthritic condition, ask whether any arthritis clinical trials are available in the area. This is a great way to get free medical care for your arthritis along with free medication for your arthritis.
7. Ask about other types of therapies that can be used along with the medicine. For instance, ice or heat to a painful area for 15-20 minutes two or three times a day can be quite effective.
8. Sometimes moist heat also can be effective. Ask your nurse or doctor which is better for you, ice or moist heat. If you’re going to use moist heat, make sure it is moist heat rather than dry heat.
9. Sometimes assistive devices such as braces, splints, neck support pillows, canes, etc. may help your medicine work more effectively. Ask whether that’s the case.
10. If no specific handouts or pamphlets are available from your doctor, ask whether you can have a photocopy of the pages from the Physician’s Desk Reference made available to you. This is difficult to get through because of the vocabulary used, but contains a lot of important information that you may want to know.
11. Remember to ask about how the medicine should be monitored. Most arthritis medicines need to be monitored fairly frequently because of side effects. This is especially true in people over the age of 60.
12. Sometimes, as your arthritis gets better, it’s possible to cut back on the amount of medicine you take. Ask about that.
13. Ask whether physical therapy modalities might be helpful in your case.
14. Make sure you let your nurse or doctor know whether you’re taking any natural or vitamin supplements. These sometimes can interfere with the effectiveness of your arthritis medication.
15. If you see an article in a magazine about your medication, bring it into your nurse or doctor. Sometimes these articles contain good information. However, sometimes these articles contain misleading, or even worse, wrong information.
16. Ask about generic drugs. Sometimes generic drugs, while cheaper than brand name drugs, may not be as effective. Sometimes though, they can be just as effective. You need to ask.
17. Make sure that you periodically ask your nurse or doctor whether there are any new drugs available for your condition. Sometimes the new drugs are more effective, safer, and more convenient.
18. If, after you start taking your medicine, you notice anything that could be a side effect, call your physician immediately.
19. Ask if there are any Internet web sites that provide good information about the medication that you are taking.
20. Do not share medications with friends or relatives. Remember the medication that has been given to you is specific for your problem. To share your medication with another person can be extremely dangerous. Likewise, if you borrow some of your relatives or neighbors medication, you may run into a terrible problem.
21. If you smoke or drink alcohol, ask about potential problems with your arthritis medicines.
22. Make sure you get the proper monitoring. Many arthritis medicines need careful evaluation of blood and urine on a regular basis.
Winning the War Against
Rheumatoid Arthritis
By
Nathan Wei
RA is a condition that forces half of patients to become disabled from the work force within five to ten years… and reduces life expectancy by as much as 18 years. RA affects about one per cent of the world’s adult population, most commonly women between the ages of 30 and 50.
The good news is that a tremendous amount of progress has been made within the last ten years in identifying patients earlier and treating the disease more aggressively. Patients with RA, if treated appropriately, can lead a relatively normal life. This is in stark contrast to the wheel-chair bound existence common as recently as 20 years ago!
Experts in the field consider early rheumatoid arthritis to be a medical emergency with mortality and morbidity equal to that for diabetes, asthma, heart disease, and other life-threatening conditions.
Rheumatoid arthritis attacks the joints in a symmetric fashion (both sides of the body affected equally) with the most common areas being the hands, wrists, ankles, knees, and feet. In addition to the swelling and pain, patients with RA often have profound fatigue and stiffness.
Rheumatoid arthritis is an autoimmune disease that attacks not only joints, but internal organs such as the blood vessels, lungs, heart, and eyes. Patients with RA are at increased risk for heart attack, stroke, and lymphoma.
Since many other types of arthritis such as gout, lupus, and osteoarthritis can look like RA a careful diagnostic approach is needed.
Laboratory testing has its pitfalls. The rheumatoid factor, a blood test found to be positive in about 80 per cent of individuals with RA, may also be positive in other disease conditions. Couple that with the fact that 20 per cent of patients with RA will be rheumatoid factor negative, then it becomes clear a diagnosis should not hinge on the results of blood tests alone.
Imaging procedures can also be misleading. Conventional x-rays often miss the erosions found with early disease. Newer imaging technologies such as magnetic resonance imaging (MRI) and ultrasound are much more sensitive.
After the diagnosis is made, there is even more hope for a patient today. In the past, non steroidal anti-inflammatory drugs (NSAIDS) used to be considered a cornerstone of therapy. That is no longer true.
Disease-modifying anti-rheumatic drugs (DMARDS) are being used earlier. Among the DMARDS currently being used are methotrexate, leflunomide (Arava), azathioprine (Imuran), sulfasalazine (Azulfidine), cyclosporine, and hydroxychloroquine (Plaquenil). These drugs attack the immune cells responsible for chronic inflammation. While DMARDS alone in combination are effective, they are relatively non-specific. Often, combinations of DMARDS are required.
Biologic Response Modifiers (BRMS) can target the disease more specifically than DMARDS. RA is a disease that is dependent on the signaling that occurs between immune cells. The signaling takes place through the use of special chemical messengers called cytokines. BRMS act at both the cytokine (chemical messenger) as well as the cellular level allowing the disease to be better controlled and in some instances put into remission.
Biologic response modifiers, which include drugs that suppress tumor necrosis factor (TNF), appear to be particularly effective.
Tumor necrosis factor is a protein that is produced by the immune cells. TNF is the major culprit responsible for inflammation-inducing damage. By block the effects of TNF, better control of RA can be achieved.
Three anti-TNF drugs are currently available: etanercept (Enbrel), adalimumab (Humira), and infliximab (Remicade). Another biologic drug, anakinra (Kineret) blocks interleukin, a different cytokine.
These drugs allow patients to have their disease controlled to such an extent that most are able to enjoy a normal work and leisure existence.
Second line biologic agents such as Rituxan and Orencia allow rheumatologists to treat patients who have failed anti-TNF drugs.
On the horizon are other biologic drugs that work at different points in the immune system- on different cytokines and on different pathways- to allow even greater as well as more specific control of disease. Since rheumatoid arthritis is a disease with many different cytokine and cellular mechanisms responsible for damage, attacking the disease at different points makes sense. In the future it may be possible to identify patients through specific tissue signals (called “biomarkers”). These biomarkers will allow physicians to type patients and give patients the specific therapy that will work best for them. Once that is achieved, the possibility of a cure becomes a reality.
Everything, though, starts with early accurate diagnosis. If damage is allowed to occur the chances for remission drop dramatically!
The 7 Most Dangerous Mistakes
You Can Make When You See a Doctor for Arthritis!
By
Nathan Wei
1. Seeing a doctor who’s not board-certified or a doctor who isn’t really an arthritis specialist. A lot of doctors will tell you they’re “board-eligible.” That’s nonsense! What “board-eligible” means is that they did the training for the specialty but either haven’t taken or- heaven forbid- failed the examination for board-certification. Don’t trust your health to one of those doctors. And worse yet, some specialists don’t pass on the first attempt. They keep taking the board exam over and over in the hopes they’ll finally pass. Ask the doctor how many times it took them. Would you rather see somebody who passed the first time or some idiot who took three and four times to pass?
Are they American trained? While some specialists have completed a residency or fellowship in the U.S., they’ve gotten their medical degree elsewhere. The medical schools overseas do not compare to the medical schools in the United States.
How long have they been practicing? It takes a good ten years or longer of real world experience to really be able to take good care of patients.
And are they specialists in the field of arthritis (rheumatology)? Orthopedic surgeons claim to be able to take care of arthritis. But they’re not rheumatologists. They haven’t received formal training in the medications used to treat arthritis. They don’t know about the newest developments in the field of arthritis. They don’t know about the side effects and about proper monitoring techniques for medications. They’re trained to cut and to operate. Why should they want to stop arthritis from destroying your joints? Since they are surgeons, they can always do surgery and replace your joints. Having an orthopedic surgeon take care of your arthritis is like putting the fox in charge of the chicken coop.
2. Waiting too long to be seen. Arthritis causes the most damage in the first six months. That’s a fact from the Arthritis Foundation. It you have to wait a couple of months just to see a doctor... guess what... the cat is out of the bag. Damage has already been done. You can’t afford to wait. And if you’re thinking, “Well, this doctor participates in my insurance...” Is that really a good reason to risk crippling and loss of independence? Participating in managed care is bad for your health. Insurance companies, not the doctor, dictate what kind of care you receive. Think about it…do you really think insurance company executives stay up at night worrying about your arthritis? Is that really good for you?
3. Rude staff and doctor. If you can’t get along with the staff and doctor, do you think your arthritis is going to take top priority? No way!!! Look for a practice where they treat you the way you want to be treated. Like a real human being.
4. Doctor rushes. Hey... you’re paying good money. Make sure the doctor knows what you’re there for and what is worrying you. Are your calls returned? Do they schedule timely follow-up visits? Are they interested in you as a whole person ... or are you just a number... a body part. Are they open-minded about alternative treatments? Do you feel comfortable discussing them?
5. They don’t care if you’re educated or not. You have to know about your disease and the medicines you’re being treated with. You’ve got to know about the side-effects and what type of follow-up is needed. These are your rights! And do these doctors know their P’s and Q’s? Have they done clinical research? What kind of reputation do they have in their field? Are they recognized as a leader in the field of arthritis? Do you want to see a leader or a follower?
And that goes double for proper follow through. If the doctor and his staff drop the ball, you could be in for a bad time. Not only is the disease going to cause problems but the medicines need to be monitored carefully. You’ve got to be seen on a regular basis!!! And what if the doctor is a medication freak? He or she gives you a medicine and that’s the end of it. And you go back and you get another medicine... and then another without any explanation. You deserve better.
6. Your doctor doesn’t refer. If you’re seeing a primary care doctor for your arthritis and you’re not getting any better and he’/she doesn’t refer, you’re making a big mistake. Remember... the damage is done in the first six months of disease. It’s important to be seen by a specialist as early as possible! The amount of medical information a doctor has to know has increased 20 times since 1950. Can you really expect a family doctor or internist to know about the latest developments on arthritis? Remember...arthritis causes most of its damage in the first six months. You’ve got to get the right treatment early!!!!!
7. Not getting a diagnosis. This is key. You need to know what you have and what can be done. There are always many treatment options available!
Doctor... What Do I Do Now
That They've Taken Away My Vioxx!
By
Nathan Wei
Ever since the huge tidal wave of publicity that surrounded COX-2 drugs hit the American public, patients with arthritis have had to deal with the consequences. While some deaths possibly could have been attributed to cardiovascular side-effects, there has been a huge downside. This has been the radical removal of medicines which had been the source of better quality of life for thousands of patients.
So what are the options?
Well for one, there is still one COX-2 drug available. Celebrex has been shown to be effective for pain associated with osteoarthritis and rheumatoid arthritis. The down side is that patients with a history of allergy to sulfa should not take it because of cross-reactivity. Also, despite the touted safety for patients with prior peptic ulcer disease, the benefit of COX-2 drugs has been negated when patients have had to take concomitant aspirin therapy. Nonetheless, Celebrex remains a viable option for patients who are in need of the benefits of COX-2 inhibition.
Older non-steroidal drugs also remain on the market. These include drugs like Relafen, Lodine, Mobic, Daypro, Motrin, Naprosyn, and Voltaren. Unfortunately, data has indicated that all non-steroidal drugs share an increased risk of cardiovascular events. In fact, it appears that many of the older drugs such as Clinoril, Voltaren, and Indocin probably have a higher cardiovascular risk than many of the newer medications.
A new plant-based cyclooxygenase inhibitor called Limbrel appears to be both effective as well as safe. Clinical trials in osteoarthritis are ongoing.
Interest in nutritional supplements has also offered a possible alternative. The recent NIH GAIT (Glucosamine/Chondroitin Arthritis Trial) has been called a “negative” study by some. Nonetheless, 66% of patients taking glucosamine/chondroitin benefited vs. 60% in the placebo group. While the numbers may not be statistically significant, no one can explain why the actual treatment group did better than the placebo group and why animal studies also show a benefit. (It’s hard to fake placebo effect in animals).
Non-drug therapies such as weight loss, thermal modalities (heat and cold), topical agents (rubs), and exercise play an important role in the management of arthritis.
Integrative therapies such as acupuncture, various herbal supplements, and hypnosis might benefit some people.
Newer therapies such as electrical pulsed coils might also help. This type of therapy has drawn much interest because of its non-invasive, non-drug properties.
It’s important that patients consult knowledgeable rheumatologists to assist them in their quest for safe, effective relief from arthritis pain.
The Top Seven Myths About
Arthritis
By
Nathan Wei
Myth #1: “Nothing can be done about arthritis...”
You don’t have to put up with arthritis. Now more than ever, there are excellent medicines that can not only treat the symptoms but also, in many cases, get the disease into remission. Arthritis when diagnosed and treated properly can be controlled.
Myth #2: “It’s all due to getting old...”
Arthritis affects all age groups. Arthritis can even affect children. Three out of every 5 people with arthritis are younger than 65 years!
Myth #3: “If I wait, it’ll go away...”
Six million Americans believe they have arthritis but have never seen a physician! A proper diagnosis and treatment are important! Who doesn’t want to see their children graduate or play with their grandchildren? It’s a choice many Americans make every day.
Myth #4: “Arthritis medicines have too many side-effects...”
Yes... Many of these medicines do have potential side-effects! Witness the latest flap over the COX 2 drugs. But...When properly monitored by an arthritis specialist, the chances for severe side-effects are much much lower! Let’s face it... any medicine you take has potential side-effects. What you and your physician have to determine is this: Are the potential side-effects- which by the way are relatively uncommon despite what the media would have you believe- worth my quality of life?
Myth # 5: “I’ll never get arthritis...”
Seventy million people in the United States (25% of the population) suffer from arthritis!” Also, arthritis strikes 750,000 new people a year. More than 97% of people over 50 will get arthritis. Just because you don’t have symptoms now doesn’t mean you won’t get symptoms soon.
Myth # 6: It’s just aches and pains... Nothing I can’t live with...
Arthritis is the #1 cause of loss of personal freedom. More than 100,000 Americans can’t walk independently from their bed to the bathroom because of arthritis. Ten million Americans are limited in their daily activities because of arthritis. Arthritis is the:
* leading cause of physician visits in adults over 65
* most common chronic disease
* most common cause of crippling
* most common cause of impairment and functional limitation in adults
Myth # 7: “My doctor can take care of arthritis...”
Unless your physician is a rheumatologist who remains active on the cutting edge of new research, there is no way he or she can “take care” of this condition. There has been a literal explosion of new treatments in the last three years. These treatments can make the difference between a life filled with joy and a life filled with dread.
"Foot Pain Relief At Last!"
By
Nathan Wei
“As an arthritis specialist, one area that I see people complain about more often than almost any other, is their feet.” So says Dr. Nathan Wei, Clinical Director of The Arthritis and Osteoporosis Center of Maryland. “This is too bad because there are many treatments that can be helpful,” Dr. Wei adds.
The foot is made up of 26 bones and 39 muscles...
The foot and ankle are designed to bear weight. The multiple joints in the feet are capable of adjusting to almost any terrain and the padding in the feet are designed to absorb shock.. The ankle joint allows the foot to move up and down, side to side, and inward and outward (inversion and eversion).
Not All Foot Pain Comes From The Foot!
Careful examination of the low back, hip, and knee should be performed because pain from these areas may affect the foot and ankle. In particular, pinched nerves in the low back can cause foot pain and weakness.
Ankle sprains are common- 25,000 people sprain an ankle every day! The goal of treatment is to relieve pain and prevent instability.Treatment of an acute sprain consists of rest, ice compression and elevation ("RICE”). Exercises to help stabilize and strengthen the ankle should be started.
Arthritis of the ankle may cause recurrent pain and swelling.Pain from arthritis typically is made worse by weight-bearing particularly on uneven ground. What this means is you should try to avoid excessive walking or running on uneven ground. Anti-inflammatory medication and proper foot support can do wonders.
Pain in the ball of the foot has many causes...
Other common causes of foot pain include:
Muscle strengthening exercises and orthotics are helpful. Two other common problems are:
Well fitted orthotics (arch supports) can alleviate not only foot and ankle pain but pain in the knees, hips, low back, and neck!!
We often take the ability to walk for granted. This ability involves the use of two engineering marvels- our feet and ankles. Because of the tremendous amount of force transmitted to the feet with walking, unique problems may develop. Attention to proper preventative care, i.e., comfortable shoes, sox, hygiene, support, along with proper prompt medical care can really put the brakes on foot pain.
So... Which One Do I Use for
My Arthritis, Doctor... Heat or Ice?
By
Nathan Wei
Heat has long been used to provide temporary relief of arthritis pain, and is used in many different forms. Contrast baths, whirlpools, electric pads, microwaveable gel packs, hydrocollator packs, infrared lamps, and hot showers are some of the different techniques used. Even warm tap water probably will meet some of your needs for heat therapy at home.
Heat can provide temporary relief of pain and stiffness, and can prepare you for physical activity or exercise. For example, morning stiffness is a common problem for many people with rheumatoid arthritis. Because your body has been still during the night you may need special help to get going in the morning. The following combination of techniques using heat can reduce the length and the severity of morning stiffness:
1. Sleep in a sleeping bag (which helps retain body heat) or with an electric blanket (following the manufacturer’s instructions).
2. Take your aspirin or other anti-inflammatory medication an hour before you get out of bed in the morning. (Keep a few crackers at your bedside to take with the medication to avoid stomach irritation.)
3. Take a warm shower or bath immediately after you get up.
4. Then do limbering-up exercises after your shower or bath while you still feel warm.
Safety is important in choosing the form of heat you use. You should take great care to avoid burns or electric shocks. Heat must be used with much caution on any area of the body with poor circulation or where you cannot feel heat or cold normally. It should not be used over areas where your skin is fragile or broken.
Only mild heat is necessary to get results. You are aiming for a temperature just slightly above body temperature, and you do not have to apply heat for a long time. You will get full benefit by using heat for 20 minutes each time.
Moist heat is any technique in which water is used to conduct the heat, such as a bath or shower or hydrocollator packs. People with arthritis prefer moist rather than dry heat, such as a heating pad. Moist heat penetrates more deeply than dry. You will have to try both and see which is more effective and convenient for you.
Heating pads are available which provide either moist or dry heat, but they should be chosen and used with care. Make sure the pad is approved by the Underwriter’s Laboratory. Look for those which have temperature control switches; those without temperature settings get hotter and hotter until you switch them off.
When using a pad, never lie on top of it and make sure you do not fall asleep while it is on. Severe burns can result! It may be wise to use a timer during the treatment. Check the instructions on use carefully. Regularly inspect the pad for any cracks in the plastic cover.
Hydrocollator packs are canvas bags containing silicone gel which retain heat for a long time. You can buy them in different shapes at pharmacies. Some people like them because they lose heat more slowly than most wet compresses. The pack is heated in water, wrapped in 8 to 10 layers of heavy toweling and placed over the painful joint.
The pack is heated in a large pot of water and placed on heavy towels. Place the surface with the thickest layer of toweling over the part to be treated.
Keep in mind that hydrocollator packs do have drawbacks. They are not practical if heat is needed for several joints, because each pack can be used for only one part at a time. They are also cumbersome to use and may be too heavy placed over a painful joint. If your hands are affected by your arthritis, it may be difficult for you to remove the heavy pack from the water with the tongs. So you may need help. Again, you must be very careful about burns. If you decide to try such a pack, follow the manufacturer’s instructions carefully.
Microwaveable gel packs are popular. Follow the instructions carefully or else the bag containing the gel may leak… or even worse explode and cause serious burns!
Physical therapists sometimes use melted paraffin as a means of applying heat, particularly to the hands. There are units available for home use as well. Because they involve high temperatures, paraffin baths should be used with caution. Patients with osteoarthritis or rheumatoid arthritis involving the hands often find paraffin to be helpful.
You can buy nylon and spandex gloves which can reduce morning stiffness of the hands for some people when worn at night. The gloves are available in both men’s and women’s sizes.
It is important to wear adequate, warm clothing in cold weather. Some people find that knitted, woolen or fleece pullover cuffs on painful joints, especially the knees, ankles and elbows are helpful in keeping the joints warm and more comfortable in cold weather.
Some people with arthritis find that heat does not help them. In fact, the reverse is often best-cold compresses. Cold may be especially effective when active inflammation produces severe pain and joint swelling. Only trying different modalities will enable you to find out which is best for you.
It is easy to make a cold pack by filling a small plastic bag with a few ice cubes. A bag of frozen vegetables wrapped in a towel can be used. Place any cold pack over the painful joint with a layer of terry cloth toweling in between. The same precautions that apply to the use of heat should be observed when using cold. The maximum benefit is achieved in less than 20 minutes. You may wish to repeat this application several times a day.
For many people with arthritis an effective approach is alternating warm and cold water applications, a process called contrast baths. It is most useful for a hand or foot which can be dipped in a large pot filled with water. If you decide to give it a try, use a thermometer to check temperatures.
1. Fill one container 2/3 full with 110 degree F water.
2. Fill a second container 2/3 full with 65 degree F water.
3. Put your hands or feet completely into the warm water for three minutes; then put them into the cold water for one minute.
4. Repeat step #3 two more times.
5. End the treatment with three more minutes in the warm water; then carefully dry the hands or feet.
Finally…and very importantly… with acute musculoskeletal pain, and particularly with injuries, always use ice. The formula to remember is RICE...
Rest
Ice
Compression
Elevation
My Dermatologist Told Me to
See An Arthritis Doctor... I Have Psoriasis and My Joints Hurt
By
Nathan Wei
Psoriatic arthritis is a distinct disease, different from rheumatoid arthritis and ankylosing spondylitis- another common type of arthritis- but sharing similar features to each. The disability and functional impairment in psoriatic arthritis can be as severe as that occurring from rheumatoid arthritis.
Typically, a patient will have had psoriasis for a number of years before the arthritis develops. A small proportion of patient will develop the arthritis concurrently with the skin disease and an even smaller percentage will develop the skin disease after the joint disease.
Psoriatic arthritis may affect most joints in an oligoarticular pattern, meaning a few scattered joints are affected and the joint inflammation does not have the symmetrical pattern seen in rheumatoid arthritis. Enthesitis, which is inflammation of the tendons that attach to bone, is common in psoriatic arthritis. “Sausage digits” – swelling of the fingers and toes so that they look like little sausages is frequent. Nail changes are also common. These include "pitting" and separation of the nail from the nailbed. Some patients will develop carpal tunnel syndrome because of inflammation in the wrist. Inflammation of the eyes is a serious complication, as is involvement of the aortic valve of the heart.
Joint deformity is frequent and affects 40% of patients with the disease. Psoriatic arthritis has a significant impact on quality of life. The skin disease is a tremendous burden and often leads to depression.
The inflammatory process that causes both the skin disease as well as the joint disease is driven by elevated levels of a substance called tumor necrosis factor, or TNF.
A patient with psoriasis who complains of joint pain, swelling, morning stiffness, and fatigue should raise a high level of suspicion for the diagnosis of psoriatic arthritis.
Laboratory testing will show evidence of inflammation and imaging procedures such as magnetic resonance imaging (MRI) can help confirm the diagnosis.
Treatments that improve the skin disease do not necessarily improve joint symptoms and vice versa.
Treatment goals include symptomatic relief and control of disease progression.
Non-steroidal anti-inflammatory drugs are helpful