A B C D E F G H I J K L M N O P Q R S T U V W X Y Z
|Amitryptiline in chronic pain|
Question : I have been started on 25mg of amitryptiline at night on top of my
normal drug routine.
Answer from drdoc : I find amitryptiline extremely useful for
chronic pain from a variety of causes, especially soft tissue rheumatism.
|Anti-inflammatory drugs (NSAIDs)|
Question : What exactly is the arthritis medicine called an anti-inflammatory / NSAID's ?
Answer from drdoc : NSAIDs
are non steroidal anti-inflammatory drugs.
|Arthritis general :|
Question : My mother has arthritis and she is over 50. I was wondering, since I heard from various people there is, whether or not a cure for this condition has been found yet. I am curious about this because if there is one, then many people have then the opportunity to be relieved!!
Answer : There is always
something that can be done for arthritis. However, you have to realize
that there are many
types of arthritis, and the therapy depends on the type. Arthritis is not a diagnosis in
itself. If there isn't a cure for that type, then there is at least a control available. If
you can, get her to see a rheumatologist.
|Arthritis general :|
|Question : I have constant pain in a few of my knuckles, as if they are bruised. I cannot squeeze things tightly without pain. I am 61 years old. Could this be arthritis of sorts? What are common symptoms? Thank you.|
|The answer is yes - it
certainly is possible. In most cases at that age, the problem is related to
osteoarthritis, which is not an aggressive arthritis, and may be easily treated in the
majority of patients with mild analgesics. However sometimes we find more serious
inflammatory arthritis conditions. These may warrant a greater aggression of therapy. The
key questions to identify that group is... a) Do you have swelling of the joints and b) Do
you get symptoms of prolonged stiffness. If a or b are positive, I would seek a specialist
|Arthritis general :|
|Question : I get a lot of pain in my right wrist and fingers. I am only 19 years old. Is this normal?|
|Answer : The
of arthritis is not only an "old age problem"
Indeed some of the more serious types are seen in young people.
See : http://www.arthritis.co.za/myth.htm
Things that make us concerned include in particular : Swelling, stiffness, morning stiffness.
If you are concerned - discuss your fears with your doc.
|Chronic pain - especially Chronic Back Pain.|
Question : I am only 35 and I am in the most excruciating low back pain, with all my tests and scans showing that there is "nothing wrong". I've been to every possible specialist and tried every painkiller and alternative therapy. I've considered suicide. Where do I go from here?
Answer from drdoc : Chronic pain is a vicious cycle, and VERY difficult to treat.
In your case you
sound like you have soft tissue rheumatism with facet joint syndrome and have got into the pain cycle, which most
been unable to break. You have to go back to the reasons it got worse in the first
place. For some reason - you are allowing it to control your life,
instead of controlling it. This usually is a subconscious psychological issue. Usually it
starts as a work related stress, or less likely a domestic stress.
|The CRP : C- Reactive protein|
|Question : What is the CRP ?
Answer from drdoc : The C-reactive protein, CRP is an inflammatory marker that we as Rheumatologists are using more frequently as a measure of inflammation. It is used as a guide to estimate the activity of inflammatory disease, and compliments the clinical assessment. It is a protein made in the liver, and is detectable using a biochemical assay. It is a simple and cheap blood test. However, it is NOT specific and will be elevated with many causes of inflammation - including infection. Interestingly, it is not elevated in active lupus, and is useful in assessing presence of infection there.
Question : I have a bone spur and arthritis in the big toe joint (where bunions occur). It's like walking on a boil. Has anyone had this and found any help for this condition?
Answer from drdoc : There are many causes of arthritis in that joint (The first metatarsal joint -
|Gout versus Psoriatic Arthritis|
|Question : I have
been told that I have gout but , I also have psoriasis. How can I tell if it is truly gout
or psoriatic arthritis?
Answer from drdoc : from the pattern of the disease. Gout is usually sudden onset and lasts a few days. Usually it affects few joints usually foot / toe. But obviously the longer it is allowed to go untreated - over time, becomes multiple joints, and may even be persistent. Psoriatic arthritis often comes on slower and lasts longer. To make it more complex - it is not unusual for them to coexist, (as opposed to RA where coexistence is very unusual) To absolutely prove gout if a difficult case - requires aspiration of the fluid in the swollen joint, which may show crystals of uric acid. This stresses again the need for a good history and clinical examination.
|Gout with Swellings around the joints|
Question : I have been diagnosed with gout. Now I notice increasing, visible changes to some finger joints, with stiffness and there are visible, hard "gatherings" mostly at the sides of the joints. I am being treated with anti-inflammatory drugs. What are the swellings and are they common in gout?
Answer from drdoc :
Those hard "gatherings ", sound like tophi - deposition of the gouty uric acid
crystals, around the joints. They are definitely compatible with the disease, and are
common - especially if the disease is allowed to progress, without proper treatment. They
are an absolute indication for "second line therapy", such as allopurinol, or
benzbromarone, as they cause bone erosion and damage. The anti-inflammatories do not treat
the underlying problem, of the increasing uric acid load in your body.
|Gout with heart failure on warfarin / coumadin|
Question : My Father (58) has had gout for many years. He has severe heart disease and is taking coumadin, amioderone, digoxin, lasix, and accupril . He has been going through one episode after the other of gout that he can't seem to get under control because of his heart medicine. Please is there medicines out there that will not interact with his heart medications?
Answer from drdoc :
Probably the best
way out is for him to see a rheumatologist. I would
suggest that he be controlled initially with low dose cortisone. In
his position, the use of an anti-inflammatory is contraindicated. He could
potentially use a COXIB such as Celebrex, but this is more difficult to sort him
out than the cortisone can. The cortisone should be -prednisone 10mg per day for
a week then 7.5 mg per day for a week , then 5 mg per day for a week then 2.5 mg
for a week. You will find that the gout attack itself will settle within about
the first 5 days. When the gout is completely quiescent, his doc should add
allopurinol 300mg per day. The cortisone will overlap for the following 2 -3
weeks. It is critical that the acute gout be GONE before starting the
allopurinol. He must take the allopurinol EVERY day for the rest of his life.
|Question : Dear doctor, I have the start of arthritis in both my knees. will it help if i start taking 500mg of glucosamine sulfate each day? Would appreciate your advice.|
Answer : Glucosamine is recommended in the book "The Arthritis Cure " by Jason Theodosakis. In fact it's use is not based on strong information. It is currently riding a wave of hype and probably unjustified enthusiasm. Nevertheless, it has some theoretical potential benefits. I have used it in Osteoarthritis, for the last 1 year, and have found only 1 in 4 benefit. This isn't miraculous, but it would do no harm to try it over 3 months and evaluate benefit. I suggest that 500mg is too little for an average adult. You are likely to require a gram. I suggest you see the alternative pages on my website, where further info on the glucosamine is available.
Question : How do I know if I have inflammation ?
Answer from drdoc : The
answer to that is generally, if you have:
|Methotrexate Ulcers ?|
Question : I get frequent ulcers when taking methotrexate - Is there anything I can do ?
Reply from drdoc : We
use the folic acid as a form of therapy to reduce side effects of the methotrexate. Mouth
ulcers are a problem with the methotrexate. They can be caused as a dose related effect,
or as a complication of low white cell count. The latter is called leukopenia, and is a
serious complication. It requires immediate cessation of the methotrexate, and IT IS IN
THIS SITUATION, that we use leucovorin - folinic acid as SALVAGE therapy to try reverse
the leukopenia. If the marrow is so suppressed , that there is severe white cell
reduction, and poor
response to leucovorin, we can use a cytokine called
granulocyte/macrophage colony stimulating factor (GM-CSF).
|Rheumatic fever versus Rheumatoid Arthritis|
Question : Is there a relationship between Rheumatic fever and Rheumatoid Arthritis ?
Reply from drdoc : They are different diseases altogether, they are both autoimmune diseases
where the body turns against self as a cross reaction to an environmental agent. In the
case of rheumatic fever, the agent is streptococcus , in Rheumatoid arthritis - it is not
|Rheumatoid factor :|
|Question - I am trying to understand the significance of a positive rheumatoid factor. As I understand it, the results of a positive test, with high titer of 314, can be used as a diagnostic indicator not as indicator of disease activity. Or possibly also a prognostic indicator. So would this mean your positive titer should always remain the same? And if not, how do you interpret subsequent titers?|
Reply: Greetings from drdoc on-line
The rheumatoid factor is only one aspect of the diagnosis, as clinical findings are the most important. Indeed, low positive titers may be seen in other situations or diseases.
The rheumatoid factors are ANTIBODIES TO a part (Fc PORTION) of HUMAN Immunoglobulin (IgG) . They are detected by AGGLUTINATION TESTS.
There are 2 main types :
SCAT : the Sheep cell agglutination test - MORE SPECIFIC
LATEX : Where latex particles are used in the detection process - MORE SENSITIVE
Of note is that 1-5% of NORMAL people in the population are positive (NB this increases with AGE ) Only 75-85 % of RA patients are positive. Therefore they are not absolutely necessary for the diagnosis. But a high Rheumatoid factor is a marker of more severe disease.
Positive Rheumatoid Factor is sometimes seen :
1. In several Rheumatic and autoimmune diseases including:
Chronic Active hepatitis
INTERSTITIAL PULMONARY FIBROSIS
2. As well as several general medical disorders - including :
SCHISTOSOMIASIS - BILHARZIA
The levels of the case quoted are significant and "significantly high". They however do fluctuate with time. However a CRP or ESR are a better test for activity of disease. I do not do serial titers of Rheumatoid factor, as they don't really help clinically once shown to be positive.
|Seronegative spondyloarthropathy versus seronegative RA|
|Question :What do these mean|
|Answer : Seronegative
spondyloarthropathy - refers to patients with a negative rheumatoid factor
that have certain clinical characteristics of an arthritis peripherally,
especially the lower limbs - knees and ankles and feet, but who also can
have spinal involvement and Sacroiliitis. Seronegative RA is different as
these patients have features clinically of Rheumatoid arthritis but are
negative for rheumatoid factor. Sometimes
as time goes patients evolve into different groups. For
both however you should get disease modifying drugs i.e. sulphasalazine,
or minocycline or even methotrexate, that can treat the underlying
disease. NSAIDs and
COXIBs don't treat the underlying disease
Question : How do I taper my cortisone dose in Rheumatoid arthritis ?
Reply from drdoc : I don't believe that one should lower the dose in an uncompromising regimented
fashion in these rheumatic diseases. Each person and their disease is different... I
don't get into the situation of mega doses for my patients unless they have systemic organ
disease involvement i.e. cardiac/pulmonary/vasculitis etc...
If at any stage the patient flares ---I go back to
the previous level and retry from that level in a structured but individualized manner.