Articles on rheumatoid pain

Rheumatoid Arthritis

Dr. N. C. Gupta, Orthopedist
Rheumatoid arthritis is an autoimmune disorder affecting the joints, symmetrically(usually). The joints become swollen, red, hot, painful & tender. The joint movement becomes limited due to pain & swelling It starts with inflammation of the synovial membrane but may involve the joint capsule and other surrounding soft tissues.It is a self limiting disease. But by the time it leaves, the patient is crippled due to contractures & deformities.Acute phase can be managed with medicines.                                     Commonly used medicines are Ibuprofen/Paracetamol/Aspirin in therapeutic doses. They help to control symptoms of pain and swelling of the joints in most of the cases by their anti inflammatory properties. Fever is also controlled.  Vitamins, minerals, anti oxidants & other supportive medicines are also needed. Omega 3 fatty acids have a very definite role to play in improving the response to the treatment.Physiotherapy helps in preventing contractures & deformities. The patient should do general exercises & keep active.He may have to be further investigatedIn established cases of Rheumatoid arthritis DMARD (disease modifying drugs) e.g. METHOTREXATE, HCQ, LEFLUNOMIDE, SAAZ etc. have to be used.They all are toxic drugs & can cause bone marrow depression along with other side-effects. They should be taken under medical supervision.Sometimes steroids may have to used.The dose of these medicines should be adjusted to the minimum required, to control the symptoms. Blood, urine Tests & other investigative procedures should be done periodically to rule out any side-effects. X rays of the affected part should be done to confirm diagnosis & assess the extent of damage.Diabetes, vitamin D deficiency or any other metabolic disorder should be ruled out. Sometimes they mimic the symptoms & create confusion in diagnosis. Associated disorders like these, most certainly affect recovery adversely.It should be ascertained that the patient is not allergic to any of the medicines that he is going to take.Rheumatoid arthritis is a chronic disorder that lasts over many years with acute exacerbation & remissions. The earning capacity of the family is adversely affected. The cost of medical treatment is high. If the patient needs surgery, it is further escalated. Most of the population in India is not covered by any medical insurance. All these factors put together create an atmosphere of depression in the family. Patient feels morally degraded &may even develop suicidal tendency.In a situation like this it becomes essential that a moral support is provided to the patient by his friends & relations. Treating doctor has avery definite role to play in keeping up the moral of patient.

Low Back Pain: What All You Must Know

Dr. (Maj) Pankaj N Surange, Spine and Pain Specialist
Back pain is a problem which is very often faced by all the human beings at least once in their lifetime. This pain, if not taken seriously can turn into a deadly disease which can put your life at stake.Some important facts about back painLow back pain is the most common musculoskeletal complaint, with potentially devastating consequences.90% of patients with acute low back pain do not require surgery. Most specialists agree that non-surgical treatment should be tried first. Surgery as first line treatment is indicated only in few selected cases. These are medical emergencies such as a broken neck or if you have symptoms such as weakness in the legs that gets progressively worse and/or bladder and/or bowel incontinence caused by the back problem.The incidence of back pain is highest between the ages of 35 and 55.Disc is not always the culprit. Small joints of spine are the source of pain in majority of patients.The pain combined with depression and anxiety in long-term cases places sufferers at risk for suicide.People who work at sedentary occupations are at a higher risk of disk injury than those who do moderate amounts of physical work.Up to 85 per cent of persons with back pain can’t recall a specific incident that brought on their pain.Early interventional treatments in back pain management have been found to return patients to work and regular activities more rapidly than past conservative therapies.Early intervention decreases unnecessary chronic pain, long-term treatments and disabilities.Heat and massage therapy cannot cure the disease. These do not provide long term solutions to the problems of back. These are mainly used for managing pain during the recovery period.Newer Developments and Better Understanding in Management of Back painA wide range of treatment is available for low back pain, depending on what is causing the pain and how long it lasts.Most people find that their low back pain improves within a few weeks. Chances are good that your pain will go away soon with some basic self-care.If you have recently developed low back pain, stay active and consider taking over-the-counter pain medicines .Staying active is better for you than bed rest. In fact, staying in bed more than 1 or 2 days can actually make your pain worse and lead to other problems such as stiff joints and muscle weakness.If your low back pain has lasted longer than 3 months, you will probably benefit from more intensive treatment.Must visit Interventional pain and spine specialist :-If you have moderate to severe low back pain that lasts more than a couple of Days;If you have back or leg symptoms that have gotten worse; If your symptoms have not gone away after 2 weeks of home treatment; Or, if improved symptoms flare up again.A physical examination by pain specialist and possibly an imaging (x-ray/MRI) test may produce new information about your condition and help direct your treatment decisions.Physical Therapy: TENS, UltrasoundHeat and Cryotherapy:These Modalities should always be considered an adjunct to an active treatment program in the management of acute low back pain. They should never be used as the sole method of treatment.Interventions: Minimally invasive non surgical procedures for management of Back PainFor back pain sufferers, interventional pain management techniques can be particularly useful. In addition to a thorough medical history and physical examination, interventional pain management physicians have a wide array of treatments that can be used including the following: Epidural injections (in all areas of the spine):The use of anesthetic and anti-inflammatory medications injected into the epidural space to relieve pain or diagnose a specific condition.Nerve, root, and median branch blocks:Injections done to determine if a specific spinal nerve root is the source of pain. Blocks also can be used to reduce inflammation and pain. Facet joint injections: An injection used to determine if the facet joints are the source of pain. These injections can also provide pain relief. Discography:An "inside" look into the discs to determine if they are the source of a patient's pain. This procedure involves the use of a dye that is injected into a disc and then examined using x-ray or CT Scan.Pulsed Radiofrequency otomy (PRFN): A minimally invasive procedure that disables spinal nerves and prevents them from transmitting pain signals to the brain. Rhizotomy:A procedure in which pain signals are "turned off" through the use of heated electrodes that are applied to specific nerves that carry pain signals to the brain. Spinal cord stimulation:The use of electrical impulses that are used to block pain from being perceived in the brain. Intrathecal pumps: A surgically implanted pump that delivers pain medications to the precise location in the spine where the pain is located. Percutaneous Discectomy / Nucleoplasty:A minimally invasive day care procedure in which tissue is removed from the disc with the help of decompressor through a very minute hole ,in order to decompress and relieve pressure on the spinal nerves. Ozoneucleolysis or Ozone discectomy: Has emerged as an affordable, least invasive approach and costs 2/3rd of the price of conventional surgery. Ozone injected inside the affected intervertebral disc under c- arm guidance, causes shrinkage of disc and thus, reducing the volume and lessening the pressure on nerves.Intradiscal Electrothermoplasty (IDET) This procedure involves the insertion of a needle into the affected disc with the guidance of an x-ray machine. A wire is then threaded down through the needle and into the disc until it lies along the inner wall of the annulus. The wire is then heated which destroys the small nerve fibers that have grown into the cracks and have invaded the degenerating disc. These techniques are exciting. They offer the possibility of treating low back pain and sciatica with much less trauma and risk than surgery.Quick tips to a healthier backFollowing any period of prolonged inactivity, begin a program of regular low-impact exercises. Speed walking, swimming, or stationary bike riding 30 minutes a day can increase muscle strength and flexibility.Yoga can also help stretch and strengthen muscles and improve postureAlways stretch before exercise or other strenuous physical activity. Don’t slouch when standing or sitting. When standing, keep your weight balanced on your feet. Your back supports weight most easily when curvature is reduced. At home or work, make sure your work surface is at a comfortable height for you. Sit in a chair with good lumbar support and proper position and height for the task.Keep your shoulders back. Switch sitting positions often and periodically walk around the office or gently stretch muscles to relieve tension. A pillow or rolled-up towel placed behind the small of your back can provide some lumbar support. If you must sit for a long period of time, rest your feet on a low stool or a stack of books. Wear comfortable, low-heeled shoes. Sleep on your side to reduce any curve in your spine. Always sleep on a firm surface.Ask for help when transferring an ill or injured family member from a reclining to a sitting position or when moving the patient from a chair to a bed. Don’t try to lift objects too heavy for you. Lift with your knees, pull in your stomach muscles, and keep your head down and in line with your straight back. Keep the object close to your body. Do not twist when lifting. Maintain proper nutrition and diet to reduce and prevent excessive weight, especially weight around the waistline that taxes lower back muscles. If you smoke, quit. Smoking reduces blood flow to the lower spine and causes the spinal discs to degenerate.

Myths and Facts About Low Back Pain

Dr. (Maj) Pankaj N Surange, Spine and Pain Specialist
· Low back pain is the most common musculoskeletal complaint, with potentially devastating consequences.· 90%of patients with acute low back pain do not require surgery. Most specialists agree that non-surgical treatment should be tried first.· Surgery as first line treatment is indicated only in few selected cases. These are medical emergencies such as a broken neck or if you have symptoms such as weakness in the legs that gets progressively worse and/or bladder and/or bowel incontinence caused by the back problem.· The incidence of back pain is highest between the ages of 35 and 55.· Disc is not always the culprit. Small joints of spine are the source of pain in majority of patients.· The pain combined with depression and anxiety in long-term cases places sufferers at risk for suicide.· People who work at sedentary occupations are at a higher risk of disk injury than those who do moderate amounts of physical work.· Up to 85 per cent of persons with back pain can’t recall a specific incident that brought on their pain.· Early interventional treatments in Back pain management have been found to return patients to work and regular activities more rapidly than past conservative therapies.· Early intervention decreases unnecessary chronic pain, long-term treatments and disabilities.· Heat and massage therapy cannot cure the disease. These do not provide long term solutions to the problems of back. These are mainly used for managing pain during the recovery period.NewerDevelopments and Better Understanding in Management of Back painA wide range of treatment is available for low back pain, depending on what is causing the pain and how long it lasts. Most people find that their low back pain improves within a few weeks. Chances are good that your pain will go away soon with some basic self-care.· If you have recently developed low back pain, stay active and consider taking over-the-counter pain medicines .· Staying active is better for you than bed rest. In fact, staying in bed more than 1 or 2 days can actually make your pain worse and lead to other problems such as stiff joints and muscle weakness.· If your low back pain has lasted longer than 3 months, you will probably benefit from more intensive treatment.· Must visit Interventional pain and spine specialist :-· if you have moderate to severe low back pain that lasts more than a couple of days;· if you have back or leg symptoms that have gotten worse;· if your symptoms have not gone away after 2 weeks of home treatment;· or if improved symptoms flare up again.·  A physical examination by pain specialist and possibly an imaging(x-ray/MRI) test may produce new information about your condition and help direct your treatment decisions.· Physical Therapy: TENS, Ultrasound, Heat and Cryotherapy:o These modalities should always be considered an adjunct to an active treatment program in the management of acute low back pain.o They should never be used as the sole method of treatment.Interventions: Minimally invasive non surgical procedures for management of Back PainFor back pain sufferers, interventional pain management techniques can be particularly useful. In addition to a thorough medical history and physical examination, interventional pain management physicians have a wide array of treatments that can be used including the following: Epidural injections (in all areas of the spine):The use of anesthetic and anti-inflammatory medications injected into the epidural space to relieve pain or diagnose a specific condition. Nerve, root, and median branch blocks:Injections done to determine if a specific spinal nerve root is the source of pain. Blocks also can be used to reduce inflammation and pain.Facet joint injections:An injection used to determine if the facet joints are the source of pain.These injections can also provide pain relief. Discography:An "inside" look into the discs to determine if they are the source of a patient's pain. This procedure involves the use of a dye that is injected into a disc and then examined using x-ray or CT Scan.Pulsed Radio frequency Neurotomy (PRFN): A minimally invasive procedure that disables spinal nerves and prevents them from transmitting pain signals to the brain. Rhizotomy:A procedure in which pain signals are "turned off" through the use of heated electrodes that are applied to specific nerves that carry pain signals to the brain. Spinal cord stimulation:The use of electrical impulses that are used to block pain from being perceived in the brain. Intrathecal pumps: A surgically implanted pump that delivers pain medications to the precise location in the spine where the pain is located. Percutaneous Discectomy / Nucleoplasty:A minimally invasive day care procedure in which tissue is removed from the disc with the help of decompressor through a very minute hole ,in order to decompress and relieve pressure on the spinal nerves. Ozoneucleolysis or Ozone discectomy: Has emerged as an affordable, least invasive approach and costs 2/3 of the price of conventional surgery. Ozone injected inside the affected intervertebral disc under c- arm guidance, causes shrinkage of disc and thus reducing the volume and lessening the pressure on nerves.These techniques are exciting. They offer the possibility of treating low back pain and sciatica with much less trauma and risk than surgery.Following any period of prolonged inactivity, begin a program of regular low-impact exercises:· Speed walking, swimming, or stationary bike riding 30 minutes a day can increase muscle strength and flexibility.· Yoga can also help stretch and strengthen muscles and improve posture· Always stretch before exercise or other strenuous physical activity.· Don’t slouch when standing or sitting.When standing, keep your weight balanced on your feet. Your back supports weight most easily when curvature is reduced.· At home or work, make sure your work surface is at a comfortable height for you.· Sit in a chair with good lumbar support and proper position and height for the task. Keep your shoulders back. Switch sitting positions often and periodically walk around the office or gently stretch muscles to relieve tension. A pillow or rolled-up towel placed behind the small of your back can provide some lumbar support. If you must sit for along period of time, rest your feet on a low stool or a stack of books.· Wear comfortable, low-heeled shoes.· Sleep on your side to reduce any curve in your spine. Always sleep on a firm surface.· Ask for help when transferring an ill or injured family member from a reclining to a sitting position or when moving the patient from a chair to a bed.· Don’t try to lift objects too heavy for you. Lift with your knees, pull in your stomach muscles, and keep your head down and in line with your straight back. Keep the object close to your body.Do not twist when lifting.· Maintain proper nutrition and diet to reduce and prevent excessive weight, especially weight around the waistline that taxes lower back muscles.· If you smoke, quit. Smoking reduces blood flow to the lower spine and causes the spinal discs to degenerate.

Losing Weight With Rheumatoid Arthritis

Ms. Swati Kapoor, Dietitian/Nutritionist
Rheumatoid arthritis is a chronic inflammatory disorder that may affect many tissues and organs but primarily affects the small joints of hands & feet. It affects the lining of joints, causing a painful swelling that can eventually cause poor bone density and joint deformity. It can lead to substantial loss of functioning and mobility if appropriate medical treatment is not given on time.It is an autoimmune disorder which means that the body’s immune system works against own tissues and organs and mistakenly starts attacking them.Rheumatoid arthritis is more common in women between the ages of 40 and 60.Rheumatoid arthritis symptoms may vary in the degree of pain and swelling. The symptoms may also disappear at times and come back. Weight loss is also a general symptom of rheumatoid arthritis in many cases. Increased catabolism (muscle breakdown) with loss of appetite can lead to malnourishment. However weight gain is a problem with many living with rheumatoid arthritis. Carrying around extra weight can put more stress on painful joints. Excess fat stored in fat cells secrete certain hormones that can promote bone damage. So, it’s very important to lose any extra weight and maintain weight in a healthy range. With painful joints it might not be possible to maintain a regular normal exercise routine. Moreover, some medications in rheumatoid arthritis can increase appetite and can add on to pounds.Following guidelines can be helpful in maintaining a healthy weight with rheumatoid arthritis:Eat A Balanced DietChoose low calorie, healthy meal options. Minimize sugar and fat intake in the diet. Opt for seasonal vegetables, fruits, whole grains, lentils, low fat dairy products. Avoid packaged and processed foods. Take advise from a qualified nutritionist who can help you design a well-balanced healthy diet schedule which can also help in losing extra weight.ExerciseIt’s a very common myth that exercises can harm those with rheumatoid arthritis. In fact, doing joint friendly exercises and water based activities can increase muscle strength and bone structure. Strengthening exercises with low impact cardio like walking, swimming are preferable options.Avoid AlcoholAccording to some studies, drinking in moderation on occasions can help in easing joint pain in rheumatoid arthritis. However, drinking alcohol on regular basis can hinder with absorption of vital nutrients. This can also add on to the pounds as alcohol is primarily sugar and can make weight loss difficult.Maintain A Food DiaryTracking your weight loss progress by writing your daily intake can help you stay disciplined and motivated. Plan ahead your weekly meals and record it on daily basis to reduce chances of deviations and to be on the right track.Re-assess Your MedicationFew medications in rheumatoid arthritis can have side-effects like water retention and increase in appetite contributing to weight gain. If you note these changes take guidance from your doctor and ask for alternatives for such medications.Try the above tips to manage your eating and activity in a better way with rheumatoid arthritis.

Know About Joint Pain

Dr. G.K. Kumar, Neurologist
Pain in the joints affects millions of people worldwide. There are many different types of joint pain—pain related to osteoarthritis, pain after traumatic injury, pain after joint surgery, pain related to inflammatory joint disorders such as rheumatoid arthritis and psoriatic arthritis, and pain related to crystal deposition in the joints such as gout or chrondrocalcinosis. Depending on the individual, pain might be felt in the joint or in the muscles around the joint. The pain may be diffuse and constant, or it may occur at rest or while moving, depending on the cause. Despite the wide range of conditions and symptoms, different types of joint pain might share similar underlying mechanisms, manifestations, and potential treatments. Why Pain in the Joints? The following issues may contribute joint painTreatment for joint pain is often inadequate. Joint pain is associated with loss of function, and treatment should focus not only on pain but also on activity and function. Medications are sometimes unsafe, and rehabilitation and physical therapy are essential. Chronic joint pain can be manageable, but patients might continue to suffer.A person's joint pain often bears little relationship to what the joint looks like on x-rays or scans, and this makes joint pain especially challenging to understand. Even when the source of the joint pain is identifiable, this might not fully explain the severity of the pain.  In addition to the suffering and discomfort associated with joint pain, the problem can exact substantial financial and other costs. These include high medical expenses, lost work days, and diminished quality and productivity in people's work and personal lives. Aging populations, sedentary lifestyles, and an increasing propensity toward obesity all mean that the problem of joint pain is likely to continue unabated worldwide. What Is Pain? Pain is a protective mechanism that alerts the brain when damage has occurred. But pain isn't just a sensation, it is a personal experience. It has emotional effects too, making us feel upset or distressed. Pain may continue when the damage seems to have gone. This is a feature of some chronic pain syndromes. Pain may be caused by a physical injury or damage to body tissues, chemicals produced by inflammation, or damage to the nerves or nerve endings. The most common causes of chronic pain in joints are osteoarthritis, rheumatoid arthritis, spondyloarthritis and psoriatic arthritis, systemic diseases, and crystal deposition disease, also known as chondrocalcinosis or pseudogout. Pain severity can be affected by a number of factors. For example: the extent to which one concentrates on the pain; the ability to enjoy various activities that can take one's mind off the pain and make it more manageable; unhappy feelings, anxieties, or depression, which can worsen pain; and prescription drugs, which can have a direct effect on the brain, chemically reducing the impact of pain. How Is Joint Pain Treated? A number of approaches are available to help manage pain, including various drug therapies, physiotherapy, and exercise.Painkilling drugs, ranging from paracetamol to codeine and, only in few cases, up to stronger options such as oxycodone, slow-release morphine, or patches containing fentanyl or buprenorphine.Non-steroidal anti-inflammatory drugs (NSAIDs) and coxibs, which are painkillers and have anti-inflammatory effects.Corticosteroids, often called steroids for short, given mostly by injection Drugs for nerve pain and chronic pain syndromes.Tricyclic antidepressants (for example, amitriptyline or dosulepin), which improve sleep and help the brain control sensations from the upper body and limbs Gabapentin, carbamazepine, and pregabalin help control some types of pain, especially when there is nerve damage.Transcutaneous Electrical Nerve Stimulation (TENS) can help ease pain, though evidence on its effectiveness is mixed (A TENS machine is a small electronic device that sends pulses to nerve endings via pads placed on the skin. TENS produces a tingling sensation and is thought to alter pain messages sent to the brain.) Other pain-relief treatments and therapies include a heating pad or hot-water bottle and technologies such as ultrasound, laser, or interferential treatment In all cases, individually tailored exercise programs are essential and contribute to regained strength and function In some cases, surgery can be effective, but individuals should always discuss this option with doctors in light of the intensity of their pain and the extent of their disability.Interventional Procedures Interventional procedures are non surgical method of pain relief. This may be useful for some of the patients with joint pain especially knee, hip& shoulder. Medications are injected accurately into & around the joint with the help of x Ray guided or ultra sound. The pain producing nerves are managed by radio frequency ablation method. Some time the swollen joints are decompressed with X-ray or ultra sound guided aspiration of joint fluids. In some conditions there may not be adequate lubricant in the joint, in such conditions synthetic synovial fluids are accurately injected into the joint with the help of X-ray or ultra sound.This particular method is called synovial fluid replacement,especially useful for knee joint pain.Multimodal Approach  All joint pains are evaluated after careful clinical examination along with biochemical ( blood investigation) , and radiological ( X-ray,CT , MRI,Bone Scan) investigations. Then treatment is planed accordingly. Multiple methods like drugs, nutritional supplements, intervention procedures,physical exercise & rehabilitation methods, life style modifications like weight reduction & posture correction, surgery are available & chosen according to the clinical condition of the patient.Multimodal approach is choosing more than one method to handle the pain effectively.Unfortunately, for some people pain is long lasting, doesn't respond fully to drugs or physical treatments, and cannot be cured by surgery. In such cases, multimodal method will be useful and also it is worth thinking about lifestyle changes, such as learning to rest sensibly (but not giving up all exercise), avoiding certain activities, asking for help, or using gadgets and home adaptations. A doctor, physical therapist, social worker, or occupational therapist can offer expert help and advice with these changes. For a small minority of people, pain can be severe and disabling. This can result in a vicious cycle of pain,anxiety, depression, and deteriorating physical fitness. People affected in this way should be referred to a pain-management clinic to learn new ways to cope with pain. 

Pain Management: Why Is It Important

Dr. G P Dureja, Spine and Pain Specialist
Most of the people suffer from different kinds of pain because of various reasons. Most of the people also tend to ignore it and move on. It is not advisable to ignore pain because you don’t know if that is casual or something serious to pay attention to. Avoiding pain will only make it worse, so it is essential to manage and treat pain. What is pain management? As the name suggests, managing your pain in a way that either it is treated or relieved, is pain management. It is also a branch in medicine called Pain Medicine, which involves in-depth procedures and techniques to ease out the pain. What are the types of pain?Majorly pain can be classified into two types, acute and chronic. Any pain that is short lived or short lasting comes under acute pain while, any pain that is long lasting or forever, comes under chronic pain. Chronic pain generally is the pain that lasts for 3 or more months. Based on, where, in the body, the pain is present, there are further three types. Somatic This type of pain is more like an exterior pain. Caused generally by the activation of receptors on the body surface or musculoskeletal tissues, it can be treated with proper rest and medication. Surgical pain comes under this type. Visceral Internal pain caused due to damage to the organs or tissues is known as visceral pain. This is not localized to just one body part. It might pain in different organs or body parts. Neuropathic Pain related to the spinal cord or peripheral nerves is called neuropathic pain. It generally occurs at the level or below the level of injury. How can you manage pain?Managing acute pain is easier than chronic. You can involve in a healthy lifestyle and physiotherapy but for advanced management and care, there are pain hospitals that manage pain well. These healthcare facilities are established especially to diagnose and manage chronic pain. What are the kinds of pain that can be treated?Various kinds of chronic pain can be treated in pain hospitals such as cancer pain, back pain, knee pain, neck pain, arthritis, fibromyalgia, migraine, etc. What are the treatments available? There are various treatment procedures that are involved in treating pain. These can be simple and complex both. It truly depends on upon the kind of pain you are suffering from. Some pain needs just lifestyle modification and counseling to be treated while the others require more complex treatments. Treatments like X-Ray guided injections, intrathecal pump implants, radiation therapy, Botox therapy and Platelet rich plasma therapy are some from a several more. These treatments can be very effective when performed by experts.

Living Well With Rheumatoid Arthritis

Dr. Dheeraj Kondagari, Rheumatologist
If you were recently diagnosed with arthritis or one of the other rheumatic diseases, you are not alone. An estimated one crore people in India of all ages and genders have arthritis or other rheumatic conditions. Many rheumatic diseases are chronic conditions. They are unlikely to go away. There may not be a cure for your condition, but effective management is available for most. Many people with rheumatic disease lead happy, satisfying lives year after year. You may be feeling anxious, even a little overwhelmed. This is a natural response to an unexpected turn in the road.How do you handle your very real concerns? By knowing the facts. First, the reality. With proper treatment, you can manage this condition and still have a good and productive life. There are numerous medications that have been proven effective and Rheumatology experts who will help. However, you also have to take control of the situation. That means making sure you get adequate exercise, ample rest and good nutrition. It also means learning about this disease and taking steps to address your own needs. The knowledge you acquire and the positive approach you take to your new lifestyle will make the difference between just coping with rheumatic disease and living well, despite your diagnosis. What is rheumatic disease?Arthritis and other rheumatic diseases are a family of illnesses that can cause inflammation (redness, swelling and pain), changes in the joints and pain in the surrounding structures.They also may make it difficult to do daily activities. In fact, there are more than 100 different rheumatic conditions including, but not limited to, osteoporosis, rheumatoid arthritis, gout, fibromyalgia, osteoarthritis, systemic lupus erythematosus, and scleroderma. While the symptoms may vary, as a rule, these conditions target the musculoskeletal system, including the bones, joints, muscles, and tendons that contribute to function. Some people also can have internal organ involvement or even more than one of these conditions at the same time. Therefore, it may take time for your primary care physician, rheumatologist, or other healthcare professional to determine your particular diagnosis and the best treatment approach for you. Your participation in this effort―and your patience―will make a substantial contribution to a successful diagnosis and your comfort levels.What can you do? Make your medical visit count!Plan ahead for your visits with your health care provider and, above all, communicate. Arrive with a list of your specific concerns. Consider bringing someone with you who can listen to the health care provider and take notes as appropriate. Respond to the medical professional's queries honestly and directly. Talk about your emotions, stress or discomfort if they are interfering with your lifestyle. Ask for a clearer explanation if you don't you understand any recommended treatment, including benefits, instructions and duration. Identify the team of medical professionals who will be of the most benefit to you. Initially,your rheumatologist, who has special training in the diagnosis and treatment of rheumatic diseases, will probably work closely with your primary care provider. Once you are diagnosed,a number of other medical care providers are available to help you manage your condition,Orthopedic surgeons, Nurse practitioners/physician assistants, Physical therapists, Occupational therapists, Pharmacists, Health educators, Psychologists. Make it a point to learn more about your medications. Rheumatologists only prescribe or recommend treatments to help patients manage their arthritis. The real key to living well with the disease lies with the patients themselves. Research shows that people with arthritis who take part in their own care fare much better. An important fact not shared openly by many doctors is that they go a mile extra to help patients who are interested in themselves and work more and more on patients who want to get better and resume their normal activities. So don’t resign yourself to fate. Only you, with the help of medicines, good understanding about arthritis and good scientific strategies can fight the disease effectively. It is very important that you take these medicines regularly and only as prescribed. You have to follow these important instructions while taking treatment for effective remedy 1)Start the medications –Early start of treatment is very important in preventing joint damage. Due to ignorance and apprehending side effects of drugs prescribed, patients do not start medications. The rheumatologist aptly takes care of patients and administers drugs as per the requirements only. If the patients do not comply and do not take the medicines prescribed by the rheumatologist, joints may get damaged permanently and one is compelled to go for surgeries to repair them, which is very costly.2) Do not give in to illogical fears about medications –Side effects are like accidents. They occur rarely and individual patient specific. If the patient follows up regularly and gets some basic tests done at regular intervals, as advised, most side effect can be identified at the earliest and corrected. Fortunately all these side effects are rare and can be managed very easily provided they are reported at the earliest possible time. Follow contraception as advised by your rheumatologist if you need to be on methotrexate, cyclophosphamide, leflunamide and mycophenolate mofetil. However after a certain washout period of these drugs, you can try to conceive again.Discuss all your concerns with your doctor.3) Don't stop the medications when you feel better. Medicines for reducing damage and inflammation need to stay in your bloodstream at therapeutic levels. Skipping a dose when you feel better could cause the pain and inflammation to return. It may be more difficult to relieve. Its better to keep it under control than allow it to flare and try to get it under control again. Your doctor will himself reduce and stop medications one by one if your disease is inactive for more than 3­-6 months.4) Keep up your appointments and do not use medicines on your own. You may not feel the need to see your rheumatologist when your arthritis is less active. Still keeping your appointments is important. Also do not continue the medicines on your own. Self treatment may be dangerous. During your regular planned visits your doctor will monitor the course of disease and determine response to treatment, adjust your treatment if necessary and Look for side effects based on clinical examination and lab tests as well.5) Do regular physical activity –Regular exercise is one of the best things for overall health. When the disease flares up, as stretching to keep joints flexible. Inactivity can make pain, fatigue and stiffness worse. As your disease becomes less active, increase your exercise. Talk to your physiotherapist about the best and safest exercises for you. Warm water aerobic exercises maybe another choice to consider as­ it relieves stiffness and pain steps down a little. 6) Quitting smoking and maintaining oral hygiene may reduce the chances of developing severe forms of arthritis according to recent evidence. They also reduce risk of cardiovascular events which is increased in Rheumatoid arthritis.7) Dietary restrictions ­- There is no clear evidence for any dietary restrictions in Rheumatoid Arthritis. However, for reducing cardiovascular risk, the American Heart Association recommends eating fish twice a week. Fish high in omega­3s are powerful anti-inflammatory foods that offer a multitude of health benefits. Don't eat fish? Other foods rich in omega­3 fatty acids include walnuts, canola oil, and soybeans.8) Fight Depression ­Living with Arthritis is not easy. It can be painful and unpredictable developments do occur. It may be hard to do normal things you enjoy. It is understandable to become sad at times, but you do not have to accept depression as a part of your disease. Discuss these feelings with your doctor. Family support is also required. Developing motivated and proper frame of mind to fight the disease is of utmost importance. According to recent evidence Individual Patient‘s interest in self care is the most important factor in the treatment of rheumatological diseases9) Don't log on without a diagnosis: Don't log on to various internet sites describing symptoms and pains to diagnose yourself. Many rheumatic diseases will be associated with elevation in sedimentation rate (so called, ESR test) pain and stiffness of the joints . So better have a documented diagnosis first. Also you should check only valid patient education sites on the web to get trustable information. 10) Whenever you are in severe illnesses due to infections, you need the opinion of a Rheumatologist available, regarding usage of the prescribed drugs.11) Pneumococal and annual Influenza vaccines are advised to prevent infections. Discuss with your doctor if you have other comorbidities like COPD,Diabetes and you are aged above 55 years.12) Get your eyes checked up by an opthalmologist every 6 months to look for steroid induced effects or hydroxychloroquine effects13) Doctors give you a prescription only after weighing potential benefits against risk. You can have increased hair loss, nausea, burning in the chest, oral ulcers, allergic reactions & skin rashes, increased friability and striae of skin, cataracts, weight gain, increase or decrease in certain cell counts, osteoporosis, avascular necrosis of bones, increase in infections, increase in blood sugars, facial hair, acne, slight increase in blood pressure, etc. while using these drugs. However, in majority of the patients these are easily manageable (Ex: increasing the dose of anti diabetic oral drugs or insulin in case of diabetic patients). It is generally advised to concentrate on the benefits of the drugs, keeping an eye on the side effects. Stopping medications out of illogical or unrealistic fears may lead irreparable damage to bones, joint deformities and serious organ damage in various diseases. Good news is that apart from the traditional anti rheumatic drugs which do work quite well,there are newer drugs in research and some, already into the market. It is possible now to prevent joint damage with these medications.

6 Frequently Asked Questions About Rheumatoid Arthritis

Dr. Pravin Patil, Rheumatologist
Arthritis is a broad term that describes inflammation of the joints (pain, swelling and redness). Rheumatoid arthritis (RA) is a disease of immune system. Patient with Rheumatoid arthritis suffer from multiple joint pains and swelling. In severe cases RA can affect eyes, lungs, heart, nerves or blood vessels.1. What are the symptoms of Rheumatoid arthritisThe most common symptoms of RA are:· Pain in multiple joints · Stiffness on getting up after a period of inactivity or in the morning · Swelling in one or more joints · Joint pains worse with rest, better with use· Fatigue /difficulty in performing routine activitiesThe most common joints involved are the hands, wrists and feet. The stiffness in the morning generally lasts longer than 45 minutes.2. How common is rheumatoid arthritis?In the general population about a 1 in 100 people develop RA. It is three times more common in women than in men. 3. What causes rheumatoid arthritis?RA is an autoimmune disease. An autoimmune disorder occurs when the immune system mistakenly attacks patient’s own healthy body tissue. In Rheumatoid arthritis body's immune system attacks normal joint tissues, causing swelling of the joint lining. Once the disease begins the joints become inflamed and, if untreated, the joints, cartilage, and bone can be damaged.4. Is rheumatoid arthritis hereditary?If you have a td family member with RA then your risk of developing RA is higher than the general population.You should see a rheumatologist if you have joint symptoms.5. Is RA a disease of old people?No. RA is most common in young and middle-aged adults but can also affect children and the elderly.6. Is there any relation with climate?Many people think that weather in winter may aggravate the arthritis. This is a misconception. Cold weather may cause more stiffness in the joints, but it will not aggravate or precipitate the arthritis.

Rheumatoid Arthritis

Dr. A N Roy, Rheumatologist
Rheumatoid Arthritis (RA) is a common form of arthritis, involving inflammation in the field of lining of joints, leading to warmth, decreased range of motion ,swelling and pain in the areas around joints. The cause is not yet known, although we do know the immune system plays an important role in the inflammation and joint damage that occurs.Genes play an important role in the development of RA.Symptoms:  May vary from person to person. In almost all the people who have RA, joint symptoms change daily. In some people, the disease may be mild with periods with activity (worsening Joint inflammation) called“FLARES”If you have RA, you will likely experience inflamed joints that are warm, swollen, tender, often red and painful, and difficult to move.  People with RA develop inflammation of the linings that surround the heart (Pericarditis) and lungs (Pleuritis) or inflammation of the lung tissue itself. Dryness of the eyes and mouth due to inflammation of tear glands and salivary glands (Sicca syndrome or Sjorgen’s syndrome) is also occasionally seen.  RA Diagnosis: The doctor will look for certain features of RA, including swelling, warmth and limited motion in joints throughout your body, as well as nodule or lumps under the skin.The doctor also may recommend certain blood tests and X –rays. The presence of an antibody called Rheumatoid Factor (RF) may indicate RA, but RF is also found in many people who don't have RA. A positive test for antibodies to cyclic citrullinated peptide (CCP) can also help diagnose RA. Because there are more than 100 forms of rheumatic diseases, often referred to as arthritis the diagnosis and management of RA require the expertise of a specialist. All people with RA should be treated by a Rheumatologist.Treatment of RA:  Currently, there is no cure for RA.However, highly effective treatments exist, and early treatment is critical to prevent  damage. Treatment Methods include medication and life style modifications focused on relieving pain, reducing inflammation, stopping or slowing joint damage, and improving patient function and well-being.Medications Used:  Two types Those that can help relieve symptoms and reduce inflammation &Those which can modify the disease or put in remission.Symptomatic Medications: are NSAIDs, Analgesics, and Corticosteroids. Disease-Modifying Medications (DMARDs) : Methotrexate, Hydrocychloroquine, Sulfasalazine, Leflunomide, Azathioprine, Cyclosporine & Biologics.   Physical and Occupational therapists: Physical therapists evaluate your special needs and teach you how to exercise appropriately for joint mobility, muscle strength and aerobic fitness. Joint Surgery Option: If you experience prolonged pain and disability caused by severe joint damage, you may think about total joint replacement to help you maintain independence.Can DIET help Control RA?: scientific studies have not proved that diet changes either cause or relieve symptoms of RA. Studies do show that omega-3-fatty acids , when taken in sufficient quantities, can modestly reduce RA inflammation. All patients with RA, and particularly those taking corticosteroids, should take calcium supplements and a multivitamin containing vitamin D. Smoking makes you more likely to get RA.How can you Best manage RA: Medications, rest, Physical Activity and self-management skills are the best combination of relieving symptoms, but focusing on the positive aspects of life can also help. Early use of disease-modifying medications is essential to good- long term outcomes.                  Treatment of RA requires Life –Long management.

Joint Pain on Weather Change (The Effects of Change in Seasons on Joint Pain)

Dr. Priyanka K. Bhandagey, Physiotherapist
Can you feel ‘weather’ in your bones? Does rain cause ‘pain’?Often many people are seen complaining about getting pain in their joints with change of season. Even with some variations in temperature or humidity in the environment, people come blaming the weather, for their sudden joint pains.* Believe it or not, the weather forecasting system may have some validity. All thanks to the barometric pressure changes on the body and brain. It might be microscopic to be noticed but can be felt. Sometimes nerves could be more sensitized due to recent or previous injuries, inflammations, scarring or adhesions. Since a long time, the link between pain and weather changes has been considered hypothetical or psychosomatic, with mixed conclusions by researchers; but it could be supported according to surveys published in the Journal ‘Pain’.**At risk peopleThe old age group and growing childrenArthritis/ Rheumatoid arthritis/ Osteoporosis/ Chronic joint painRaynaud’s disease/ FibromyalgiaRecent or past surgeries/ Injuries/ Fractures, without proper post-rehabilitation and physiotherapyWeak joints (bones or muscles) due to lack of sunlight exposure and Vitamin DLack of proper nutrition/ Water intake/ SleepLack of exercises/ Sedentary lifestyleWhy consult a Physiotherapist?They say change is good, but this might not be true every time. With change in climate, people commonly complain of increased pain in the body. Such variations may occur with change in season, not only when people stay in the same place but also when they might travel to a different place.Joint pain can be triggered leading to tightness or stiffness. DO NOT SELF DIAGNOSE! Consultation with a Physiotherapist is only for the benefit of people and most importantly it comes without any side effects. No one can do anything about the weather apart from being prepared. Reassurance is necessary that pain is only temporary and short lived. Your Physio is the one who can help you get prepared with the care one has to take to avoid further damages. Although weather prediction may not be in hands of a Physiotherapist, having people establish a good plan of care can help them remain pain-free!!Tips Our advice would be to “KEEP WARM - KEEP MOVING” and the following comfort measures should be taken:Dressing in layers - keep warm and protected in winters.Get good amount of sleep.Have sufficient sunlight exposure - for healthy bones.Hydrate/ drink plenty of water - it increases flexibility and lubrication in joints, and reduces wear and tear of joints.Weight loss - advised in individuals with improper height-weight ratio. Avoid fatty foods and maintain a healthy diet rich in Vitamins and Minerals.Using heat modalities or hot water fomentation at home - as muscles are relaxed, pain is reduced in a soothing way.Not just winters, joint pain can shoot up with weather changes anytime. Unless otherwise sensitive, ice therapy can be taken.Always remember to maintain a good posture - avoid sitting or standing in one position for too long.Stay active - don’t be a couch potato!Importance of Physiotherapy exercisesThe benefits of exercising are longer lasting than other modalities and pain killers or medications which act only on the temporary symptoms like ‘pain’. It helps to warm-up the body as a precautionary measure.Stretching helps to loosen the stiffness in painful joints and maintain mobility, which helps in better fluid circulation and thus decreases pain. Exercises are essential to strengthen the muscles and bones, and prepare the joints to bear environmental changes.But always keep in mind to exercise within the pain limit. “DON’T TRAIN HARD, TRAIN SMART”.