As promised: Notes on osteoarthritis - do you have it?

The Osteoarthritis checklist:

1. age > 40  ____

2. female     ____

3. overweight to obese ____

4. pain in knees on standing and prolonged walking ____

5. hand most peripheral joints painful and growing knobs ____

6. neck and lowback pain ____
7. experienced pain in the above joints for more than 3 months _____


Two sets of hands of 2 females
first degree cousins

8. a close relative positive for the checklist? _____

There it is. Check, check, check, check for 4 or 5 items?

Osteaorthritis is the most common joint disease that affects man (dinosaurs were shown to have this arthritis!). From the above check list, one sees that it is an arthritis of the middle aged to the elderly, mostly women (men, too), and causes pain during use, in specific sites. It can be inherited, and is shown to affect the hip joints less in Asians than in Caucasians.

Good news!

Come in for consult early. The rheumatologist and physiatrist can be the best starting points (surgery can be avoided, you know):

1. There are safe ways to control pain:

                physical therapy consisting of appropriate exercises and muscle strengthening
                occupational therapy with appropriate foot wear prescription
                weight loss
                low doses of paracetamol

    2.   There are ways to control deformities:
              
                occupational therapy consisting of
                     lifestype adaptation techniques, for example 
                        special ways to   open doors, carry objects etc
                splints if deformities have set in

    

Notes on a "new year"

 Even if it is just another day,

labeling it with the start of a set of numbers

makes it sound so different, so hopeful.

It is a wonder that just by doing that, we can feel that we are facing a new

 --hmmm well, something.

It's amazing how the mind and feelings respond to numerical suggestions,

in such a hopeful note!

Remember, it is just another day -

the new year is a tomorrow we experience day in and day out.

Let us make January 1, 2012 a special tomorrow

and like every tomorrow, know what we Hope -

Romans 5:2 !

Blessed tomorrow, and tomorrow, and tomorrow...

Arthritis tid bits

 Arthritis:   

Take the test:
1. Who painted this piece?

Answer: _______________

2.What arthritis was thought
to have afflicted this great painter?

Answer: _________________________________________

For the tid bits now....

• common in the elderly - osteoarthritis
• common in middle aged men - gout
• common in middle aged women - myofascial pain syndrome, fibromyalgia
• common in children - growing pains of childhood, juvenile idiopathic arthritis
• common in promiscuous males/females - infectious arthritis, reactive arthritis
• common among those with Turkish and Japanese descent - Behcet's Syndrome
• common among ethnic Chinese and European descent - ankylosing spondylitis

Watch for further posts on these conditions or look them up!

What precipitates a gout attack

Gout has been called the "king of diseases" (due to the extreme pain and disability like no other that it causes) and the "disease of kings" ( due to many a royalty who did have this arthritis). The source of such descriptions I cannot trace currently, but if I am not mistaken, these still appeared in the 9th edition of an important medical book, c1981. The most recent edition of the same, 18th ed., no longer carries such description (shame).

And while excessive intake of most food (red meat, alcohol, shellfish and innards) is the popular cause of such debilitating arthritis, there are other known precipitants in susceptible individuals, that should be checked and removed or replaced, if ever very necessary. There are 3 important ones that are commonly taken and many times necessary:

1. low dose aspirin (dose given as blood thinner to prevent heart attacks)
2. antihypertension drugs containing hydrochlorothiazide ( as a single agent or combined with other drugs for hypertension, prefixed or suffixed in many preparations as "plus" or "co" )
3. anti tuberculosis medicines

Tips on what to do:

1. The heart specialist can replace your low dose aspirin with other blood thinners ( please, only  if you have the real severe, exquisitely painful joint in  gout -usually the big toe, andkle and knee- not any body ache or pain!) 
2. Your doctor can also change your antihypertensive medicines to replace the hydrochlorothiazide part (which is a good drug for hypertension and can be used in non-gouty individuals, of course)
3. Your rheumatologist together with your infectious disease or family doctor can modify your anti tuberculosis medicines.

Sleep lack and arthritis - any link?

Yes indeed, there is. Have you ever gone through night or nights without sleep, or a jet lag perhaps and got aches all over, aside from feeling heavy, and feverish? If you haven't, you must be the exception- contact me!

It is now known that the sleep wake cycle (meaning sleeping nights and awake daytime, not the other way around please) directs special hormones and blood elements called cytokines, to switch on and off important brain centers and specialized organs, to create a refreshed state - this, usually after a night sleep of 7-8 hours. Short of this, (which most of us have), these blood elements direct what is known as "sickness behavior" -fatigue, pain, reduced activity, depressed mood, decreased sexual behavior and a string of other disorders.

Ever wondered why when you should just go on and sleep after a grave yard shift, you can't because of muscle and joint pains? This is part of the sickness behavior. Sustain the wakefulness another day or for several more days, the sickness behavior can blow up into actual illness - inflammation of joints, blood vessels, and other organs. In fact, after a night of lack of sleep, the blood examination CRP, can be elevated, and this has been traced to higher risk for heart attacks, among others.

Sleep  is the periodic suspension of consciousness during which the powers of the body are restored. (Mirriam-Webster)

Sleep equals restoration- simple and fair enough!

If you are in a sleep predicament:

1. Go see the sleep specialist (a pulmonary internist, a neurologist or an ENT specializing in sleep)
2.  "have to" shift that shift - dont get stuck in the graveyard one
3. Insomniac? Check your sleep environment - flickering tube light, laptop light, must be replaced with a yellow steady light of the old fashioned incandescent bulb and a good book (added personal endorsement here)
4. Block off that noise (snoring significant other needs # 1 and for the neighbor karaoke-ing, ear plugs, you can find good ones in Handyman or Ace...)
5. Warm glass of milk? - some do with coffee ??? or tea ...

  

clip art, Windows

Go get enough sleep!

Rheumatism in December - Is rheumatism (arthritis) seasonal?

Is rheumatism (arthritis) seasonal?

Not really.

There are aches and pain in and around joints or in muscles that are related to unaccustomed activity. Take these cases:
- 56 year old female, hospital worker (mostly seated in the lab), complains of heel pain about 3rd week of December. Her heel is tender to pressure, in the sole more so.
- 65 year old lady has swelling of theleft knee in the first week of December, and remembered the same condition some years back during the holy week.

Common to the 2 cases are gender and age group and one other fact, which many times, could be missed during the doctor visit - both had spent an average of 5 hours doing Christmas shopping, and for the second case, walking in a religious procession for at least 3 hours.

Does this feel familiar? Here are some tips to avoid this bane:
1. Check out those shoes. Get into a comfortable soft soled footwear, with enough arch support (or buy one during the shopping)
2. Have regular rest periods during the outing - clue is don't wait for discomfort in the calf muscles before finding a seat, so this should be about every 30 min for some, 45 min or even 1-2 hours for the younger ones.
3. Cold packs around the ankle area can help after a long shopping walk - just for 10 minutes, while putting up feet to rest.

The Bean Story

"I ate beans for lunch and now I have this terrible back pain! "

As an anecdote, I'd say, 85% of patients in my clinic with pain in the back, limbs and joints, blame beans and its relatives - peanuts, mongo, the like-  for the predicament. Somehow, embedded in the minds of many is this notion that arthritis is one and the same, what ever body part gets painful and swollen, and that beans do it.

Truth is, there are a hundred or so conditions that cause pain in the back, limbs, and joints. One of these, is the Gout. This arthritis can be precipitated by food, -not just food, but inordinately large amounts of red meat, alcohol and beer, small fishes and shellfish and internal organs, in susceptible individuals - the obese, those with family history of gout and mostly, the male gender.
Where's the beans?  Not in this new list published in 2010.

There is a small catch though. In the Philippines, high salt content in the diet, plus, the way we eat our mongo and peanuts (by the spoonful and bowl), may still be responsible for these acute attacks of painful toes, (podagra) that come after a night of beer drinking (with bowls of peanuts on the side). Never mind the steamed crabs and tiger prawns sauteed in ginger and coconut milk!

After decades of untreated gout, this may happen. So, careful....

                                                                      photo borrowed with permission from the

Section of Rheumatology

UP-PGH

The Bone and Joint Decade 2010 and Beyond

The Bone and Joint Decades : 2010 and Beyond - an Unfinished Business

Ester Z. Gonzales-Penserga, MD

(Lecture given on the occasion of the 2010 Philippine Orthopedic Society Annual Meeting)

The Bone and Joint Decade (BJD) is a global movement,  proclaimed by the World Health Organization declaring that the first ten years of the 21^st century be directed at bringing awareness to bone and joint diseases, their effects on the individual and society and to encourage research in the field, aiming at the widest spectrum of issues, from medical education, lay and patient concerns on treatment, self help programs and advocacy. All sectors of society, including government was encouraged to adapt and participate through voluntary and innovative efforts to bring BJD goals to reality in the unique settings of each nation and its people.

The Philippines responded to the call, with five specialty organizations, namely, the Philippine Rheumatology Association, Philippine Association of Rehabilitation Medicine, Arthritis Foundation, Osteoporosis Society of the Philippines Foundation, Inc. and the Philippine Orthopedic Association,  forming the Philippine Council for the Bone and Joint Decade (PCBJD) in the year 2000. The collective work resulted in the Philippine government’s recognition of the BJD on July 5, 2004 through Presidential Proclamation 657 declaring the Bone and Joint Decade in the Philippines. It became the 54th government worldwide to recognize the BJD initiative.

 The PCBJD started yearly nationwide awareness programs since its inception in 2000. Major cities in the country – Iloilo, Bacolod, Davao, Cebu and Cagayan de Oro City soon actively initiated public awareness campaigns with mass media and local government participation. The In-office Exercise program, 3pm Banat Buto, a major output, was introduced to big government and private offices for integration into their health programs. The PCBJD, likewise, got involved in launching the Road Trauma Prevention program, which was presented to the Metro Manila Development Authority. In these different projects, patient groups and pharmaceutical companies helped. The PCBJD was likewise represented in international meetings of the BJD, together with patient representatives. Abroad, similar projects materialized, notably, educational materials of Japan using the “manga” comics concept, the Netherlands’ project on improving medical curriculum on the diseases, Canada’s on line programs on exercises, among others. More than 100 governments worldwide have declared the BJD in their respective countries.

 2010 marks the last year of the first decade of the BJD. For all the good intentions and the cohesive work done by the PCBJD, we see so much work still needs to be done, and issues to be pursued. Similar to other member countries, including developed nations, engagement with government should be optimized. The Philippine public health priority still hinges on infectious diseases, cardiovascular diseases and cancer. Muskuloskeletal diseases rank low in priority. Sustaining the programs that have been started, finding funds with which to embark on landmark researches on musculoskeletal diseases, are among the unfinished work. Despite these odds, we in the PCBJD will present and turn over to the next generation of advocates these programs to pursue, and build upon, so that the Filipino patient with bone and joint diseases can be fully managed and served.

EULAR Conference in London

The 2011 EULAR Congress in London proved to be a balanced meeting, with schedules easy to handle, and topics quite balanced. Osteoarthritis was discussed at length, with some new insights, while rheumatoid arthritis still got the top billing.

EULAR in London

May 25-28, 2011 is EULAR (European League of Associations for Rheumatology) Congress in London. More commentaries in a day or 2. I hope that balanced treatment of topics will make this trip worthwhile - balanced, as in, discussions of new inflammatory entities- MAS and other rare birds, etc... and less of the relooped RA topics! - But London by itself makes the 15+ hour trip worthwhile already.

Readers may want to know that there are many arthritis meetings worldwide, one being the EULAR.
There is the APLAR (Asia-Pacific...), ACR (American College of Rheumatology), OARSI (Osteoarthritis Research International), now also known World COngress of Osteoarthritis, Lupus International, Osteoporosis,.... and other regional and almost always individual countries have their own arthritis meetings.

Maximizing Treatment for Osteoarthritis: A 3 Part Story (2011 Abstract of Lecture)

Treatment of Osteoarthritis remains a challenge, and reviewing data from the mid 1990’s to present, the advances in understanding the disease have not been matched with advances in treatment,  compared to that seen in rheumatoid arthritis, for instance.

This symposium has 3 parts, namely, new concepts in pathogenesis and pathology that has fueled research in targeted therapy, use of OA treatment guidelines and the future of OA treatment.

Part 1: Osteoarthritis as a disease is a heterogenous entity, with incongruence in its anatomic, radiographic and clinical characteristics. Osteoarthritis in the spine, hands, hips and knees can be different diseases, with different risk factors and remain radiographic entities for extended periods before they manifest clinically as pain. Pain is generated by various mechanisms, the recent concept being, bone marrow lesions (BMLs) that are consistent anatomically with pain and progression of cartilage disease. Inflammatory elements are established in synovium, subchondral bone and periarticular fat pad, triggering studies on new targets of treatment.

Part 2: Treatment has focused on pain control and prevention of disability. Clinical practice guidelines abound, by specialty, country, by advocacy. Adherence to these expensive projects is in question. Western data show low adherence to recommendations on exercise and weight loss, and instead, drug prescription and surgery are resorted to more often than necessary. Non-pharmacologic treatment remains by evidence, the first line treatment for the control of pain and for preserving function. Drug treatment starts with analgesics. The GAIT study shows a rather big placebo effect for OA pain and the effects of many of drugs are small over that of placebo.

Part 3: Targeted treatment and newer approach to control pain and preserve function continue to be explored. Disease modifying OA drugs have long been in the market with inconsistent evidence. Diacerein, avocado unsaponifiables, chondroitin sulphate, glucosamine salts have known anti- metalloproteinase and anti -cytokine effects. The clinical effects of disease modification are difficult to measure. Current studies on monoclonal antibodies are promising for the control of pain, but again, these modalities would suffer from cost considerations.

In summary, treatment for OA can be maximized by considering the patient as a whole, keeping them functional and pain free, in the safest way possible. For now, clinical practice guidelines contain recommendations that have been judiciously studied for evidence of efficacy and safety and should therefore help the clinician achieve the objectives of treatment.

Arthritis IQ

Only 2 took the test....
Hmmmmm....

Arthritis IQ: what do you know about arthritis? (answers next posting)

1. When I have pain in the muscles and joints, I should refrain from eating legumes and fish sauces, meat, etc.
       True
       False
2. Pain in the legs and feet in young adults can be due to:
       A. beer binge last night
       B. poorly fitting shoes
       C. unusually long walks (in the mall... or some field work) )or travel
       D. something I inherited from my parents
3. When my shoulders and back are painful, I should have a back massage.
      True
      False
4. Which infections can also present with arthritis?
      A. hepatitis
      B. HIV
      C. influenza (flu)
      D. all of the above
5. Diabetes is a common disease that can have rheumatism as common symptom.
      True
      False
     

Pain all over

If you are a woman in your 40's and has pain in the neck, chest, upper and lower back, arms and thighs, legs, check out these other symptoms:

1. poor sleep or insomnia
2. non refreshing or non-restorative sleep (tired on waking up in the morning)
3. easily irritated bowels, abdominal pain, diarrhea or constipation
4. headaches
5. "feeling low" and disinterested
6. fatigue

Fibromyalgia

is not an uncommon condition and is now recognized as a distinct form of rheumatism

that causes pain all over -

"achy body".

It can be severely debilitating  and may cause

loss of interest in routine and work-related activities of daily living.

It can come and go, but generally, treatment is needed in order to avoid disability.

It can be treated with both non-drug and drug treatment.
It is important to
search for other causes or diseases, that can cause pain in similar parts of the body,
before ascribing the symptoms solely to fibromyalgia.

A rheumatologist or physical and rehabilitation medicine specialist can help you.

Confusing arthritis with other conditions

Arthritis

is inflammation of joints (shoulders, elbows, knees for example), 

causing swelling, pain, warm joints,

with difficulty to move the joint due to pain and stiffness.

Rheumatism

includes arthritis conditions

and  other diseases that cause

pain and swelling in parts of the body surrounding the joints

like

tendons, muscles, ligaments, skin and other connective tissues.

The arthritis doctor is sometimes consulted for numbness and paralysis, movement disorders like Parkinson's disease, and blood vessel (arteries and veins) disorders like varicose veins and blocked arteries. These conditions are generally caused by diseases of the nerves, blood vessels and brain, and not necessarily arthritis by themselves.

Some arthritis can also affect nerves, blood vessels and brain. A rheumatologist can see the difference.



Some facts about arthritis

Did you know that...

 ... that there are more than 100 different kinds of arthritis?

... of these 100 different kinds, only 1 is caused by uric acid -rich foods?

... that children can have arthritis?

... some arthritis develop after having infections

like

tonsillitis, diarrhea and sexually transmitted diseases?