FAQ Category: General

You may be experiencing the effects of muscle weakness. Muscle weakness is a fairly common problem as we get older and in those who are physically deconditioned. You don’t have to be a “couch potato” to slowly lose muscle definition and strength.

Another term for anything that’s wrong with the muscles is myopathy (myo = muscle and pathy = pathologic or diseased). Muscle weakness or myopathy can be caused by a wide range of medical problems such as infections, endocrine diseases, muscular dystrophies, cancer, and neurologic conditions.

Other causes of muscle weakness include drug toxicity, rheumatologic diseases (e.g., fibromyalgia, sarcoidosis), and vitamin deficiency. A rare cause of muscle weakness is inflammatory muscle disease including three forms: polymyositis, dermatomyositis, and inclusion body myositis.

See your medical doctor before jumping to any conclusions about the seriousness of this symptom. A physical exam is the place to start. Lab tests, X-rays, or other imaging studies may be needed in order to get to the bottom of your weakness. It may turn out that all you need is a bit more exercise or different exercise regimen from your current workout.

Dermatomyositis is a muscle condition characterized by muscle weakness of unknown cause accompanied by the type of skin changes you just described. Medical therapy begins with antiinflammatory drugs (e.g., corticosteroids) to reduce inflammation.

If one drug doesn’t work, it may be necessary to combine several drugs together to get the intended result. If you don’t see the “turn around” expected, don’t hesitate to encourage your mother to return to her doctor for a re-evaluation.

Exercise (aerobic or cardio and strength training) is a key feature of treatment. Exercise will NOT make the disease worse and has been shown to make things much better. Exercise will help keep the weakness from getting worse rapidly. It’s still likely that strength will continue to decline but it will happen at a much slower pace.

Physical activity and exercise are also important in keeping the joints moving and preventing muscle and joint contractures (soft tissues get stuck on one position and can’t stretch or move). Patients must be educated to understand that exercise has its own anti-inflammatory effects and should be a part of each day.

Whatever you can do as a family to help your mother get started (and keep going) on an exercise program would be very beneficial. A physical therapist can help her find a suitable baseline that won’t make things worse. The therapist will guide her through a gradual progression that will include strength training, balance training (to prevent falls), and cardio conditioning.

She will be able to do much on her own at home. But if she’s not self-motivated, it may be better to seek out a membership in a health club, gym, YMCA, or similar work-out place that would provide the socialization, support, and encouragement she needs.

This is a question that has baffled researchers and scientists for decades now. We know that diet, nutrition, and activity level all play key roles in joint health. But there are biochemical and genetic influences as well.

For example, cells called fibroblasts needed for tissue repair stop forming sooner in older adults compared with younger people. Cartilage cells in younger adults also produce more immune cells such as interleukin-1(IL-1) and IL-7 needed for normal inflammatory responses and healing.

It appears that there are also age-related changes in the cartilage matrix. Fewer growth factors and more products designed to break down collagen are also observed in the cells of older adults.

Even knowing these changes can contribute to the development of osteoarthritis doesn’t answer the question of what causes these biochemical effects linked with aging? Most likely, the development of osteoarthritis is a multifactorial (meaning many causes) event. Hopefully, current and future studies will help unravel the mysteries of osteoarthritis and set us on a path of prevention.

SSEP stands for somatosensory-evoked potentials. It is a test that helps monitor neurologic function when the spinal cord is involved in a surgery. SSEP became popular in the late 1980s and early 1990s. It is still one of the most widely used intraoperative monitoring device used during complex spinal surgeries.

SSEPs don’t monitor all aspects of spinal cord, spinal nerve, and vascular (blood supply) function. They are not reliable to test motor (muscle) function and should not be used with patients who already have a neurologic problem.

At first, it was thought that SSEPs were very reliable but studies have since showed there can be a high rate of false negatives. A false negative is a test that doesn’t indicate a problem when there is one.

SSEP does allow for continuous monitoring throughout the operation. This concept is referred to as real-time monitoring. That’s one reason why a majority of surgeons still use it. The information offered by the test does have a significant lag time in providing warnings.

It is often advised to use the SSEP along with at least one other test. For example, there is another test called the motor-evoked potential (MEP) that can be used along with the SSEP. The MEP gives a more sensitive and timely warning that there may be a problem with blood supply to the spinal cord.

Your surgeon will know when to use each test and when more than one test is needed. Not all tests are available at each surgical center. Cost considerations enter into the decision. Ask your surgeon for more information about the test, how it will be used for you, and the pros and cons of the test when used for the kind of surgery you will be having.

Painful or tender areas of the thumb, wrist, and/or forearm are common hand problems. Usually, the affected person is diagnosed with one of three conditions: trigger fingers, De Quervain syndrome, or intersection syndrome.

These three conditions all fall under the category of tenosynovitis (inflammation of the synovial lining around the tendons). But often, they aren’t really inflammatory conditions.

How do we know this? Scientists have examined cells taken from painful tendons, tendon sheaths, the synovial lining, and other supportive soft tissue structures. By looking at them under a microscope, they have been able to see that very few (sometimes no) inflammatory cells are even present. So what’s going on?

It’s more likely that repetitive motions (using the finger or hand over and over) have caused the lining around the tendon (called the tendon sheath) to form extra fibers and then start to thicken. Thickening of the tendon sheath is referred to as hypertrophy.

The fingers and hand are delicate structures and carefully put together. Every layer of tissue (tendon, sheath, synovium) and each layer of space between have just the right amount of room for smooth sliding and gliding of the tendons. Even a small amount of thickening can cause a problem called stenosis. Stenosis is a narrowing of the normal space allowed for the tendons to move through the tendon sheath.

Intersection syndrome is more often seen in athletes such as tennis players (or other racquet sports), weight lifters, and rowers. De Quervain syndrome is seen more often in older women (40 years old and older), African Americans, and members of the military.

Depending on which tendons are involved determines the location of the symptoms and thus the name of the condition. For example, De Quervain syndrome is more likely to cause pain close to the base of the thumb and wrist just above the thumb. Intersection syndrome causes pain or tenderness and swelling on the thumbside of the forearm above the wrist.

You can see how housekeeping staff and others who use their hands performing repetitive tasks are at risk for any one of these conditions. Early treatment can help put a stop to the formation of fibrosis and hypertrophy.

But conservative (nonoperative) care may require rest and a change in your work load (or at least how you perform your tasks). Splinting may help and a hand therapist may be able to offer you helpful tips for ways to modify your work if you can’t take time off to rest. If you are able to take some time off, the therapist’s advice will also help when you go back to your work tasks.

Your daughter has a wonderful gift of generosity. If more people would donate vital organs and body parts to those in need, the world would be a better place. In some countries in Europe, donation is automatic unless you opt out. In the United States, it is quite the opposite.

And the need to advance research is very great as well. Many new orthopedic and other surgical techniques are tried and perfected first on animals. The next step in the process is to perform the same thing on cadavers (bodies preserved after death for study) before attempting them on live humans.

To give you a specific example that pertains to many athletes, a study was done using cadavers to map out the blood supply to the hip labrum. The labrum is a thick rim of fibrous cartilage around the edge of the hip acetabulum (socket).

It is there to increase the depth of the hip socket. The labrum also provides a seal to help protect the hip articular (joint surface) cartilage. This is an area that is frequently damaged or injured in athletes.

Researchers from the Iran University of Medical Sciences teamed up with researchers from the Department of Anatomy at the Legal Medicine Research Center in Tehran (Iran) to perform this study. They examined the hips of 35 cadavers. They used a special colored silicone that was injected into the blood vessels around the hip labrum.

The donor hips came from 28 cadavers ranging in age (at the time of death) from 20 to 50 years old. Cause of death was unknown but there was no damage to the hips and no sign of previous surgeries to the area.

Twenty-four hours after the silicon injections, they carefully took the hips apart and examined the blood vessels (now clearly visible from the injected dye). They found the beginning point (source) of the blood supply to the labrum and followed it to its insertion site into the hip joint capsule.

Beautiful color photos are provided to show the structures of the hip (e.g., bone, capsule, labrum). The blood vessels throughout the area show up as a green color in full detail. For the first time ever, the vascular ring pattern around the labrum is clearly seen. The authors describe the location and pattern of these blood vessels.

By finding the source of the blood supply to the hip acetabular labrum, these researchers were able to show that the blood vessels do NOT come from the joint capsule or the subchondral bone (layer of bone just underneath the cartilage).

Instead, there is a special layer of loose connective tissue between the hip joint capsule and the surface of the labrum (next to the capsule). This tissue lining contains a separate blood supply to the labrum now referred to as the periarticular vascular ring.

Knowing that injury to the labrum does not include damage to the blood vessels is an important finding for surgeons attempting to repair a torn labrum. This knowledge is essential as studies have also shown that repair (rather than removal) of a torn labrum yields the best results for patients with this type of injury.

On the basis of their findings, the researchers suggest taking a closer look now at current techniques used to repair a torn labrum. Every effort should be made to avoid damaging the periacetabular vascular ring.

It appears that if the loose connective tissue containing the vascular ring is not disrupted, then no damage is done to the labrum’s vascular supply. Labral repair with preservation of this capsular-sided connective tissue will enhance healing.

And that is just one of many, many ways cadaver studies benefit athletes (and others)!

More and more adults are being affected by osteoarthritis (OA) than ever before. It is estimated that over 25 million americans have been diagnosed with OA. There may be many more who don’t report their symptoms to a physician or ask anyone else for help.

There are two main reasons for this dramatic increase: people are living longer and many of them are overweight to the point of obesity. We used to think osteoarthritis was a joint disease caused by wear and tear. But that simple explanation doesn’t begin to outline the complexities of joints, their function, and dysfunctions.

With that in mind, physicians have turned away from just prescribing pain relievers and antiinflammatories. Now the approach is one of self-management. Patients are expected to work with their support team of orthopedic surgeon, primary care physician, physical therapist, and occupational therapist to preserve and protect their ailing joints.

That is done with a wide range of treatment choices from a simple shoe insert to correct joint alignment and walking stick to off-load the joint to the more invasive joint replacement. There are many other choices between those two options.

In addition to shoe modifications, supportive neoprene sleeves and stabilizing joint braces may be prescribed. Good nutrition and exercise are extremely helpful, not just with weight loss but with the health of the joint itself. Modalities such as heat, cold, electrical stimulation, and acupuncture can be used during acute flare-ups.

Offering suggestions at a social setting like bridge club can be a challenge. Many people just want to be heard and sympathized with. Often they aren’t really looking for suggestions.

If you are not an arthritis sufferer yourself, you won’t be able to report what has worked for you. But you can comment on what you’ve read on-line about the new self-management team approach, which we’ve just described.

It might be possible to redirect the conversation from complaining more toward getting others to describe what has worked for them and contributing what you’ve learned on their behalf. Good luck — with the bridge game and in being a supportive friend.

The first thing to do is discuss your concerns with the grandparents. Living locally, they will know what the chances are of even coming across a snake on their property or in their area.

The usual advice given children (and adults for that matter) about snakes is to leave them alone. The temptation to pick them up or at the very least, poke them with a stick, should be avoided.

If the children come upon a snake suddenly or unexpectedly, the snake may strike out of self-defense. But if it is sunbathing on a rock or moving along on its own, instruct the children to slowly walk backwards away from the snake.

You may feel reassured to know that out of 6,000 snake bites reported (admittedly, many are never reported) in the United States, only 12 result in death each year. One out of three people are bitten by venomous snakes like rattlesnakes, cottonmouths, copperheads, and coral snakes.

Symptoms may develop right away up to hours later. They can be mild to severe and include nausea, vomiting, pain, numbness (even paralysis), and bruising and swelling of the area. More serious symptoms such as difficulty breathing, blood clot formation, and drop in blood pressure require immediate medical treatment.

Though you may not want to mention these symptoms specifically to the children, it’s a good idea to let them know the consequences of approaching or touching snakes can be very serious.

You don’t have to worry about snake bites at all times and in every state. Most snakes are hibernating and nowhere to be seen between November to March. The prime months for snake sightings and encounters are between April and October. And if they happen to live in Hawaii, Maine, or Alaska — these are states where there are no native venomous snakes.

Many people on vacation or living in areas where poisonous (venomous) snakes reside may wonder what to do if either you or someone with you gets bitten by a snake. Well, just as you suspected, one thing you shouldn’t do is follow the old Western cowboy movies.

DON’T put a tourniquet around the arm or leg. DON’T cut around the bite and suck out the venom. Get medical help as quickly as possible. With cell phones and GPS units, fast emergency aid is often just minutes away.

What will the medical personnel do for a snake bite? Emergency medical techs (EMTs) are always taught to use the A, B, Cs first. A is for airway — make sure the person’s mouth and trachea are clear. B for breathing. If the person is not breathing, a special emergency device can be used to pump air into the lungs. And C for circulation or compression. C reminds the EMT to check for a pulse or heartbeat and/or start applying chest compression if necessary.

If you or anyone in your group has EMT training, don’t hesitate to put it to good use while someone else calls for help. In some situations, once the patient has been transported to a medical facility and evaluated, there may be nothing else required.

Those patients are just kept under observation for eight to 12 hours. During that time, the local site of the bite will be cleaned and then monitored for any changes in size, color, swelling, or bleeding. When antivenin is available, this antidote to the snake bite is given to the patient right away.

Most people do alright after a snake bite. Every effort is made to keep the limb from swelling up. The worry about gangrene setting in and losing a limb or life is real but extremely rare.

A very good question. You probably see some spiders during daylight hours but as your spider boards suggest — spiders are more often unseen house guests. Most prefer dark corners and try to avoid contact with humans.

Keeping the floors (and especially the corners and edges of rooms) swept clean or vacuumed is an important place to start. Dust, animal hair, and little piles of dirt attact spiders.

To keep spiders out of bed with you (or your child), don’t use a dust ruffle around the bottom of the bed. This just gives the spider a “leg up” so-to-speak. And don’t throw the sheets, blankets, or covers on the floor.

Never leave articles of clothing or shoes on the floor. That is an open invitation to a spider to make his or her home in a dark but warm environment. Before putting clothes or shoes on yourself or your children, shake them out and quickly look them over for any unwanted surprises.

Once your children start to dress themselves, teach them the same techniques. You’ll probably have to do it as a game to avoid scaring them. If you know the “Eensie weensie” spider song, it’s a good choice for explaining how spiders like to climb up things — like water spouts mentioned in the song and bedclothes hanging down.

If you have a serious spider infestation, it may be wise to contact a local pest control agent. Prevention by using sprays and chemicals is usually not a preferred solution with children in the home. But it is an option and can certainly help reduce the risk of spider bites. Your local county extension office is often a good place to start when looking for advise of this kind.

Colchicine was approved in 2009 by the Food and Drug Administration for the treatment of gout. This medication has an anti-inflammatory effect. It also inhibits urate crystal from forming deposits (the basic problem with gout).

Colchicine isn’t really a new drug — it’s been used for gout for 200 years. But the FDA has never formally approved it. As a result of reviewing the effectiveness and safety of this drug, a new nongeneric drug (Colcrys) has been developed, approved, and is now available.

Studies show that low-doses of this drug within 12 hours of an acute attack are very successful. Too high of a dose can result in the type of symptoms you experienced. For those who can’t tolerate colchicine, there are other choices.

Allopurinol is another possibility. This drug is one of the serum uric acid (SUA)-lowering therapies. It works by inhibiting a substance called xanthine oxidase, which then reduces the production of urate.

Zyloprim is the brand name for allopurinol. Zyloprim does not take away the acute attacks of gout. But it is useful in preventing recurrence. Other allopurinol drugs on the market include Allohexal, Allosig, Progout, and Zyloric.

As with all drugs, there are some patients who can’t tolerate allopurinol. They develop an itchy skin rash, severe diarrhea, and fever. Having a reaction to colchicine doesn’t necessarily mean you’ll have a similar adverse response to allopuriol. Your primary care physician (or rheumatologist if that’s who you are seeing) will monitor you closely for any problems.

Don’t give up. It can take a bit of time to find the right medication that works best for you. Getting hold of the symptoms early on can help prevent long-term problems (e.g., bone and joint destruction) later.

You are not alone! Gout is the most common inflammatory disease affecting joints. The number of people who are affected has more than doubled in the last 20 years. Although men are affected most often, women can have this problem, too.

Gout is a problem with the breakdown of uric acid, a compound that forms when purine is metabolized and passed out of the body through urine. Too much uric acid in the body causes crystals to form in the joints. The result is attacks of joint pain, swelling, and even oozing of crystals from the affected joint. The big toe is a common target for crystal formation in gout, but the ear and elbow are also common sites for crystal formation.

There are three basic ways to get control of your gouty symptoms. The first is to make sure you have been diagnosed accurately. Other joint diseases such as septic (infectious) arthritis or pseudogout can look like gout. In fact, it’s possible to have both gout and one of these other joint problems.

An accurate diagnosis depends on removing fluid from the joint and examining it under a microscope. The presence of urate crystals is the “gold standard” for making the diagnosis. Other imaging studies may be ordered such as X-rays, ultrasound, CT scans or MRIs. Each of these tests offers a little piece of information that helps define the location, severity, and extent of disease.

In many cases, a change in diet is enough to resolve the symptoms. This can be the downfall of success with treatment for some people. Eliminating purines is important. Purines are found in high concentration in meat and meat products, especially internal organs such as lunch meats, liver, and kidney as well as some fish products. The increased intake of fructose-sweetened soft drinks has also been linked with an increased risk of gout.

Food does account for about one-third of the body’s daily uric acid load. The rest comes from mechanisms within the body that produce this compound. When it is not passed out of the body through the kidneys and intestines, just the right conditions in the body result in the formation of uric acid crystals called tophus.

That’s where medications can be helpful. Not everyone responds the same to the drug options available. It may take a bit of time to work with your physician to find the right choice (and optimal dose) that’s best for you. Some of the drug choices include antiinflammatories, steroids, and serum uric acid-lowering agents.

Other joint diseases such as septic (infectious) arthritis or pseudogout can look like gout. In fact, it’s possible to have both gout and one of these other joint problems.

An accurate diagnosis depends on removing fluid from the joint and examining it under a microscope. The presence of urate crystals is the “gold standard” for making the diagnosis. Other imaging studies may be ordered such as X-rays, ultrasound, CT scans or MRIs. Each of these tests offers a little piece of information that helps define the location, severity, and extent of disease.

Nonsteroidal antiinflammatory medications (NSAIDs) are used to combat the inflammatory process. Steroid-based anti-inflammatories called corticosteroids (oral by mouth or injected into the joint) can also be used to decrease swelling and relieve pain.

Another common medication that has been found effective with gout is called colchicine. Colchicine has an anti-inflammatory effect. It also inhibits urate crystal from forming deposits. Studies show that low-doses of this drug within 12 hours of an acute attack are very successful.

One other group of medications available to lower urate levels in the body is allopurinol. This drug is one of the serum uric acid (SUA)-lowering therapies. It works by inhibiting a substance called xanthine oxidase, which then reduces the production of urate.

Zyloprim is the brand name for allopurinol. Zyloprim does not take away the acute attacks of gout. But it is useful in preventing recurrence. Other allopurinol drugs on the market include Allohexal, Allosig, Progout, and Zyloric.

Whatever is keeping you from getting control of your gouty symptoms must be identified and corrected. You will need to see your physician and let him or her help you get to the bottom of the problem and find a solution that will work for you. New experimental drugs are under investigation that might help patients who have done everything possible but still experience recurrent attacks.

Treatment for RA has changed quite a bit in the past 10 to 15 years. Studies show that patients get better results if their disease is treated early and aggressively. Early is easy to understand. What does ‘aggressively’ mean?

Aggressive treatment starts with the use of medications called disease modifying anti-rheumatic drugs or DMARDs. Many patients are familiar with the most commonly prescribed DMARD: methotrexate or MTX. MTX has been around since the mid-1980s. But it wasn’t always recommended right away because of concerns about toxicity. Only those patients with severe, advanced disease were given this drug.

Now we know that adverse responses to methotrexate (MTX) are much less than feared and the drug offers enough benefit to make it worth taking. Improved symptoms means better quality-of-life all the way around. And even better than that, disease modifying anti-rheumatic drugs (DMARDs) have been shown to slow and even stop joint destruction.

Today’s best care starts patients on methotrexate (MTX) right away. Aggressive treatment requires taking methotrexate (MTX) at increasing dosages over a period of three to six months until you have gotten the best (maximum) response. Response is monitored closely.

Anyone who is not getting the desired or expected results by the end of six months’ time will be given another DMARD or possibly one of the newer biologic agents. Biologic agents include etanercept, infliximab, adalimumab, and abatacept. These drugs fall into a category called tumor necrosis factor-alpha inhibitors or TNF-alpha inhibitors.

Many studies have shown that combining methotrexate (MTX), plus one other DMARD along with one of these biologic agents gives much better results than monotherapy with just one or the other. Taking all three types of medications is referred to as triple therapy.

With the new disease modifying anti-rheumatic drugs and biologic agents on the market, rheumatologists and primary care physicians have new and improved tools to help treat patients with rheumatoid arthritis.

Your physician is offering you what we call “best care” for your rheumatoid arthritis. Today’s motto is: “care you would give your mother”. It’s possible now for you, “Mom”, and everyone else with this disease to remain pain-free, active, and even disease-free for much longer than ever before. Early intervention is the new “gold standard” of care! It sounds like you are in good hands.

Treatment for RA has changed quite a bit in the past 10 to 15 years. Many new drugs are out on the market now specifically for rheumatoid arthritis. These medications have made it possible for many, many arthritis sufferers to experience remission.

Remission refers to the absence of any signs of the disease. No symptoms means improved function and increased activity. That is good news for anyone who previously couldn’t even zip up their own pants or pick up a cup of coffee.

Patients who don’t respond to monotherapy (the use of one drug at a time) often do better when medications for rheumatoid arthritis are combined (combination therapy). If symptoms can’t be controlled with two drugs combined together, then triple therapy (the use of three separate classes or types of drugs) can be used.

Up to 90 per cent of all patients with rheumatoid arthritis (RA) do respond well to monotherapy, combination therapy, or triple therapy. Of course, the more medications a person requires to control their disease, the more costly it can become.

But studies have shown over and over that effective treatment of this kind can slow and even stop the progression of joint destruction from RA. It’s hard to put a price tag on how much money patients are saving by controlling their symptoms. Putting a figure in dollars and cents corresponding to reducing the need for surgeries, preventing loss of employment, and avoiding poor quality of life is equally difficult.

If your mother is responding well to the drug regimen prescribed by her physician, then it may be possible to look for ways to help finance those medications. Your local pharmacist will be able to advise you on any cost savings possible through the use of generic drugs to replace brand names. Most communities also have a Council on Aging or other Aging Services who can help your mother cover the expense of these drugs (or find ways to cover other expenses so she has added dollars to pay for the meds).

As you already know, lupus, also known by its full name: Systemic Lupus Erythematosus or SLE is a chronic and often debilitating condition. It’s an autoimmune disease with many different signs and symptoms affecting all systems of the body. Autoimmune means the immune (defense) system starts to mistake your own cells as “foreign” and begins attacking them.

The destruction that takes place can affect any part of the body but especially the skin, joints, organs, the nervous system, and the blood. The body produces antibodies against itself (called autoantibodies). These immune cells go throughout the body producing an inflammatory (healing) response when it isn’t needed. The result of chronic inflammation is a breakdown of tissues over time.

But as you have discovered, the use of antiinflammatory medications and immune suppressing drugs has a downside, too. That’s why scientists have turned toward finding better ways to target the problem rather than just treating the symptoms.

Medications in a new class of drugs referred to as biologics are on the horizon. These agents treat the disease at the cellular level. The first group of disease modifying anti-rheumatic agents found to be effective started with antimalarial drugs.

Physicians found that by using antimalarial medications, patients with lupus (SLE) could manage their disease, reduce flare-ups of symptoms, and take less of the more damaging steroidal antiinflammatories. Antimalarials work well for mild conditions.

Another disease modifying anti-rheumatic drug (DMARD) that has worked for lupus is methotrexate (MTX). This drug seems most effective for patients who don’t respond to the antimalarials and who have skin or joint problems. Like other DMARDs, methotrexate (MTX) works at the enzymatic and cellular level to alter the inflammatory process.

That brings us to the most recent research focus: biologic agents. Most of the other drugs used for lupus suppress the immune system. Biologic agents stop the specific biologic steps in the pathway leading to lupus. Most of these agents are in clinical trials but close enough to be released for use soon.

There are half a dozen different biologic approaches being investigated. The first is called B-cell depletion. Specific cell-surface antigens (e.g., CD20 and CD22) are targeted. By stopping the action of these immune cells, the process of lupus can be halted.

The main biologic drug under investigation with these effects is called rituximab. It is a monoclonal antibody. It was first used and approved for non-Hodgkin lymphoma but it seems to be helpful in cases of severe lupus that does not respond to the more standard immune suppressive medications. Data from various studies around the world is being collected on the most effective dose and delivery of this drug for lupus.

Three other classes of biologic agents under investigation include costimulatory interactions, cytokine blockade, and B-lymphocyte stimulator (BlyS). As you might imagine just from their names, the way they interact with the very complex immune system isn’t simple.

Each one targets a different area of the immune system in trying to stop the disease process. Some stop B- and T-cell formation (active immune cells). Others don’t reduce the initiation of B-cells but keep the B-cells out of the bloodstream.

Some interfere with the signaling pathway that keeps the autoimmune cycle of self-destruction from repeating itself. There is a cascade of steps in the pathway. Each drug targets a different step along the chain of command.

It’s expected that many of these drugs will be fully investigated and approved for routine use as part of a management program. You may already be using one of the disease modifying drugs. Keeping close contact with your rheumatologist is the best way to ensure you are getting what you need to manage your condition with the least side effects possible.

Experts agree that anyone with systemic lupus erythematosus (SLE), also known as lupus for short has an increased risk of death when compared with similar adults of the same age who don’t have lupus.

But there are ways to manage and modify this disease that can extend your life. For example, it is important to make lifestyle changes that can reduce your risk of heart disease, osteoporosis, and arthritis. Avoiding tobacco use (especially smoking) while practicing good nutrition and getting plenty of exercise daily are important tools in beating the odds.

Some other general principles that can make a difference include avoiding sun exposure, sulfa drugs, and high-dose estrogen (hormone) therapy. These are known triggers for lupus episodes. If you are taking immune suppressing drugs, watch carefully for any signs of infection and see your physician right away. Infections must be treated immediately without delay to avoid long-term problems.

In general, you should be monitored by your physician every four- to eight-weeks (more often during flare-ups). Close monitoring can help prevent organ, joint, or skin damage before it becomes irreversible. Keep a close eye on your blood pressure. Don’t miss having your blood tests done when advised to do so by your doctor.

Although there is no known cure yet for lupus, early and careful management can go a long way to extend your good health, avoid complications, and improve quality of life. Good control of your symptoms with available medications can help halt the destructive processes brought about by this disease.

It’s easy to assume as we get older that any joint pain must be osteoarthritis, often jokingly referred to as “Uncle Arthur” or “Arthur Itis”. This is all the more true if we observed a close family member (such as a parent) go through the same thing.

But, in fact, there are many other possible causes of joint pain such as tumors, metabolic bone disease, osteomyelitis (infection), neurologic problems, and ligament instability. How does the physician make the diagnosis?

It’s a multi-step process from taking your history to performing a physical exam and then ordering appropriate tests. The physician knows to look for involvement of specific joints including the spine, hips, knees, thumbs, and middle joints of the fingers.

The most common symptoms reported by patients with osteoarthritis are joint pain, joint stiffness, and creaking, snapping, or cracking of the joints with movement, a phenomenon called crepitus. The pain and stiffness eventually cause loss of motion and function. Over time, joint deformity may occur as well. A noticeable limp may develop.

Morning stiffness that gradually gets better with movement in the first 20 to 30 minutes after getting out of bed or after sitting for too long is another red flag. In fact, so many patients experience this symptom, it has been given a name: the gelling effect or sensation.

A single symptom doesn’t define osteoarthritis. Just having joint pain or stiffness isn’t enough to know you have osteoarthritis. There is usually a collection of three or more of the common signs and symptoms along with joint changes seen on X-rays needed to confirm the diagnosis.

An accurate diagnosis is the key here. Before jumping to any conclusions, make an appointment with your primary care physician and discuss your symptoms and concerns. Once it is clear what is causing the symptoms, then the appropriate treatment can be recommended. Early intervention will give you the best results, so you are right not to delay finding out what’s going on and what to do about it.

There are many different causes of joint pain and stiffness. The older we get, the more possibilities arise. There can be metabolic disorders, other bone diseases, and even other types of arthritis.

The physician usually relies on a multi-step process to rule in (or rule out) osteoarthritis. The first step is the patient history. Although osteoarthritis often affects both joints at the same time (e.g., both knees, both hips), it can develop in a single joint as a result of an accident or trauma some time in the past. The involved joint will start to get tender and the bones enlarge until the joint is clearly bigger looking than the uninvolved joint.

Physicians try to avoid what are called diagnostic pitfalls. It is easy to misinterpret patients’ pain, deformity, X-rays, and lab results. An accurate diagnosis depends on the physician having an understanding of similarities (and differences) between signs and symptoms of osteoarthritis and other possible causes of joint pain.

Blood values can offer information about the level of components in blood normally linked with inflammation. For example, erythrocyte sedimentation rate, commonly referred to as ESR will be elevated with inflammation. C-reactive protein (CRP) is also increased. And antinuclear antibodies (ANAs) may rise.

But the wise physician also knows these values increase with age or obesity. Careful interpretation of lab values is advised in older adults with joint pain. The presence of any or all of these lab values doesn’t immediately confirm a diagnosis of osteoarthritis.

It’s a fact that sometimes disease processes just don’t present clearly enough at first to know for sure what’s going on. The progression of diseases or conditions (like osteoarthritis) may result in diagnostic delays. It looks like the first physician “missed” the diagnosis but in fact, it just may have taken some time for the clinical picture to develop enough to be sure of the true underlying cause.

It’s good that you have an accurate diagnosis now to work with. Your situation is not that uncommon among joint pain sufferers. Hopefully, your question will help others struggling with a similar situati

There is some suspicion (and proof) that patients on Workers’ Compensation with injuries incur more costs in the course of their treatment. Are they taking advantage of the system? Or is the system the problem?

Studies that seem to verify the increased utilization of health care services and thus increased costs associated with Workers’ Compensation usually include all types of medical problems. That approach can skew results and generate conclusions that might not fit all circumstances.

In a recent study, the authors looked at patients with just one type of problem: upper extremity disorders (shoulder, arm, and hand). They chose this particular area of work-related injuries because it is the most common Workers’ Compensation claim. They compared various aspects of patient care (diagnostic testing, treatment, wait between diagnosis and surgery, number of doctor visits) between patients on Workers’ Compensation and patients covered by standard health insurance.

It turned out that the way in which patients were treated in the Workers’ Comp group had more to do with the system than the patient. What do we mean by that?

Well, patients in the standard insurance group could have surgery right away when it was recommended by the surgeon. Workers’ Compensation patients had to wait until all the paperwork was completed. This included letters of request and justification being filed and accepted. Often a second opinion was required adding to the total cost and delaying recommended treatment.

As a result, patients in the Workers’ Compensation group also had a higher number of doctor visits at a higher total cost. The fact that patients on Workers’ Compensation are in effect “on paid leave” has been suggested in the past as an explanation for why they take longer to recover from injuries and accidents.

This concept is referred to as a moral hazard — they are paid to stay in the sick role and they don’t have to pay for their care so there is no incentive to get better.

Some experts suggest that moral hazard is the reason Workers’ Compensation patients have more doctor visits, higher rates of surgery, and longer waits between diagnosis and treatment. But, at least from this study on individual clinical data, the authors suggest it’s more a result of how the system is run than how the patient uses the system.

Besides the additional paperwork required, they pointed out that it’s the surgeon who decides what tests to order. And some of those tests are probably ordered because the surgeon knows Workers’ Compensation requires them for reimbursement. So Workers’ Comp patients can’t really be faulted for the longer time it takes to get treated and get well.

The first thing to do is see your primary care physician and get an accurate diagnosis. Fibromyalgia symptoms are wide ranging and vary tremendously from person to person. They also mimic many other conditions, problems, and diseases.

So before going down the rabbit hole (an expression from Alice in Wonderland), make a list of your symptoms and concerns and take it with you to your doctor. Your doctor can sort out all the symptoms, select the best tests, and rule out other reasons for your physical distress.

Physicians are trained to take a good patient history and interview patients about psychosocial stressors. It turns out that psychologic, emotional, and social stresses are linked with a higher rate of FMS in the general population.

The information gleaned from the medical intake examination will help your physician identify any risk factors you may have for fibromyalgia syndrome. Some of the more common risk factors include traumatic injury, heavy lifting or pulling, and mood disorders. Anxiety, depression, and post-traumatic stress disorder also seem to be linked with FMS. Having a bipolar illness increases the risk of developing fibromyalgia syndrome (FMS) dramatically.

What causes this condition to develop? Sometimes FMS occurs as a result of some other medical condition. For example, patients with rheumatoid arthritis (an inflammatory disease), metabolic dysfunction (e.g., thyroid problems), or cancer often develop a type of FMS referred to as reactive fibromyalgia. It’s important to identify whether or not the FMS is primary (the main problem) or secondary (caused by other problems).

Early recognition, diagnosis, and treatment can provide a faster resolution of symptoms and much improved prognosis. In fact, half of all adults diagnosed with fibromyalgia early in the development of their disease (and who are adequately treated) no longer have this problem two years later.

Your physician’s expertise in understanding medications that can help and prescribing the right one for you is important. He or she will refer you to others such as a physical therapist, massage therapist, or other skilled health care professional who can help as well.

Again, it’s best to know what you are treating specifically (fibromyalgia or something else) before trying everything out there that’s advertised to “cure” this problem. Your physician will know what studies have shown that support (or don’t support) various treatment options available.