Arthritis & Rheumatism

There are over 100 types of arthritis and rheumatic diseases including osteoarthritis, rheumatoid arthritis, and fibromyalgia. This site provides the latest arthritic and rheumatic information including the treatment options available.



Arthritis is a common disease that affects millions of people worldwide. This can be felt in the person's joints, skin and organs inside the body. Should the person feel anything wrong, it is advisable to go straight to the doctor. Doctors have discovered that there are over 100 types of arthritis. Given the number, the doctor will not be able to know which one is affecting the person without an examination.

There are 2 common forms of arthritis. The first is rheumatoid arthritis which is considered a chronic disease. There is inflammation in the joints caused by cartilage damage. Anyone who has this will suffer long term joint damage that will lead to chronic pain and disability. Pain is usually felt when waking up in the morning and will gradually disappear during the day.

Rheumatoid arthritis is a problem that will not go away. This happens in three stages. The first is swelling. The second is the rapid division and growth of cells. The third is when these cells release enzymes that will eat the bone causing the joint to lose shape until the person will not be able to move it anymore.

Since this is systemic disease, it can spread and affect other organs in the body. The best way to prevent is from happening is detecting it early to prevent the person from being disabled. This can be treated with proper medication and therapy. There many drugs available that the patient can use. Some drugs offer pain relief to reduce the inflammation. Others can just do one function.

The second is called osteoarthritis. This happens more often than rheumatoid arthritis but unlike the first, there is no inflammation present. The cartilage in the joint is damaged and will eventually degenerate. Pain will slightly be felt when the person gets up but this will hurt later on during the day. Osteoarthritis can either be primary or secondary. When it is primary, it is often associated with age. It is similar to a car where the parts have to be replaced due to wear and tear. Doctors consider this to be normal as people grow older.

The secondary type is often associated with something else that has caused this to happen. Some of these factors are an injury that took place, heredity, obesity and bone density. Osteoarthritis can be treated with medication, exercise, weight control, joint protection, physical and occupational therapy. This is done to relieve the pain and slow the progression of the disease. Both of these are caused by different things. The common thing between these 2 types is that joint pain can happen anywhere in the body.

Given the many medications available to treat this disease, the patient has to be aware of the side effects of each before choosing which one to use. The doctor should explain these to the person in order to make the right decision.



Thursday, October 25, 2007

Can Rooster Comb Injections Prevent Knee Replacement?

Osteoarthritis (OA) of the knee is one of the most common problems seen by both rheumatologists as well as orthopedists in the office. The standard forms of therapy include maintenance of proper weight, exercise, application of cold, bracing, analgesics (pain killers), anti-inflammatory medicines, steroid injections, and viscosupplementation. This latter type of treatment involves the injection of a lubricant directly into the knee. These lubricants consist of a purified form of a protein called hyaluronic acid (HA). These preparations are effective in relieving pain. pain relief from OA of the knee starts between the 5th and 13th week follwoing injection. While HA is felt to be effective for pain relief, it has been unclear as to whether there are any other benefits.

Two recent studies have demonstrated that viscosupplementation may actually forestall the need for eventual knee replacement surgery and also may represent a long term cost savings. The first study from Louisiana State University surveyed patients from a large orthopedic practice. A total of 863 patients (1187 knees) were evaluated. All patients had grade 4 changes, meaning they had “bone on bone” and were candidates for total knee replacement. Using survival analysis of the data, it was estimated that total knee replacement was delayed approximately 3.8 years in 75 percent of the knees receiving viscosupplementation (Waddell DD, et al. J. Managed Care Pharm. 2007; 2:113-121.) In another study, investigators in Thailand studied one hundred and eighty three patients with knee OA (208 knees) who failed conservative treatments and did not have contraindications for surgery were enrolled.

All patients were treated with one course of three hyaluoronic acid injections at weekly intervals and followed up for a minimum 2-year period. In case of successful treatment (response group), repeated doses were recommended. If the patients did not improve within one month after completion of the injections, they would be classified as a non-response group and total knee replacement surgery was considered. Cost of direct medical costs (drugs), hospitalization, and resource utilization were recorded and analyzed. They concluded that IA-HA (joint injection with HA) should be considered as a medical intervention before surgical procedures in knee OA patients who failed conservative treatments. Even though the cost of IA-HA treatment would increase the total costs of treatment and some patients might fail, it was only 6.44% of the total costs. On the other hand, if patients responded to IA-HA treatment, then the surgical procedures were not required. This treatment would represent a savings of 63.26% of total costs. (Turajane T, et al. J Med Assoc Thailand. 2007; 90;1839). While, the exact analyses and conclusions of these two studies are different, they do suggest that HA may be cost effectve in delaying the need for total knee replacement. There are five HA preparations available. They are Hyalgan, Synvisc, Supartz, Orthovisc, and Euflexxa. Only Euflexxa is not derived from a chicken source. The number of injections required varies from 3-5 depending on the preparation used. Hyalgan and Supartz generally are given as weekly injections for 5 weeks while Synvisc, Orthovisc, and Euflexxa are given as weekly injections for 3 weeks. Thes injections should be administered using either fluoroscopic or ultrasound needle guidance to ensure accuracy. Side-effects are minimal when administered by trained specialists. HA injections are worth a try even with grade 4 knees if patients wish to delay surgery.

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