Other Rheumatic Conditions We Treat
When you think of orthopedics, broken bones and joint replacements may likely come to mind. However, orthopedic medicine can treat many more conditions than you may realize. From inflammatory bowel syndrome to Lyme disease, the experts at OSMS can create a personalized treatment plan that will help you live life to the fullest.
(ENTEROPATHIC RELATED ARTHRITIS)
Inflammatory bowel diseases (IBD) is characterized by chronic inflammation in the digestive tract and sometimes can be associated with inflammatory arthritis. IBDs include Crohn’s disease (CD) and ulcerative colitis (UC). Patients with CD experience inflammation in the lining of their digestive tract that affects areas from the small intestine to large intestine or both. UC causes inflammation and sores in the inner lining of the large intestine (colon) and rectum. IBD is a serious ongoing health issue and can be potentially life-threatening. Researchers aren’t sure what causes IBDs.
Symptoms
Arthritis associated with IBD begins with pain in the lower back and stiffness in the morning or after a period of inactivity. Other joints that may be affected include the knees, hips and shoulders. Depending on the type of arthritis you have, small joints of the hands and the heel, buttocks, and foot may also be affected.
For both CD and UC common symptoms include:
- Severe diarrhea
- Stomach pain
- Fatigue
- Weight loss
Treatments
The goal of IBD treatment is to induce remission. Nonsteroidal anti-inflammatory drugs (NSAIDs) are not recommended because these agents may worsen IBD symptoms. Corticosteroids, sulfasalazine and methotrexate may be helpful in some cases. In UC, removal of the affected portion of colon the can lead to remission.
Your doctor may recommend physical therapy, especially if your spine is affected by arthritis. A healthy lifestyle that includes a nutritious diet and regular exercise is important for IBD patients also.
Myositis occurs when you have inflammation in the muscles. The most common types of myositis are:
- Polymyositis which causes muscle weakness around the middle of the body and affects both sides of the body.
- Dermatomyositis which causes muscle weakness as well as a skin rash.
Other forms include juvenile dermatomyositis and inclusion body myositis, which mostly affects older people. Myositis can be caused by an injury, infection or an autoimmune disease, or a virus. Certain medications also can cause myositis.
Symptoms
Most people with myositis experience muscle weakness. Other symptoms include muscle pain, fatigue, and difficulty with movement, swallowing, or breathing.
Patients with polymyositis experience flares with muscle weakness (mostly in the thighs, hips and shoulders), lung issues, joint pain, fever, weight loss, and skin color changes due to cold temperature.
Dermatomyositis causes a skin rash and muscle weakness. Purple or red patchy rashes may develop on the eyelids or on areas such as the knuckles, elbows, knees and toes. Dermatomyositis may also cause weight loss, fever, lung issues and sensitivity to light.
Treatments
There is no cure for myositis, but your doctor can help you manage symptoms with medications, usually beginning with high doses of corticosteroids to reduce inflammation. Doctors will also treat the underlying cause of the disease, including antibiotics for infections or disease-modifying antirheumatic drugs (DMARDs) for autoimmune disease. Disease-modifying immunosuppressant drugs, such as azathioprine and methotrexate, may be used when corticosteroids fail to work. Immunoglobulin may also be used intravenously.
A healthy lifestyle that includes a nutritious diet and regular exercise is important for myositis patients. Your doctor may recommend nutritional supplements and physical therapy to help support regaining muscle strength.
Bursae are small, fluid filled sacs that act as cushions between your bones and soft tissue. The bursae help reduce friction in areas including your shoulders, elbows, hips, and knees. Bursitis occurs when the bursa become inflamed and irritated. Typically, bursitis occurs in the hip and is called either trochanteric bursitis or hip bursitis, depending on its location.
Sports injuries or repetitive movements are common causes of bursitis and tendinitis, but it can also be caused by:
- Poor posture or walking habits
- An abnormal or poorly positioned joint or bone
- Some types of arthritis and related conditions
- Metabolic conditions such as diabetes
- Certain medications
Symptoms
Bursitis and tendonitis cause pain, inflammation, and tenderness in areas around a joint. Symptoms can appear suddenly and may last for days or longer. Symptoms may resolve on their own, but if they don’t, your doctor can treat them effectively.
Treatments
Your treatment plan will focus on reducing pain and inflammation, preserving mobility and preventing recurrence. Your doctor may recommend physical therapy for specialized treatment.
Common treatment options include rest and splints, hot and cold compresses and/or over-the-counter and prescription medicines to relieve pain and/or inflammation. For more severe symptoms, your doctor may prescribe a stronger analgesic or NSAID.
Corticosteroids are another option for medication. These powerful anti-inflammatory medicines.are injected directly into a joint in your doctor’s office.
You can be proactive in your own treatment of bursitis or tendinitis. One of the best ways to prevent a recurrence is to avoid or modify activities that caused the problem in the first place. Ask your doctor for suggestions on changes you can make to your routine. He or she can also recommend range-of-motion exercises to help improve flexibility. Finally, maintaining a healthy weight will take additional pressure off of your joints.
Lyme disease is caused by bacteria transmitted from an infected tick, commonly known as a deer tick. According to Mayo Clinic, when left untreated, Lyme disease can cause:
- Chronic joint inflammation (Lyme arthritis), particularly of the knee
- Neurological symptoms, such as facial palsy and neuropathy
- Cognitive defects, such as impaired memory
- Heart rhythm irregularities
Symptoms
In the early stages of Lyme disease, you’ll often see a small, red bump where the tick bite occurred. This is not necessarily cause for alarm since it normally resolves itself after a few days. You should contact your doctor right away if the following symptoms occur within a month of the bite:
- A bullseye shaped rash that spreads
- Fever, chills, and fatigue,
- Body aches and a headache
- Joint pain
- Neurological problems
Treatments
Your doctor will prescribe oral or intravenous antibiotics to treat Lyme disease, depending on your symptoms. Although in some cases, patients experience lingering symptoms, for most, the antibiotic treatment is effective for Lyme disease as well as Lyme arthritis.
Calcium pyrophosphate dihydrate crystal deposition disease (CPPD) occurs when crystals form deposits in the joint and surrounding tissues. This results in inflammation in the joint and eventually the breakdown of joint cartilage. People with CPPD often have other forms of arthritis including osteoarthritis, a chronic rheumatoid arthritis (RA)-like inflammatory arthritis, or pseudogout. Similar to gout, pseudogout causes acute pain.
Causes for CPPD are unknown. Genes likely play a role since CPPD runs in families. Researchers also suspect low blood magnesium or thyroid issues may also be factors.
Symptoms
Pseudogout will affect about 25 percent of people with CPPD. It comes in attacks that last for days or weeks. Unlike gout that usually affects the big toe, pseudogout most commonly affects the knee. Symptoms include a hot, red, swollen, and stiff joint and fever.
A smaller percentage of people with CPPD will experience chronic rheumatoid arthritis-like symptoms involving joints on both sides of their body (e.g., both wrists or both knees). The pain and swelling are also less than with pseudogout. It’s not uncommon for people with CPPD to have osteoarthritis affecting the knees, hips, shoulders, elbows and ankles.
Treatments
Doctors will use a combination of treatments to help relieve pain and inflammation and improve joint function. For most people, treatment will include medications such nonsteroidal anti-inflammatory drugs (NSAIDs) or corticosteroids. For severely painful and swollen joints, doctors may use a needle to remove some of the joint fluid and then inject the joint with a numbing medication and a corticosteroid to decrease inflammation.
Polymyalgia rheumatica (PMR) is an inflammatory disorder that causes aching, stiffness and flu-like symptoms. It is rarely seen in people under 50 years old and is typically seen in people 70 and over. Women are more often affected by the disease than men.
Researchers aren’t sure why people get PMR, but they do believe it is an autoimmune disease where the immune system attacks the body’s connective tissues.
Symptoms
Inflammation of the joints and surrounding tissues causes stiffness that is usually worse after periods of rest or inactivity. People with PMR commonly have pain in two or more of the following areas:
- Buttocks
- Hips
- Neck
- Thighs
- Upper arms and shoulders
Other symptoms of PMR include fatigue, fever, weight loss and poor appetite.
Treatments
Your doctor will create a treatment plan with the goals of reducing pain and inflammation and treating stiffness, pain, fatigue and fever. Treatment includes anti-inflammatory medications, such as corticosteroids to help reduce inflammation and relieve stiffness and pain. Mild cases may be treated with nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen.
Regular exercise like walking or swimming is essential to maintain joint flexibility, muscle strength and function. It’s also important to give your body plenty of time to rest.
When tiny collections of inflammatory cells (granulomas) grow in different parts of your body, it causes a condition known as sarcoidosis. It occurs most commonly the lungs, lymph nodes, eyes and skin. Although there is no cure for sarcoidosis, but most people are able to manage the condition well. In 50 percent of people, sarcoidosis will resolve itself on its own. A smaller percent of people will have sarcoidosis for years and may suffer organ damage as a result.
Sarcoidosis usually occurs between the ages of 20 and 40. African-Americans have a higher incidence of the disease than white Americans. The condition also tends to run in families.
Symptoms
Symptoms of sarcoidosis will vary depending on which organs are affected and may appear suddenly or gradually over time. Some people have the disease and never develop noticeable symptoms. The following are common symptoms of sarcoidosis:
- Fatigue
- Fever
- Swollen lymph nodes
- Weight loss
Some people also develop skin problems, eye symptoms, lung problems and cardiac issues.
Treatments
Your doctor will probably recommend medication for severe symptoms, including corticosteroids which are powerful anti-inflammatory drugs. Other medications that suppress the immune system may be prescribed, such as methotrexate (Trexall) and azathioprine (Azasan, Imuran). Other drugs might be recommended for skin problems and inflammation.
If sarcoidosis has severely damaged your lungs, heart or liver, you may be a candidate for organ transplant.
Scleroderma is a condition that affects about 300,000 Americans. It can be categorized as either localized scleroderma or systemic sclerosis.
Localized scleroderma mainly affects the skin, but also can affect tissues beneath the skin including fat, connective tissue, muscle and bone. It is more common in children and in adults it affects women more often than men. The disease appears in people between the ages of 20 and 50. There are two types of localized scleroderma. Linear scleroderma causes lines or streaks of thickened skin form over an area of the body, such as an arm, leg or the head, and may cause deep-tissue injury (ulcers on the skin). Morphe scleroderma is characterized by one or more hard, oval, discolored patches of skin.
The second type, systemic sclerosis can affect many parts of the body, including the skin, blood vessels, digestive system, heart, lungs, kidneys, muscles and joints. Thirty percent of people with scleroderma have systemic sclerosis. There are two types of systemic sclerosis. Limited scleroderma which affects the skin on the face, fingers and hands, and lower arms and legs and diffuse scleroderma, where the skin thickening is widespread and may affect any part of the body.
Scleroderma is believed to be an autoimmune disease where the body produces too much collagen which causes the skin to thicken and may cause internal organs to function abnormally.
Symptoms
Symptoms of scleroderma can vary and include:
- Calcium lumps under the skin
- Digestive problems
- Dryness of the mouth, eyes, skin or vagina
- Heart, kidney and lung problems
- Stiff, swollen, warm, or tender joints
- Muscle weakness, often in the upper arms or thighs
Skin changes, such as hardening and thickening, and a shiny appearance or loss of hair over the affected area may also occur.
Treatments
Although there is no cure your doctor can recommend treatments to help manage symptoms, including medications and lifestyle changes.
Sjögren’s syndrome is a chronic, autoimmune disease that attacks the normal cells of glands that produce moisture in the eyes, mouth and other tissues. The result is dryness of the eyes, mouth and other body parts.
Primary Sjögren’s occurs when the condition exists by itself. While secondary Sjögren’s develops as complication of a pre-existing disease such as rheumatoid arthritis, lupus, scleroderma or myositis.
Sjögren’s syndrome affects one to four million people in the United States and ninety percent of them are women. Sjögren’s syndrome tends to run in families
Symptoms
The most common symptoms of Sjögren’s are dry eyes and mouth. Other symptoms of Sjögren’s include:
- Itching, burning and red eyes
- Thick or stringy saliva
- Swollen salivary glands
- Mouth sores, pain and loss of taste
- Yeast infection in the mouth
- Dry cough or hoarseness
- Dryness in nose
- Difficulty speaking, swallowing or eating
- Vaginal dryness
According to the Arthritis Foundation®, Sjögren’s syndrome also can cause swollen or painful joints, muscle pain or weakness, dry skin, rashes, brain fog (poor concentration or memory), numbness and tingling sensations in the arms and legs due to nerve involvement, heartburn, kidney problems and swollen lymph nodes.
Treatments
Although there is no cure for Sjögren’s your doctor can recommend medications and create a treatment plan for your individual symptoms.
Vasculitis is an autoimmune disease that occurs when the immune system attacks the blood vessels by mistake, causing inflammation and leading to a narrowing of the vessels. Vasculitis can occur along with a rheumatic disease, such as rheumatoid arthritis or lupus. In severe cases, patients can develop organ damage or die. Anyone can be affected by vasculitis.
There are many types of vasculitis that are classified according to the size of the blood vessels affected. The cause of vasculitis is unknown.
Symptoms
Some people with vasculitis may have few signs and symptoms while others may become very sick. Symptoms can come and go quickly or develop over months. The symptoms of vasculitis vary depending on the type of vasculitis, the organs involved and the severity of the condition. Fever, loss of appetite, weight loss and fatigue are not uncommon. Vasculitis can affect specific organs and body systems, causing a range of signs and symptoms.
Treatments
Like its symptoms, treatment for vasculitis varies depending on the type, which organs are affected and the severity of the condition. Treatment is aimed to reduce inflammation in the affected blood vessels.
Commonly prescribed medications include corticosteroids, such as prednisone for inflammation and disease-modifying antirheumatic drugs (DMARDs) that kill the cells causing the inflammation.
Raynaud’s phenomenon occurs when the blood vessels that feed the fingers and toes get smaller in reaction to cold or emotional stress. The result is painfully cold, tingling or numb fingers, toes, hands, feet, lips and/or tongue. They may also change color to pale white or blue.
Most people with Raynaud’s have what is called primary disease occurring on its own. It can happen at any age, but usually begins before age 30 and is more common in women and people who live in cold climates.
Secondary Raynaud’s phenomenon is less common, but it is often severe. It occurs with other diseases, such as lupus or scleroderma and may be linked to certain medicines, such as chemotherapy drugs, or the use of vibrating tools, such as a jackhammer.
Symptoms
People with Raynaud’s phenomenon often experience:
- Extreme sensitivity to cold
- Skin color changes
- Coldness, pain and numbness
- Warmth, tingling and throbbing
- Skin ulcers and gangrene in more severe cases
Treatments
Your doctor will recommend a treatment plan form primary Raynaud’s phenomenon to help prevent the episodes from happening. For secondary Raynaud’s phenomenon, treatment will be directed toward the disease responsible for the condition and to prevent ulcers and tissue damage. Most people with Raynaud’s phenomenon won’t require medication to control attacks, unless they are severe.
If the condition doesn’t respond to treatment and threatens to damage tissue, your doctor may recommend surgery. Surgical procedures include cutting the nerves that control narrowing of the blood vessels or performing surgery to widen the blood vessels.
You may be able to control attacks on your own by:
- Keeping dry and warm
- Reducing stress
- Quitting smoking
Antiphospholipid antibody syndrome (APS) is an autoimmune disease which can cause clotting in arteries and veins and/or miscarriages. It is the result of proteins in the blood called anti-phospholipid antibodies (commonly called aPL) formed against the person’s own tissues.
Blood clots in the arteries in the heart and brain are extremely dangerous and can lead to heart attacks and stroke. Most often clots forming in the veins occur in the lower legs. These clots can break off and travel to the lung, causing a very serious condition called pulmonary embolism.
The aPL can lead to early and late miscarriage and preeclampsia in pregnant women and may also may attack the placental tissues.
Symptoms
You may have aPL in your bloodstream for a long time and not know about it. Typically, blood clots usually occurs when other conditions that favor clotting are present, such as prolonged inactivity (e.g., seated on a long airline flight), surgery or pregnancy. Additional risk factors include:
- Hypertension,
- Obesity
- Smoking
- Atherosclerosis (hardening of the arteries)
- The use of birth control pills
- An associated systemic autoimmune disease
Treatments
Your doctor may prescribe anticoagulants (blood thinners), initially with intravenous heparin and then followed by oral warfarin (Coumadin) to treat blood clots. If you have aPL, oral anticoagulation is required to prevent recurrences.
For pregnant women, your doctor may recommend injections of heparin and low-dose aspirin to prevent miscarriage, which has been shown effective for most women and babies. Additional therapies such as intravenous immunoglobulin infusions and administration of corticosteroids (prednisone) may be helpful in some instances.
Nobody knows what causes periodic Fever, Aphthous Stomatitis, Pharyngitis, Cervical Adenitis (PFAPA), but it is characterized by recurring episodes of fever, sore throat, mouth sores and swelling of the glands in the neck. Researchers feel it may be the most common recurrent fever (autoinflammatory) syndrome that does not come from an infection.
Anyone can develop PFAPA and it usually starts between the ages of two to five years. Rarely, PFAPA may develop at an older age in adults.
Symptoms
Common symptoms of PFAPA include fever with mouth sores, swollen lymph nodes and sore throat that begin suddenly and last for three to seven days. The episodes then recur every few weeks. Some children have other symptoms like joint pain, rash, abdominal pain, headache, vomiting or diarrhea. Children are completely healthy between episodes and develop normally.
Usually the disease will resolve itself between ages 10 and 20. A small number of people may continue have occurrences during adulthood.
Treatments
Doctors may prescribe a single dose of steroids (usually prednisone or prednisolone) when the symptoms first start, which has been shown to shorten and sometimes end the episode. Other medications like cimetidine and colchicine, when used regularly, may prevent future episodes in some children. Several studies have found that tonsil removal cures PFAPA in more than 80% of patients, but the role and timing of surgery in treating PFAPA is not fully understood.
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