by Nathan Wei, MD, FACP, FACR
Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.
Click here: Second Opinion Arthritis Treatment Kit
The word "arthritis" literally means joint inflammation, but it is often used to refer to more than 100 different diseases that can cause pain, stiffness, and swelling in the joints.
These diseases may affect not only the joints but also other structures such as muscles, bones, tendons, and ligaments, as well as internal organs.
Relief from pain plus maintenance of daily function are the goals of treatment.
Pain is the body's warning system, alerting the person that something is wrong. The International Association for the Study of Pain defines it as an unpleasant experience associated with actual or potential tissue damage to a person's body. Neurons-nerve cells- that transmit pain signals are found throughout the body. These cells respond to noxious stimuli such as injury or tissue damage. For example, if one cuts themself, chemical signals travel from neurons in the skin to nerves in the spinal cord to the brain, where they are interpreted as pain.
Most forms of pain can be divided into two general categories: acute and chronic. Acute pain is temporary. It lasts a few seconds. Some examples of things that cause acute pain include burns, cuts, and fractures. Chronic pain, such as that seen in people with osteoarthritis and rheumatoid arthritis, ranges from mild to severe and can last years.
Chronic pain is a major health problem in the United States. More than 70 million Americans are affected by some form of arthritis, and many have chronic pain that limits daily activity.
The pain of arthritis may come from different sources. These may include inflammation of the synovium (tissue that lines the joints), tendons, or the ligaments; muscle strain; and fatigue. A combination of these factors contributes to the intensity of the pain.
Factors that contribute to the pain include inflammation within the joint or damage that has occurred within the joint.
Each person has a different threshold and tolerance for pain.
A pain diary is a good way to record discomfort. A patient can describe the situations that cause or alter the intensity of pain, the sensations and severity of pain, and the reactions to the pain.
The doctor will usually do the following:
• Take a history and ask questions about the duration, character, and intensity of pain as well as aggravating factors.
• Review medications
• Conduct a physical examination
• Get laboratory tests
• Get imaging procedures such as a CAT scan (computerized axial tomography) or MRI (magnetic resonance imaging) to see how much joint damage has been done.
There is no single treatment that applies to everyone with arthritis.
• Medications--pain relievers such as acetaminophen may be effective. Patients with arthritis generally have pain caused by inflammation and often benefit from aspirin or other non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Motrin or Advil). These drugs help but also have potential side effects.
• Heat and cold--The decision to use either heat or cold for arthritis pain depends on the type of arthritis.
Patients with poor circulation should not use cold packs.
• Joint protection--Using a splint or a brace to to rest and protect joints from injury can be helpful.
• Transcutaneous electrical nerve stimulation (TENS)--A small TENS device that directs mild electric pulses to nerve endings in the skin may relieve arthritis pain. TENS seems to work by blocking pain messages to the brain.
Biologics --These drugs used for the treatment of inflammatory forms of arthritis such as rheumatoid disease reduce inflammation in the joints by blocking a substance called tumor necrosis factor, a protein involved in immune system response.
Disease-modifying anti-rheumatic drugs (DMARDs)--These are drugs used to treat people with rheumatoid arthritis who have not responded to NSAIDs. Some of these include the Arava, methotrexate, and hydroxychloroquine (Plaquenil). These drugs affect the immune system responsible for a disease like rheumatoid arthritis. Treatment with these medications requires careful monitoring to avoid side effects.
Corticosteroids--These are hormones that are very effective in treating arthritis but can cause side effects. Corticosteroids can be taken by mouth or given by injection. Prednisone is the corticosteroid most often given by mouth to reduce the inflammation of rheumatoid arthritis.
Other products--Hyaluronic acid products like Hyalgan and Synvisc mimic synovial fluid that lubricates the knee joint and permits joint movement.
• Weight reduction--Excess pounds put extra stress on weight-bearing joints such as the knees or hips.
• Exercise--Swimming, walking, low-impact aerobic exercise, and range-of-motion exercises may reduce joint pain and stiffness. In addition, stretching exercises are helpful. A physical therapist can help plan an exercise program that will give you the most benefit.
• Surgery-- The surgeon may perform an operation to remove the synovium (synovectomy), realign the joint (osteotomy), or in advanced cases replace the damaged joint with an artificial one (arthroplasty). Total joint replacement has provided relief from pain but also improves motion for many people with arthritis.
Another exciting new area involves the use of stem cells and platelet-rich plasma (platelets are cells in the blood that contain multiple growth and healing factors).
With new technology, it is possible to obtain stem cells from the patient's bone marrow by using a small needle with local anesthetic to harvest bone marrow cells from the iliac crest (pelvic bone). The stem cells are then concentrated using a special technique and injected into an arthritic joint (usually a hip or knee) along with platelet-rich plasma derived from a patient's blood sample. The procedure is done entirely with local anesthetic and small gauge needles so that it is much less invasive than surgery. The result is the regrowth of cartilage along with a reduction in pain. It is hoped that this technique will reduce the need for joint replacement in the future. For more information as to whether you might be considered a candidate for this procedure, contact the Arthritis Treatment Center at (301) 694-5800 or www.arthritistreatmentcenter.com.
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Click here Second Opinion Arthritis Treatment Kit
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