Rheumatology Q & A - KAIT Jonesboro, AR - Region 8 News, weather, sports

Rheumatology Q & A

Question 6/16/2002: I had back surgery L5s1 disk Dec 14 2001. It still hurts me to ride in the car, the muscle on your right side, that’s the side the never was damaged, hurts when I try to turn over in bed, also I get pressure in my lower back across both hips.
Answer: It is not uncommon to have pain in the back for up to one year after back surgery.  However if the pain has changed, you need to first tell your surgeon, and then if he thinks it is not related to the surgery, see a Rheumatologist.

Date: 20020511
Question: I have had bad knees that crutch when I walk up the stairs etc... for years. Also, my outer hipbone has been snapping when it's lifted for about three years to. Now it seems all my major joints have followed suit to snap & pop when used. Especially in the morning etc... I also have certain joints that are sore or tender. My wrist & ankles sometimes feel as if their fractured or sprained. The soreness comes and goes. I been off & on celebrex ,skelexin etc... They help with soreness & pain.
Answer: You are describing polyarthritis, perhaps with some degree of fibromyalgia. You need to see a Rheumatologist for a full evaluation and course of therapy. NEA Clinic - (870) 935-4150 (for appointment)

Date: 20020429
Question: I have a red spot on top of my knee it is feverish and my knee is swollen and is beginning to hurt at the back of my knee and down my leg it aches both ways up and down.
Answer: You need to see your family doctor first. This may be an inflammatory arthritis such as gout, or it could be an infection. Blood clots often need to be ruled out as well in a situation such as yours.
NEA Clinic - (870) 935-4150 (for appointment)

Question: What do you think of fibromyalgia? Doctors don't seem to recognize it as a disease. But nothing they do for me or to me helps.
Answer: Fibromyalgia is a common cause of chronic musculoskeletal pain. The etiology of the problem is unknown. There are no abnormalities on physical exam other than muscle tenderness. No radiographic or laboratory changes. The problem though is real and it can be potentially disabling if not dealt with appropriately. Therapy involves use of medication to restore sleep and help with mood disorders (if associated with pain symptoms) those medications can help to some extent but it is the patient himself/herself that plays the major role in the healing process. Exercise in the form of daily low impact aerobic exercise (best done in water) and active, positive approach to the problem can bring lasting results.
NEA Clinic - (870) 935-4150 (for appointment)

Question: I have severe pain due to back problems. I have pain between my shoulders, in my neck and my lower back and pelvic area. I have a herniated disc in my lower back and I have been injured in a car wreck, which damaged my left collarbone, my neck, and my middle back. The pain is so severe at times that I cannot do anything. Do you have any suggestions as to what I can do about this? I need some help. It seems to be affecting my muscles too. Do I need to see a neurologist?
Answer: Although you have some disc problems, the symptoms sound more like Fibromyositis as well. Given these symptoms, you probably need to see a Rheumatologist in order to sort out these different types of pain, and come up with a logical treatment approach.
NEA Clinic - (870) 935-4150 (for appointment)

Question: My shoulder is sore at the joint. What is wrong?
Answer: Shoulder pain is common to see in someone your age. The most common problem is bursitis as a result of overuse and subsequent inflammation. Often a steroid injection to the bursa gives complete relief. A rotator cuff tear is another cause of chronic shoulder pain. It usually takes a MRI scan or arthrogram of the shoulder to confirm this problem. Arthritis of the shoulder is usually as a result of previous trauma if just one shoulder is involved. A combination of physical therapy and anti-inflammatory medications is often necessary to give relief. Rheumatologists and orthopedic surgeons deal with chronic shoulder pain.
NEA Clinic - (870) 935-4150 (for appointment)

Question: I am having a burning pain in my back, usually up and down and not in the spine area. I have this pain during the daytime, usually after I have been up several hours. Sometimes it feels like something is moving up and down my back. Also, sometimes it feels similar to the feeling when they did physical therapy on my knee with some type of electrical device. This part doesn't hurt, just the feeling. I have had a bone scan and spine x-ray that showed that didn't show any problem. Could be a parasite?
Answer: It is very unlikely that this is due to any parasites. It sounds like you may be having some neuralgia or even fibromyalgia. The bone scan is only positive if there is inflammation, infection or cancer in the bone. The spine films only show if there is a problem with the bone in the back, plus your alignment. You may need to see a specialist in arthritis, or an internist to have some more evaluation.
NEA Clinic - (870) 935-4150 (for appointment)

Question 4/5/2002: What is Lupus?
Answer: Lupus is a disorder of the immune system known as an autoimmune disease. In autoimmune diseases, the body harms its own healthy cells and tissues. This leads to inflammation and damage to various parts of the body. Lupus can affect the joints, skin, kidneys, heart, lungs, blood vessels, and brain. Although people with the disease may have many different symptoms, some of the most common ones include extreme fatigue, painful or swollen joints, unexplained fever, skin rashes, and kidney problems. There is no cure for lupus, although most people can lead fairly normal lives with appropriate treatment of this disease. For more information, call or write the Arthritis Foundation, Arkansas Chapter, 6213 Lee Av. Little Rock AR 72205 1-800-482-8858.
NEA Clinic - (870) 935-4150 (for appointment)

Question 3/30/2002: I have Fibromyalgia, and there is never a day I am without pain. I take Mobic and Flexareel. I have tried every kind of Autro meds out there and rubs from over the counter. Is there anything you can add that might help I have not tried?
Answer: Fibromyalgia may not respond to the usual anti-inflammatory medications used for arthritis. IN fact most of the time these agents are ineffective. Muscle relaxors also have not proven to be consistent in pain relief. Most Rheumatologists now use SSRI class antidepressants in some form in their therapy. This class includes, Celexa, Prozac, Paxil, and Zoloft. Exercise therapy and well as massage therapy may be helpful.
NEA Clinic - (870) 935-4150 (for appointment)

Question 3/25/2002: have been on Methotrexate since 1989 for Rheumatoid Arthritis. Recently due to higher than normal BP my PCP put me on Hydrochlorot. I started at 25 mg/day and recently have been moved to 50 mg/day. I was told today that Hydrochlorot has sulfur in it. Is that true? If it is true should I be on that in addition to Methotrexate or should I be given an alternative without sulfur?
Answer: Methotrexate is a medication that was used for many years in cancer treatment. Doses used were much higher than what we customarily use for Rheumatoid Arthritis treatment. With higher doses, increase in blood levels leading to increased drug toxicity can occur. Certain medications can affect MTX blood levels by decreasing elimination of the drug via urine or by other mechanisms. Organic acids such as sulfonamioles can potentially increase MTX blood levels. In doses of MTX used to treat Rheumatoid Arthritis this interaction is not clinically significant. NEA Clinic - (870) 935-4150 (for appointment)

Question 3/18/2002: Hi, is there any exercise programs, or yoga that would help a person that suffers from fibromyalgia?
Answer: Exercise is crucial in treatment of fibromyalgia symptoms. Low impact aerobic exercise like walking or exercise in water are most commonly suggested. Exercise regimen is usually individually tailored to patient needs. Rules are to stretch and warm-up before exercise.
NEA Clinic - (870) 935-4150 (for appointment)

Question 2/28/2002: Are bone spurs the same as herniated disc? What causes bone spurs? What can be done about them?
Answer: Bone spurs are extra calcium deposits that are found in areas of increased pressure or use. They are not ruptured discs, although ruptured discs may calcify with time.
NEA Clinic
(870) 935-4150 (for appointment)

Question 2/13/2002: How would you know if you have arthritis? What are the side effects of that and how to stop it?
Answer: Arthritis may have many faces. In general arthritis is inflammation of the joints. It usually does not primarily involve the muscles, but the muscles may eventually ache as the arthritis progresses. Most arthritis is of the variety called Osteoarthritis. This form primarily involves the weight- bearing joints and the ends of the fingers. On the other hand, rheumatoid arthritis is known to present with tremendous joint stiffness and involvement primarily of the wrist and knuckles. If you think that you have arthritis, see your primary care doctor and maybe eventually a Rheumatologist.
NEA Clinic
(870) 935-4150 (for appointment)

Question 2/4/2002: What is the best thing to do for fibromyalgia? I have severe pain all over my body but especially in my neck/shoulder/back area. Can you tell me what to do for this condition?
Answer: Fibromyalgia, or Fibromyositis is an especially difficult condition to treat successfully. First you must be sure that the diagnosis is correct, since this is a diagnosis of exclusion and many conditions may mimic fibromyalgia. Assuming the diagnosis is correct, combinations of treatment options are used. Exercise of the involved group is important. Heat therapy is often helpful as well. Correction of any sleep disorder is needed to have any chance of success. Often the use of SSRI antidepressants has been found to be quite helpful. Short-term use of anti-inflammatory agents or muscle relaxors has also been helpful at times. Routine walking may increase your natural morphine and therefore decrease your overall pain. There is no cure, but there are options that may make the condition tolerable.
NEA Clinic
(870) 935-4150 (for appointment)

Question 1/31/2002: Recently you ran a story on KAIT-TV about a new treatment for arthritis in the shoulder. Could you please give me some information or contacts that will help me get in touch with someone for this treatment.
Answer: The recent story on KAIT news had reference to the use of hyaluronic acid use in the shoulder. To date the FDA has approved the general use of this substance in the knees. We have had good success in decreasing the pain and inflammation of the knees with this agent. Realize that this is not a cure, but rather a way to buy time. If you want more information about the use of this write to Michele Hooper, M.D., University Hospitals of Cleveland. 11100 Euclid Ave Foley 201, Cleveland Ohio 44106.
NEA Clinic
(870) 935-4150 (for appointment)

Question 1/31/2002: I have heard about the way they can shoot that medicine into your arms to give you relief, I have Osteoarthritis in my shoulders, knees, and back. Have had two cages put into my lower back. But my shoulders hurt all the time. How can I find out if I could be used to try that medicine they put in your shoulder, I sure would be a subject to try it. Please let me know if I could?
Answer: The recent story on KAIT news had reference to the use of hyaluronic acid use in the shoulder. To date the FDA has approved the general use of this substance in the knees. We have had good success in decreasing the pain and inflammation of the knees with this agent. Realize that this is not a cure, but rather a way to buy time. If you want more information about the use of this write to Michele Hooper, M.D., University Hospitals of Cleveland. 11100 Euclid Ave Foley 201, Cleveland Ohio 44106.
NEA Clinic
(870) 935-4150 (for appointment)

Question 1/24/2002: How do you cure severe back pains without having to visit a chiropractor?
Answer: The secret to curing severe back pain is making the proper diagnosis. A full evaluation by the physician is needed with careful attention to the history and physical exam. Depending on the exam findings, one can determine if further diagnostic studies are needed. Sometimes just proper rest and use of hot and cold packs will resolve the problem. In the more severe cases with ruptured discs, surgery may have to be done to relieve the pain.
NEA Clinic
(870) 935-4150 (for appointment)

Question 1/8/2002: I have rheumatoid arthritis, I have tried all the steroids, and now taking Celebrex twice daily, methotrexate three times weekly, and Ultram for pain. My question is the new drug Remicade right for me? Besides hurting all the time, the medicines upset my stomach.
Answer: Remicade is a monoclonal antibody that neutralizes TNF, one of inflammatory molecules produced by synovium in the joints. Remicade is an infusion. It is used in conjunction with methotrexate in patients with rheumatoid arthritis. Remicade was proven to effectively reduce symptoms of arthritis but also was proven to retard the progression of joint destruction. Remicade is very tolerated by most patients. There is a possibility of allergic reactions, but those are relatively rare. Remicade would not be used in patients with hepatitis, tuberculosis, or other serious infections.
You would need a thorough evaluation by a Rheumatologist prior to starting this type of treatment.
NEA Clinic
(870) 935-4150 (for appointment)

Question 1/5/2002: My son, age 12, is taking Prednisone which is making his joints ache severely. Is this a common side effect? How can I give him relief?
Answer: This would be quite unusual. In fact Prednisone is the main drug used to combat severe arthritis. You need to discuss this with your family doctor, or see a pediatric Rheumatologist.
NEA Clinic
(870) 935-4150 (for appointment)

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