Rheumatology Q & A (2001) - KAIT Jonesboro, AR - Region 8 News, weather, sports

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Rheumatology Q & A (2001)

Question 12/13/2001:  What is an ANA (antinuclear antibody in bloodstream) mean? What are the possible causes? What are the treatments?

Answer:   Antinuclear Antibody (ANA) is a marker antibody used sometimes to identify some collagen vascular diseases.  These are conditions that involve the production of an antibody against body cells, thus causing inflammation. Systemic Lupus is the most common condition associated with a positive ANA test.  However other conditions like scleroderma and rheumatoid arthritis may cause an elevation of the ANA.  Unfortunately about 20% of the general population may have a positive ANA and absolutely no disease.  In those situations other DNA markers must be used to identify the presence of disease.  Because of the high percentage of false positive tests, many people think they may have Lupus, when they just have an elevated ANA.

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Question 11/14/2001:  I have been diagnosed with fibromyalgia. What tests other than blood test and x-rays should I have done to be sure this is what I have.  I have a lot of pain and discomfort. I take Flexirill and Elavil every night. I'm not 100% convinced this is what I have.

Answer:   Fibromyalgia (Fibromyositis) is a diagnosis of exclusion.  Therefore, other muscle conditions must be considered and ruled-out before a diagnosis can be made.  There are no x-ray findings characteristics for Fibromyalgia.  Primary muscle diseases can be ruled out with blood tests.  The most important & common disease to consider is Polymyalgia Rheumatica, which presents much like fibromyalgia, but has an elevated SED-rate blood test.

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(870) 935-4150 (for appointment)

 

Question 10/28/2001:  I would like to know the difference between Degenerate Disc Disease and degenerate Bone Disease?

Answer:   Degenerative disc disease is a condition that may occur even in a fairly young adult.  In this condition, the space between the vertebrae is narrowed causing pressure on the nerves as they exit the space.  The most painful part of this condition is an acute ruptured disc in which the thick gel portion of the disc is pushed out against the nerve causing intense pain. Degenerative arthritis on the other hand is seen in middle-aged to elderly individuals.  This condition has to do with the joint space, especially the knees hips or other weight bearing joints.  Another term for this condition is Osteoarthritis.  This condition is treated primarily with anti-inflammatory drugs, weight loss and in the extreme case joint replacement.

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(870) 935-4150 (for appointment)

 

Question 10/18/2001:  Can you tell me the difference between Degenerative Disc Disease and Degenerative Bone Disease?

Answer:   Degenerative Disc Disease (DDS) means that the space between the vertebra has become compromised over time.  The disc material may crack or decay and allow the center portion of the disc (the nucleus pulposa) to push against the spinal nerves and cause sciatica in the lower extremities or radicular pain in the arms if the neck is involved. Degenerative Bone disease on the other hand refers to osteoporosis.  In this condition over time the mineral content of the bone decreases, leaving the bone weak and likely to fracture.   Your bones are constantly in a process of remodeling such that over about ten years you have a new skeleton.  You want that new skeleton to be as strong as the previous one.

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(870) 935-4150 (for appointment) 

 

Question 10/17/2001:  Is there a medication that will relieve my pain in my joints caused by lupus?

Answer:   If you truly have Lupus, then you need to see a Rheumatologist.  There are many types of medications used to slow the progress of this disease.  Since it is an autoimmune process, Prednisone remains the primary agent used whenever you have a flare of the disease.

NEA Clinic

(870) 935-4150 (for appointment) 

 

Question 10/3/2001:  What is and what to do for gout?  And what are the affects of it on a person?

Answer:   Gout is a form of arthritis that causes sudden severe attacks of pain, tenderness, redness, warmth and swelling in some joints.  It usually affects one joint at a time.  The large toe is most often affected but other joints can be involved.  Gout results from abnormal deposits of sodium urate crystals in the joint cartilage that are later released in the joint fluid. Uric acid crystals may also form in the kidney causing kidney stones.  There is no cure for gout, but it can be treated and controlled.  Symptoms are often relieved 24 hours after onset.  Anti-inflammatory medicines are the first line of therapy.  These include ibuprofen, Indocin and even Cortisone. Colehicine in low doses is also effective. Drugs like Allopirinol decrease the level of uric acid and should be used to prevent future attacks but not treat an acute event.  See your family doctor or Rheumatologist if you have trouble with Gout.

NEA Clinic

(870) 935-4150 (for appointment) 

Question 9/14/2001:  What is fibromyalgia?
Answer:  Fibromyalgia is a term used to describe a condition that involves the muscles and structural tissue of the body.  It does not involve the joints but may be associated with arthritis.  It may cause considerable pain.  There is no cure for this condition, but relief of the pain may come with stretching, massage, heat therapy, and exercise.  Muscle relaxors may be of temporary benefit.  To make this diagnosis, you have to rule out other conditions first such as Polymyalgia Rheumaticia, Lupus and Rheumatoid Arthritis. 

Question 8/26/2001:  I was told I have Trapezius strain. What is this & what can I do about it?

Answer:  The Trapezius muscle groups involve the back of your neck to the wing bone (scapula).  It is commonly involved in accidents or with repeated activity.  It is natures way of saying, "no more work" when you have persistent discomfort.  The primary treatment is rest-but when that is unsuccessful; help come from physical therapy or chiropractic manipulation or anti-inflammatory medications, muscle relaxors or even heat therapy. When pain persists despite all of these modalities, further diagnostic tests as CT or MRI Scan of the neck region may be needed.

 

Question 8/24/2001:  If I have a low antibody level and an elevated antibody level does this mean I have lupus?

Answer:   No. About 20% of the population has a positive ANA test and yet no evidence of systemic Lupus.  It takes much more than an antibody test to diagnose Lupus.  For more information, see an Internist or Rheumatologist. 

 

Question 8/24/2001:  What does it mean if you have a low antibody @1:40-1:80 what does it mean if your antibody level is elevated to1: 80.

Answer:  We assume you mean that you have an elevated antinuclear antibody (ANA) level.  It is estimated that 20% of the general population may have an elevated ANA level and never have Lupus.  Lupus (SLE) is a complex autoimmune disease and requires much more than a (+) ANA for diagnosis. 

 

Question 8/23/2001:  Are there new health warnings for Celebrex users?

Answer:  No. There was a comment on a national news program, which has not been proven, that Celebrex might increase the risk of heart attack. Increased platelet aggregation has not been clearly associated with this drug. 

 

Question 8/21/2001:  I had to go the E.R. about 2 weeks ago and I have two bulging disc in my back, I had a hysterectomy done over a year ago. Do you think that I should have my doctor do a bone density test to see if there’s anything there, at times I can’t even walk across the room because my back tries to give on me, my legs fell like they are asleep and feel tingly. Thanks.
Answer:  A "bulging disc" in your lumbar spine means that the space between the bones in your back is compromised, causing some pressure on the spinal nerves as they exit this space.  Osteoporosis is a completely different process that occurs over time with the bone becoming weaker.  It is very unlikely at your age that you have osteoporosis, so a bone density test is probably of little value.  If you continue to have symptoms of a pinched nerve (leg numbness), you need to see your doctor for more therapy or tests or referral to a neurosurgeon.

Question 6/8/2001:  I wake up in pain every morning in the middle of my back and it is steadily getting worse, so much so, I can hardly walk when I get up from the bed. What is causing this pain?
Answer: 
If you are having persistent back pain not caused by any specific activity, you need to see your doctor for a complete evaluation. There are many causes for continued pain.

Question 6/2/2001:  I have severe pain in my lower back and across my shoulders.  The pain is like electric hits in different places on my body.  There are also knots forming on my collarbones and are sore. My feet burn, sting, and goes numb.  It hurts all the time and I can’t sleep at night due to pain all over in my joints and muscles.
Answer: 
You have described a multitude of symptoms, which may represent several conditions.  You need to see a Rheumatologist with these severe symptoms. 

Question 5/25/2001:  I have degenerative joint decease and Fibromyalgia and would like to know if they are related to Arthritis and if so what can be done for this?
Answer: 
Degenerative Joint Disease is just another way of saying Osteoarthritis.  This is by far the most common form of arthritis and is associated with a genetic predisposition and wear and tear on the joints. Fibromyalgia on the other hand is not arthritis, although often associated with arthritis.  It involves the muscles with pain in regions not associated with joints.  Degenerative Joint Disease is treated with anti-inflammatory medicines-Fibromyalgia is treated with antidepressants, physical therapy, massage, exercise and some muscle relaxors. 

Question 5/21/2001:  I had polio when I was 4, my muscles in my legs are very weak and getting worse, I have pain in them and in my back, my doctor says this is arthritis, but could this be post polio syndrome, I'm very tired of this pain, what can I do?
Answer: 
As you know, polio causes damage to the peripheral nervous system and subsequent weakness of the muscles served by those nerves.  Most patients who have pain in this situation have Fibromyositis, and not arthritis, especially if the pain is in the muscles.  There are some other conditions, like Plymyalgia Rheumatica, which may cause pain and muscle weakness. You need to see a Rheumatologist for further evaluation. 

Question 4/20/2001:  What exactly is vasculitis? My doctor didn't tell me anything about it and I'd really like to know.
Answer: 
Vasculitis is a non-specific term that may be associated with many conditions.  In general it means that there is inflammation at or near the capillaries under the skin or other organs.  It may cause a red rash or itching or pain.  It may be associated with conditions like Rheumatoid Arthritis or Lupus, or it may come about after a viral infection. Vasculitis is usually treated with the anti-inflammatory drug Cortisone.

Question 4/10/2001:  Where does Lupus really come from?  Are there any doctors who specialize in lupus the way we have doctors that specialize in cancer?
Answer: 
Lupus (Systemic Lupus Erythematosus) is a rare condition in which your body attacks itself.  We do not know the cause, but antibodies are involved to damage the cells of the body. Lupus may affect the skin, joints, kidneys, brain and other organs.  If you think you have Lupus, you need to see a Rheumatologist. 

Question 4/8/2001:  My mother has Ankolosing Spondylitis, What can you do for this condition?Answer:  Ankolosing Spondylitis is an inflammatory arthritis that primarily involves the spine and causes increasing stiffness.  Genetic factors may be involved.  Some other diseases may cause this condition.  There are some treatments to slow the progression and inflammation in this condition.  If you have this condition, you need to see a Rheumatologist. 

Question 3/23/2001:  My doctor placed me on Steroids this week; "Knee" problems.   Was working until I put too much weight on them. Now can't extend the left leg. Much pain, can’t walk, will exercise help or hinder?  I'm still on medication. Answer:  Short courses of steroids may help acute inflammation in joints. Anytime however your pain has increased, you need to rest the joint and have the knee reevaluated if there is a change in function or appearance.

Question 3/20/2001:  I'll go into some background about my mother's back pain.  It all started when she was lifting heavy boxes in the attic at the place of her employment. Ever since then, she has been having severe pain in the center of her back.  She has tried Ben Gay, heating pads, resting, and everything else.  Now she cannot lift anything heavy or even bend over as far as she used to be able to.  Her doctors cannot find a problem, and they don't seem very worried about it.  She is in her early forties and has been an almost perfect health specimen up until now.  Please, if you have any suggestions for curing or decreasing Mom's back pain, let me know.  Thank you very much.
Answer: 
The diagnosis and treatment of chronic back pain is sometimes quite difficult.  A detailed history and physical exam is essential.  Then appropriate diagnostic tests such as MRI scan, CT scan, and myelograms may be used.  As a general rule if the pain in the back is much worse than the pain the legs, you are not dealing with a surgical problem.  To treat back pain sometimes requires a total team effort with use of physical therapy, chiropractic physicians, medications, pain specialists and sometimes acupuncture.  A Rheumatologist is a good starting point for someone like your mother.  

Question 3/18/2001:  How can severe pain in the center of the back be cured?
Answer: 
Before you can have a cure, we must know the cause.  Start with a good history and physical exam by your doctor. He/she may then do some more diagnostic tests to pinpoint the cause of the pain, and then recommend a treatment plan. 

Question 3/14/2001:  What can be done for Restless Leg Syndrome?
Answer: 
"Restless Leg Syndrome" is properly called nocturnal myoclonus.  This is different than nocturnal leg cramps and can sometimes cause significant sleep disturbances.  Through the years, the most helpful medication has been Klonopin as a once a day pill at bedtime.  In severe cases, Mirapee, a drug used in Parkinson's Disease has also been used.  You need to see your doctor to be sure you have the correct diagnosis.

Question 3/7/2001:  I was told that I have tested positive for lupus antibodies, should I be on a preventive medicine so I won't get full blown lupus?

Answer: 
As much as 20% of the general population may have a positive ANA test.  This in of itself does NOT mean that you have Systemic Lupus, or that you ever will have the disease.  No medicine is available or needed for this situation.  

Question 3/4/2001:  I have been diagnosed with Severe Lumbard Canel Stenois and 2 bulging disks, also some large spurs. Would acupuncture (needles) help relieve the pain? What course of action would you recommend to help this?
Answer: 
Without knowing your physical findings or the degree of pressure on the spinal nerves, it is not possible to make a clinical judgment.  In some cases, surgery is necessary to gain relief of the nerve pain.  Acupuncture has been used in some centers for temporary relief, but this type of pain can be reproduced by twisting, turning motion of the back.  A proper exercise program and occasional use of anti-inflammatory agents may also help. 

Question 2/20/2001:  Area of pain: follow the rib cage down to where it curves in towards the center of your back.  At the same time imagine where the lower tips of your lungs are.  That is the area of pain for me.  Lately it has lasted for a long time.
Answer:  The area you described is in the lower thoracic spine region.  The lungs have no pain sensors, so they can't hurt.  However, the pleural lining can cause pain, as well as the muscles and vertebrae.  You need to have a good physical exam by your physician and then appropriate tests.

Question 2/16/2001: Am I to young to have arthritis?
Answer: Although when we think of arthritis, we usually think of the elderly, some forms of arthritis can be found in young people. Examples of this include Juvenile Rheumatoid Arthritis, Gout, Rheumatoid Arthritis, Lupus, Reiters Syndrome, and Post-Traumatic Arthritis. If you think you have arthritis, you should see a Rheumatologist.

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