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All About Ankylosing Spondylitis

Wednesday, May 27th, 2009

Ankylosing spondylitis (AS) is type of chronic arthritis that primarily affects the spine. The joints between the vertebrae of the spine and ligaments that allow the back to move become inflamed, sometimes leading to the joints and bones fusing together. This inflammation often leads to stiffness of the back and hips.

The name of the disease describes its destructive nature. “Ankylosing” means stiff or rigid, “spondyl” refers to the spine, and “itis” means inflammation. AS belongs to a family of diseases known as spondylarthropathies that attack the spine. These diseases include psoriatic arthritis, Reiter’s syndrome (a form of reactive arthritis, sparked by infection) and enteropathic arthritis (arthritis related to digestive disorders such as inflammatory bowel disease or celiac disease).

While AS progresses, it can also cause inflammation of other organs in the body, including the eyes, lungs and heart valves. Anemia (reduced number of red blood cells) is also associated with the chronic inflammation of ankylosing spondylitis.

The impact of AS varies widely from individual to individual. Some patients experience episodes of back pain that come and go, whereas others have chronic symptoms that worsen and cause severe joint and back stiffness, loss of motion and deformity.

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Arthroscopy: Before, During and After

Wednesday, April 1st, 2009

The patient’s baseline data is gathered prior to the procedure. A physician evaluates the patient’s medical history, including symptoms and allergies, and conducts a physical examination to assess motion, stability, strength and alignment of the joint.

Arthrography or other x-rays are taken of the joint, and the physician may order other tests, such as MRI (magnetic resonance imaging), bone scan or blood tests. The benefits and risks involved with arthroscopy are discussed with the patient.

The patient is typically instructed not to eat anything for at least six hours before the procedure. Small amounts of clear liquids (e.g., water, apple juice) may be allowed up to a few hours before the surgery.

Local, regional or general anesthesia may be used during arthroscopy depending upon the wishes and needs of the individual patient and surgeon. A tourniquet is usually applied above the operative joint to decrease blood loss and increase visibility. The procedure itself generally lasts about an hour, occasionally as long as an hour and a half.

The surgeon makes a small incision in the skin around the joint and inserts an arthroscope. The joint is then filled with a sterile saline solution to provide a better view.

Surgical instruments (e.g., scissors, clamps, shavers, lasers) can be inserted either through the arthroscope or through additional small incisions. Damaged tissues are then removed or repaired.

This may involve:

* Removal or repair of torn cartilage
* Reconstruction of a torn ligament or tendon
* Trimming and smoothing of rough areas of bone
* Removal of loose fragments of bone or cartilage
* Removal of inflamed synovium (the fluid sac lubricating the joint)

After surgical repair, the arthroscope and other instruments are removed. The joint is flushed with a sterile saline solution. The incision may be closed by suture, paper tape or stitches, and the joint is covered with a bandage.

After the procedure is complete, the patient is taken to a recovery room for a few hours. Vital signs are monitored until the patient is stable and surgical dressing is inspected for drainage and reinforced. The patient is taught to recognize and report symptoms that may indicate complications, such as severe or persistent pain, excessive drainage, redness, swelling or fever.

The physician may prescribe analgesics for pain and nonsteroidal anti-inflammatory drugs (NSAIDs) for pain and inflammation. Antibiotics may be given to help prevent infection. Devices such as splints, slings, crutches, canes and walkers may also be prescribed.

The patient is typically allowed to go home in one or two hours. It will be necessary for someone to drive the patient home. The joint will need to be wrapped, rested, iced and elevated for several days following the procedure to reduce swelling and pain.

The surgical dressing may typically be removed the day after surgery. The patient may be allowed to shower but will be instructed to avoid directing water at the incisions and will be prohibited from soaking in a tub. The incisions need to be kept clean and dry. Physical therapy or occupational therapy, including gradually progressive exercises of the joint, may be recommended.

Several follow-up appointments may be necessary. Typically, during the first of these, the physician removes the sutures, tape or stitches. The patient can usually resume daily activities within a few days, but the joint may require several weeks to fully recover.

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Arthroscopy Conditions Diagnosed or Treated

Tuesday, March 31st, 2009

Arthroscopy may be used to confirm diagnosis of or treat a large number of conditions, including acute trauma to soft tissues. These may be removed, repaired or reconstructed. Examples of such injuries, which often occur during sports, include:

* Rotator cuff injuries. Injury to muscles and tendons that connect the upper arm bone (humerus) to the shoulder blade (scapula). Arthroscopic surgeons can complete tasks such as repairing tears or performing An ACL tear involves the anterior cruciate ligament of the knee joint and is a cause of knee pain.acromioplasty, which involves shaving bone from a point (acromion) on the scapula.

* Anterior cruciate ligament (ACL) tears. A complete tear requires extensive rehabilitation to restore function and ease knee pain.

* Meniscus injury. Injury to the cartilage disc (meniscus) between the two surfaces of a joint. These are often allowed to heal naturally. However, arthroscopy may be used to repair these injuries if the tear is complex or the symptoms occur daily. Also, it may be completed if general function is hindered or if leaving the injury unrepaired may cause further damage.

* Achilles tendon injuries. Arthroscopy may be used in treating tears to the Achilles tendon, a common cause of foot pain.

Other conditions in which arthroscopy may used include::

* Rheumatoid arthritis. A chronic, inflammatory form of arthritis. Affected portions of the synovium (fluid sac lubricating the joints) may be removed with arthroscopic assistance.

* Infectious arthritis. Arthritis caused by infection. Arthroscopy may be used to wash out the joint. This may provide minor, temporary relief.

* Osteoarthritis (OA). Degenerative bone arthritis. The use of arthroscopy in the treatment of OA is controversial. Some studies suggest that it provides little or no more benefit than a placebo. However, arthroscopy may be used to smooth off the roughened edges of bone. This is widely done in the knee. It may offer temporary relief of symptoms and may slow down the arthritic process, but it cannot stop the disease.

Osteoarthritis

* Chondromalacia. Softening or degeneration of the cartilage in the joint. This may be identified with arthroscopy. If it is not extensive, it can be treated with arthroscopy, but extensive chondromalacia may require other treatment methods.

* Patellofemoral syndrome (runner’s knee). Arthroscopic shaving of the patella (kneecap) is sometimes recommended to address difficult cases of this overuse injury, a common cause of knee pain.

* Articular debris. Loose fragments of bone or cartilage in the joint. These may be identified and removed with arthroscopy.

* Carpal tunnel syndrome. Carpal tunnel syndrome is a compression of the median nerve in the wrist that causes wrist pain. Tennis elbow is a repetitive stress injury that causes elbow pain during specific arm movements.

* Tennis elbow (lateral epicondylitis) or golfer elbow (lateral epicondylitis). Types of repetitive stress injury that affect tendons and muscles in the elbow. Arthroscopic surgery can removed damage tissues and release tendons to relieve these causes of elbow and arm pain.

* Hemarthrosis. Accumulation of blood in the joint. The blood can be drained during arthroscopy.

* Mechanical dysfunction. This may include the abnormal alignment or instability of the joint. Arthroscopy may be used to correct this.

* Osteophytes (bone spurs). These may be removed via arthroscopy.

* Fractures. Sometimes arthroscopy is used to determine whether surgery is needed for a broken bone, such as in the glenohumeral region of the shoulder.

Fractures can be incomplete (only cracked or partially broken) or complete (in two pieces). Hip replacement surgery involves inserting a plastic cup and metal ball into an enlarged hip socket.

* Torn labrum. Damage to the cartilage rim of the socket-like acetabulum in the hip. In some cases, arthroscopic repair of a torn labrum may prevent degeneration of the hip and avert or delay the need for a hip joint replacement (arthroplasty).

* Synovitis. Inflammation of the synovium. Synovectomy (removal of the synovium) may be performed with arthroscopic assistance.

* Osteomyelitis or other joint infections. Joint tissue biopsies may be collected and some instances of infection treated during arthroscopy.

* Radial tunnel syndrome. Impingement of the radial nerve in the elbow. Symptoms are similar to those of tennis elbow. Arthroscopy may be recommended if conservative treatments such as occupational therapy fail.

* Gout or pseudogout. Arthroscopy may be used to examine crystal formations in these arthritic conditions.

* Frozen shoulder (adhesive capsulitis). Arthroscopy might be an option if noninvasive methods fail to stretch the capsule, increase range of motion and ease shoulder pain.

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About Rheumatoid Arthritis

Sunday, March 22nd, 2009

Rheumatoid arthritis (RA) is one of the most debilitating types of arthritis. It can cause the joints to swell and eventually become deformed, making it difficult to perform routine tasks.

RA begins in the joints, where two or more bones meet. There are several types of joints. Arthritis occurs mostly in synovial joints, which can move, such as those in the hands, wrists, ankles, knees and feet. For each synovial joint, a space enclosed by the ligaments and adjoining bones forms a cavity called the joint capsule. The outer layer of the capsule is formed by a fibrous membrane. The inside of the capsule is lined with a membrane called the synovium. This membrane secretes synovial fluid, which fills the joint capsule and provides lubrication. The ends of the bones encased in the capsule are cushioned in soft cartilage. The cartilage and synovial fluid permit the bones to move without rubbing against each other.

People with RA experience inflammation in the joint capsules, which affects the movement of the joint and causes pain. RA is an autoimmune condition, which means people with RA have an abnormal immune response. Normally, the immune system protects the body from outside invaders, such as germs. Immune cells (e.g., white blood cells) attack these invaders and flush them out or make them inactive. Part of this process normally produces some inflammation in tissue.

For someone with autoimmune response, the immune system misidentifies regular body tissue as an outside invader. It attacks the tissue and tries to destroy it. In RA, certain types of white blood cells attack parts of the synovium, causing the inflammation that characterizes RA. The process by which this occurs is not well understood. The synovium thickens, which causes the joint to swell. The synovium can form a body called a pannus, which has granular tissue that covers the bone and cartilage. The pannus tissue reacts with enzymes and erodes the bone surface.

RA usually begins in the smaller joints of the fingers or feet. It frequently occurs in the same joints on both sides of the body. It eventually may move to involve more joints, including the wrists, ankles, elbows and knees.

RA is a chronic condition, but attacks may vary. There are periods of severe inflammation called flare-ups, and RA can go into remission for long periods of time. A few people may experience one flare-up followed by remission. However, RA is generally a progressive (worsening) illness. It may start in a few small joints and eventually spread to other joints and tissues, such as cartilage, bones and ligaments. Some RA patients eventually have substantial functional disability that prevents them from working.

RA is a systemic disease, meaning it can involve other body systems. RA can affect the linings of the heart, lungs and blood vessels, and increases the risk of heart disease and heart failure. It can also affect the eyes and the nerves. Inflammation of the blood vessels (vasculitis) can be life-threatening, causing skin ulcerations and infections, bleeding ulcers, hemorrhage and nerve problems.

Rheumatologists classify the status of RA patients based on their ability to function:

* Class I. Completely able to perform usual activities of daily living.
* Class II. Able to perform usual self-care and work activities, but limited in other activities (i.e., sports or chores).
* Class III. Able to perform self-care activities but limited in work and other activities.
*Class IV. Limited in ability to perform usual self-care, work and other activities.

RA can occur at any age and in all races and ethnic groups. It generally begins between the ages of 30 and 50. Although adults are primarily affected, there is also a disease called juvenile rheumatoid arthritis that can affect children.

Women are more commonly affected by RA than men. Of the 1.3 million Americans with RA, at least two-thirds are women, according to the Centers for Disease Control and Prevention (CDC). Women with RA tend to experience remission of symptoms during pregnancy and flare-ups after giving birth or while breastfeeding.

RA is not the same as osteoarthritis (OA), the degenerative form of arthritis most common among elderly people. Although both forms of arthritis cause joint pain, there are several major differences:

* OA involves degeneration of joint cartilage. RA involves inflammation of the membranes lining joints, caused by immune dysfunction.
* RA usually occurs symmetrically, such as in both hands or both knees. OA may occur on one side (e.g., in one knee).
* OA affects only the joints. RA can affect other systems in the body, including the lungs, nerves or heart.
* OA usually affects people over age 50. RA affects people between 20 to 60 years of age.

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Rheumatoid Arthritis (RA)

Friday, March 20th, 2009

Also called: RA, Systemic Rheumatic Disease, Rheumatoid Disease, Rheumatic Joint Disease, Subacute Rheumatic Arthritis, Acute Rheumatic Arthritis

Osteoarthritis is the most common type of arthritis and is caused by joint cartilage deterioration. Rheumatoid arthritis (RA) is an autoimmune condition that involves joint inflammation and pain. Although less common than osteoarthritis, RA is more debilitating and usually starts earlier, between the ages of 30 and 50.

About 1.3 million Americans, at least two-thirds of them women, have RA, according to the Centers for Disease Control and Prevention (CDC).

The cause of RA is not entirely understood. It begins with an altered immune response, in which immune cells attack normal cells in the joints. This causes inflammation and pain in the joints, frequently in the same joint on both sides of the body. RA can also affect the eyes, heart and other organs.

RA may begin as pain, swelling or stiffness in a few joints. The progress of the disease varies. It may remain the same for many years or progress to other joints and systems in the body. The swelling can deform the bones and tendons in the joints, which may make the joints difficult to use. Some people eventually lose the ability to work or perform daily tasks.

Physicians may use multiple blood tests and a physical examination to diagnose RA. Guidelines to classify the disease include joint pain or swelling in multiple joints for more than six weeks.

There is no known cure for RA. Treatment concentrates on pain relief and slowing the progression of the disease.

Great strides have been made in recent years with drugs that can slow RA’s progress. Drug treatment may include basic pain relievers such as acetaminophen or anti-inflammatory drugs. Other drugs modify the disease’s progress or work on parts of the immune system that malfunction to trigger RA. The course of RA is different for each patient and different drug combinations may provide relief. No drugs can reverse damage inflicted on the joints.

Some surgical procedures can remove parts of damaged joints or even replace a joint (arthroplasty).

Research into the causes and progress of RA continues. Scientists are studying genetics and the biochemistry of the immune system. Other studies focus on potential new drugs, drug combinations or other treatment methods.

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Posts Tagged ‘bones’

All About Ankylosing Spondylitis

Arthroscopy: Before, During and After

Arthroscopy Conditions Diagnosed or Treated

About Rheumatoid Arthritis

Rheumatoid Arthritis (RA)

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