Question

I suffer from mild osteoarthritis, in my knee hip, and lumbar area. It flares up for very little reason e.g. sitting in an awkward position, or performing tasks, which require bending. Is it safe to take an anti-inflammatory drug on these occasions? My GP has prescribed them but has not informed me if I could use them from time to time.

Answer

It is entirely reasonable to take the anti-inflammatory medication when you are experiencing pain and stiffness in your joints. It is not absolutely necessary to take them on a continuing basis because they are usually prescribed for symptomatic relief. It is important to take such medication with food or after food in order to protect against the possibility of gastric side effects. Long-term continuous use of anti-inflammatory drugs can result in ulcer formation and gastric bleeding. Therefore if your symptoms are severe and you need to take the medication more frequently you should consult with your GP again.

Question

I have recently being getting pains in the joints in my hands. My mother had severe osteoarthritis of her hands and eventually became so incapacitated that she couldn't do anything for herself. I am really worried that I will follow that pattern. My 2 sisters also suffer with pain in their joints. Is there anything I can do to halt or reverse or limit the damage? Does it also mean I will get it elsewhere? I am really depressed over this.

Answer

I can understand your fears and concerns especially since you have had first hand experience of the potentially devastating effects of arthritis on a person’s quality of life. You have witnessed the gradual decline of your mother’s health and independence and now you are experiencing pains in your hands and wonder if this is a case of history repeating itself. I would question the diagnosis of osteoarthritis because the aggressive nature of your mother’s course of illness would suggest to me a more active form of arthritis such as rheumatoid arthritis. You also say that your symptoms are of recent origin. There are many innocent causes of hand pain and your symptoms do not necessarily suggest that you will follow the same path as your mother. For example if your work involved typing then your hand pain could be due to wrist strain. Perhaps you have had a recent flu like illness and are experiencing some residual muscle and joint pain after the event. If your joints are swollen and look inflamed or if the joints just don’t look right to you then visit your GP and be medically assessed. However, if you are just experiencing some pain with no other symptoms and your performance is not affected then it is reasonable to take simple pain relieving remedies and carry on. If the pain shows no sign of abating over the coming weeks then visit your GP. My main message to you is that your views on arthritis have been heavily coloured by observing your mother’s suffering. The hand pain you are experiencing does not mean that you will repeat her awful experience.

Question

My spine is curving and for the last 3 weeks I’ve had dreadful pain in my lower back, hips and shins. My x-rays showed little space for my hips to move in the sockets. I also have chondromalacia of the patella and had my left kneecap removed last year. Am I possibly looking at more surgery, like hip replacements? My physiotherapist won't touch me until I've seen my orthopaedic surgeon, but I'm afraid he won't do much, as he was on holidays when this happened and I went to a chiropractor and he did the x-rays for me. What do you think?

Answer

The sign you refer to on your hip x-rays is technically referred to as “loss of joint space” and is a feature of osteoarthritis of the hip. The hip joint is an example of a ball and socket joint where the ball refers to the rounded head of the femur or thighbone and the socket refers to the cup shaped socket in the pelvis into which the head of the femur fits. The opposing surfaces of the ball and socket are covered with a layer of shiny lubricated cartilage that allows one surface to glide over the other. This material is not radio-opaque, which means that it is invisible on the x-ray and in the case of a normal hip x-ray a gap is clearly visible between the surfaces of the ball and socket. In the case of significant osteoarthritis this covering material has been eroded and the gap between the ball and socket disappears. This results in one rough surface of bone grating off the other, which gives rise to the pain and stiffness we associate with arthritis. “Loss of joint space” is a cardinal feature of osteoarthritis of the hip. The possibility certainly exists that you may need a hip replacement and the orthopaedic surgeon is the best person to advise you on this matter. I would attend the specialist and get his opinion on what needs to be done. I would not be deterred from that course of action because you had previously attended a chiropractor. That fact should have no relevance with regard to your future management.

Question

I'm in my 40s and have been diagnosed with Brown's Syndrome. I’ve been told to visit a rheumatologist, as this syndrome may be associated with rheumatoid arthritis. Can you comment?

Answer

Brown’s syndrome is a form of strabismus or squint. It is manifest by a failure of the eyeball to elevate during adduction, which is the technical term for turning the eyeball inwards. Eye movement is controlled by a series of slender muscles inside the orbit that are attached to the external surface of the eyeball. The particular muscle that is implicated in Brown’s syndrome is the superior oblique muscle. Most cases of Brown’s syndrome are congenital and are usually left alone unless the strabismus is problematic. However, it can occur as a consequence of inflammatory conditions such as rheumatoid arthritis. It is postulated that the tendon of the superior oblique muscle becomes inflamed as a consequence of the diffuse inflammation that is a feature of rheumatoid arthritis. In that condition the inflammation can involve tendons and various tissues other than the joint surfaces. I would assume that you have been advised to attend a rheumatologist in order to verify if you have rheumatoid arthritis and also to receive specialist advice on further management of your condition.

Question

I'm really worried about my elderly father. Last November we were told he has prostate cancer, which has spread to the bones. (He does not know about it). Yesterday he agreed to have a knee replacement carried out due to severe arthritis. Can you please tell me if having cancer may complicate his recovery and if there is any other way he could get pain relief without going under a general anaesthetic. Painkillers and injections into the knee joint in the past have failed to help. We were told that he may live up to two years with the cancer and I'm worried that having this operation may shorten his life. In general how well do older cope with such operations?

Answer

Question

Recently I have had severe pain and swelling in my left foot around the big toe area. An x-ray confirmed a diagnosis of osteoarthritis of the MTP joint of the big toe. What exactly does that mean? Also last year something similar happened to my right foot and I was diagnosed with gout. I took medication for the gout and it went. Can both of these conditions combine to cause this present ailment?

Answer

The MTP joint is the metatarsophalangeal joint, which refers to the joint between the first metatarsal bone and the first phalanx of the big toe. Put simply, that is the joint at the base of the big toe where the toe is joined to the foot. Osteoarthritis means that arthritic changes have taken place in the joint and it is possible that these changes could be gout related. Gout leads to the accumulation of uric acid crystals in the MTP joint and these crystals can trigger the familiar picture of acute inflammation giving rise to a swollen and tender big toe. Over time repeated attacks can lead to more permanent changes in the joint. You should discuss this matter further with your GP to establish if there is a causal relationship between the gout and the osteoarthritis in your specific case. Sometimes it may be necessary to take medication on an ongoing basis to prevent attacks of gout. Since your GP is more familiar with your overall medical history he or she would be the best person to advise if such treatment was advisable for you.

Question

Would you be kind enough to inform me if a hernia could be misdiagnosed? I suffer from hip and knee pain, and get severe spasms at times. I have been informed by my GP that this is a form of arthritis, but I can relate to many of the symptoms of hernia. I am in my 7Os and a very active person. What do you think?

Answer

You ask if a hernia could be misdiagnosed, to which the simple answer is yes. Doctors are fallible and it is possible to make a wrong diagnosis in virtually any condition you care to mention. It is clear that you believe that you have a hernia yet your doctor has diagnosed arthritis. There is a clear gulf of understanding between your concerns about the possible diagnosis and the actual diagnosis given by your GP. Go back to your GP and tell him that you think you may have a hernia. I am sure that your doctor would be happy to review the situation with you and fill in the gaps between your understanding of the situation and his diagnosis.

Question

I have discomfort in my right hip. It is painful at night and now I am limping. I intend going to the doctor as soon as I can. Is it arthritis or disc trouble? It has been troubling me for 2-3 weeks but this week it has got worse.

Answer

I think you are right to see your GP. Your condition needs to be properly diagnosed. The problem could be in the hip or travelling to the hip from the lower back, a situation we refer to as referred pain. In other words the pain is travelling along a nerve pathway, away from the primary location of the problem. This usually happens with pressure on a nerve such as happens with a “slipped disc”. Arthritis of the hip is a possibility however there are other problems of the hip that do not involve bone damage. The capsule of the joint could be inflamed or there may be a problem in the muscles surrounding the hip joint.

Question

My 77 year old father has been advised by his GP to have a hip operation. My family are terrified of this because of his age and the possible anaesthetic risks. My father is healthy and is not on any medication except a painkiller for the arthritis. Can a hip operation be performed without a general anaesthetic? Also, my father is a heavy smoker all his life. Would he have to give up smoking before the surgery? I fear that this would be very difficult for him. He is in terrible pain.

Answer

Presumably the hip operation you refer to is a total hip replacement. This can be safely performed under epidural, spinal or general anaesthesia. Usually the anaesthetist decides which type of anaesthetic to use depending on the person’s general state of health. Notwithstanding the fact that your father is a smoker he might be fit for a general anaesthetic. However, irrespective of which type of anaesthetic is used smoking still constitutes a risk particularly with regard to the post-operative risk of DVT (deep venous thrombosis). It would be helpful if your father gave up smoking but I fully acknowledge that it can be very difficult to stop after a lifetime’s habit of smoking. Even if your father could reduce his level of smoking pre-operatively that would be beneficial. As you are aware there are many forms of nicotine substitutes available in gum, patch or inhaler form. These might be of help to your father. Any investment he could make in reducing or eliminating smoking would be worthwhile. Finally, I would not be unduly concerned about your father undergoing surgery at 77 years of age. Age alone should not be an excluding factor to deny him an operation that could transform his quality of life. In other words his age is not a contraindication to surgery.

Question

My father suffered a cardiac arrest while being treated in hospital for osteoarthritis. He was on life support for one week but was left with hypoxic brain damage. Three years later he is going downhill, the system as much as his condition has contributed to this. What can you tell me about this type of damage, and what more can I do? He is in a nursing home and I visit most days.

Answer

The term hypoxic brain damage means that your father suffered an injury to his brain due to lack of oxygen, which in turn was triggered by the cardiac arrest. The term cardiac arrest means that his heart had stopped beating and therefore the circulation of his blood was suspended for the duration of the arrest. In such circumstances the brain can become permanently damaged if it is deprived of oxygen and glucose for more than a couple of minutes. If a person were to survive a cardiac arrest their level of recovery would depend on the length of time that the arrest lasted for and which areas of the brain sustained the injury. Predicting long-term recovery from hypoxic brain injury can be difficult. It is difficult for me to give you a more comprehensive answer because you do not outline the extent of your father’s disability. Since he is in a nursing home three years after the event I presume that he is incapable of independent existence and probably will not be returning to the family home. You ask about yourself; “what more can I do”? I certainly would not underestimate the importance and value of what you are already doing. Visiting him and spending time with him, even if there is not much communication with him, may of much more value to him than you realise.

Question

I have received conflicting opinions from two specialists regarding my ten-year-old daughter. One said that my daughter had juvenile arthritis and the other said that she had osteomyelitis. She also has molluscum contagiosum on her bottom. I am very confused. Is there a linkage between these various conditions?

Answer

You have described three separate conditions that are not related to each other in any shape or form. Molluscum contagiosum is a self-limiting viral infection of the skin. Osteomyelitis is a bacterial infection of bone and juvenile arthritis is usually a variant of rheumatoid arthritis that occurs in young people. The treatment of the latter two conditions is quite different therefore you need clarity about the actual diagnosis. I suggest that you discuss this matter with your GP who may need to refer your daughter to a specialist with a particular interest in bone and joint disorders in children.

Question

I am taking methotrexate for arthritis. Can I take difene at the same time?

Answer

Methotrexate is a folic acid antagonist that is being increasingly used in the treatment of arthritis with encouraging results. It belongs to a category of treatments for arthritis known as “disease modifying agents” which means that they can alter the course of the disease rather then simply relieve the symptoms. Difene is a non-steroidal anti-inflammatory drug, which relieves pain and inflammation. Both methotrexate and difene can usually be taken together safely but do clarify this with your GP first.

Question

Is it safe for a pregnant woman to come in contact with a person with rheumatoid arthritis?

Answer

Yes is the answer to your question. Rheumatoid arthritis is not a communicable disease, which means that you cannot pass it on to somebody else. It is a disease process that arises within an individual and is not transmitted. A potential threat may exist if a pregnant woman comes in contact with another person with an infectious disease but even in that case the infectious agent has to be transmitted to the pregnant woman. In other words there is no risk for the pregnant woman to be in the company of an infected person. She also has to acquire the infection. No risk exists for the mother or foetus in the scenario you have outlined.

Question

I was diagnosed with “psoriatic arthritis” over a year ago. My problem began with inflammation of the knee, which was then followed by psoriasis. My knee was so badly inflamed that I had to get an operation to get the synovial lining removed after inflammatory tablets did not work having taken them for several months. It was so swollen and bent that I could not walk. Thankfully after the operation I got movement back. Since then I have been on a drug called salazopyrine. For the past two months I have been getting pains in my fingers, toes and especially in my elbow joints, no attack of psoriasis as yet, but the pain is getting worse. I was tested for rheumatoid but results were negative. I am just afraid of what’s going to happen next. Is it going to spread throughout my body and what does the future hold for me?

Answer

Psoriatic arthropathy is a form of arthritis that occurs in people who have psoriasis. Sometimes the arthritis can precede the development of the typical skin rash that we recognise as psoriasis. The joint condition can occur in approximately 10% of psoriasis sufferers. It is not possible for us to predict which sufferers of psoriasis will develop the arthritis. Both sexes are equally affected. The peak age of onset is between 20 to 30 years old but it can occur at any age. There are no specific diagnostic tests for psoriatic arthropathy. The negative test result for rheumatoid arthritis that you refer to was presumably done to out rule the presence of that particular form of arthritis. Psoriatic arthropathy tends to be a mild form of arthritis but you appear to have suffered a very active form of the condition. It is difficult to give a prognosis to you but in general terms the condition is subject to remission and relapse. Therefore you can expect that you might have intermittent flare-ups of the condition followed by periods of remission. The drug salazopyrine that you refer to in your question is prescribed to attempt to modify the course of the illness. If that drug is not successful for you there are more potent alternatives. Although we cannot cure the condition I would be confident that it should be possible to bring your condition under control.

Question

I was diagnosed with psoriasis 5 months ago. Two months after this diagnosis I developed pain in both wrists which has been there ever since. I was given an anti-inflammatory gel which helps but if I don't use this the pain returns. I am worried about a possibility of psoriatic arthritis. Is this the likely cause?

Answer

Psoriatic arthritis or arthropathy tends to affect the wrists, knees, ankles and fingers. It is certainly possible that it is the cause of your wrist pain. It is estimated that over 80% of the people affected with psoriatic arthritis exhibit signs of nail involvement. These signs typically include pitting of the nails. This looks like multiple small superficial indentations in the surface of the nails. Some people also exhibit detachment of finger or toe nails. If any of these signs are present in your case that would be additional strong evidence of psoriatic arthritis. Between 20 to 30% of people with psoriasis also have arthritis. Psoriasis can start at any age with the arthritis tending to occur after the onset of the skin condition. However, in approximately 19% of cases the arthritis commences first. You can learn more about psoriasis and psoriasis arthritis from our special psoriasis clinic which you can access at: http://www.irishhealth.com/clin/psor/

Question

I have been diagnosed with psoriatic arthritis in my left knee. This causes my knee to become inflamed. What can I do to reduce this inflammation?

Answer

The management of your arthritis depends on the severity of the condition and the frequency of relapse. Minor degrees of inflammation can be satisfactorily treated with standard non-steroidal anti-inflammatory drugs. However, if the inflammation were severe and was occurring on a frequent basis more aggressive drug management might be necessary. This could include the use of methotrexate or salazopyrine, both of which help to modify the course of the disease rather than simply relieving pain and inflammation. If such a course of action were necessary these “disease-modifying agents” could be used in conjunction with the non-steroidal anti-inflammatory drugs.

Question

I have been suffering from rheumatoid arthritis for over a year and my doctor feels it may be worthwhile trying methotrexate. I am not sure about trying this drug, as I believe the side effects can be very severe. What can you tell me about the safety of this drug?

Answer

Methotrexate is a powerful drug and is a very effective agent in controlling rheumatoid arthritis. It is not a painkiller and belongs to a category of drugs known as immunosupressants. Since rheumatoid arthritis is an autoimmune disease it is very logical to treat the disease with a drug that acts directly on the immune system. The term autoimmune means that the immune system of the body is turned inwards against the body itself rather than the usual stance of responding to a threat from outside the body. An immunosuppressant alters the negative potential of the autoimmune process. The potential side effects of methotrexate are well documented but it is important to appreciate that side effects are not inevitable. Not everybody on this drug develops side effects. However, people undergoing treatment undergo regular monitoring of their blood. Particular attention is paid to the blood count and the white blood cell count in particular. If the white cell count falls below a certain level the drug dosage is reduced or stopped altogether. Liver and kidney function are also monitored in order to detect any adverse effects in relation to those organs. As with any powerful drug it is important to strike a balance between potential benefits and the risk of side effects. It is also important to consider that if a drug such as methotrexate is not used the risk exists that the arthritis could progress which could result in significant damage to the joints. Rheumatoid arthritis can be a very aggressive disease in some cases. It is very reasonable to use this drug subject to the routine blood monitoring taking place. Once the monitoring is in place and treatment protocols are followed the drug can be used safely. In other words we know it has the potential of causing side effects and that is the reason why regular monitoring is put in place.

Question

I am suffering from rheumatoid arthritis. I can’t sleep at night. When I go to bed the pain in my hands is terrible. Have you any suggestions on how to stop this?

Answer

Night pain is a common symptom for sufferers with rheumatoid arthritis. I assume that you have told your GP about your pain and are not suffering on in silence. It may be possible to change your medication or even adjust drug dosages to give you better relief. Some drugs have a long duration of action, which means that the pain relieving effect can last for the duration of an average night’s sleep. Some anti-inflammatory painkillers are also available in suppository form. When taken in this form the drug is slowly released into your system throughout the night and this can give good pain relief as well as reducing morning stiffness, which is another troublesome symptom from rheumatoid arthritis. Some sufferers also get relief from wearing wrist splints in bed, which maintains the hand and wrist in a position of ease during the night. Splints are also very helpful in preventing contractures. Splints can be obtained through medical suppliers. Alternatively you could make contact with the Arthritis Foundation of Ireland, which also has a catalogue of various devices that could be very useful for the arthritis sufferer. The Foundation can be contacted at: http://www.arthritis-foundation.com.

Question

What is rheumatoid factor? Is it a kind of debris in the blood or what? What does a high rheumatoid factor in a person with rheumatoid arthritis mean exactly?

Answer

Rheumatoid factor is an antibody that is present in the blood of over 80% of people with rheumatoid arthritis. The test is mainly used in the diagnosis of rheumatoid arthritis and a high level of rheumatoid factor is usually indicative of an aggressive form of the disease. Rheumatoid arthritis is a form of autoimmune disease, which means that the body’s immune system reacts against various structures within the body rather than the more usual stance of defending the body against external threat. The presence of the antibody is not always diagnostic of rheumatoid arthritis. It can also be present with other diseases such as SLE (systemic lupus erythematosus), scleroderma and chronic viral infection. Therefore the significance of a positive test result has to be interpreted in the light of other test results and the patients’ symptoms and physical signs.

Question

I am on daily warfarin because of atrial fibrillation. I know that I am not supposed to take aspirin for headache, since it also thins the blood, but would like to know what analgesic I can take for headache or arthritis pain in the neck.

Answer

Paracetamol would be an appropriate analgesic for you to take since it does not interact with warfarin. If something stronger was required to relieve your pain you should consult with your doctor. There are several prescription analgesics available that can be taken with warfarin. You should also be aware that there is a potential for interaction between alcohol and warfarin.