Ankylosing Spondylitis
Arthritis
Consult Now Signs and symptoms of Arthritis

The word “arthritis” literally means joint inflammation (“arthr-” means joint; “-itis” means inflammation). It refers to more than 100 different diseases. These diseases usually affect the area in or around joints, such as muscles and tendons. Some of these diseases can also affect other parts of the body, including the skin and internal organs. Arthritis usually causes stiffness, pain and fatigue. The most common diseases mong arthritis are osteoarthritis, rheumatoid arthritis, and gout and increasingly, fibromyalgia.
Many types of arthritis show signs of joint inflammation: swelling, stiffness, tenderness, redness or warmth. These joint symptoms may be accompanied by weight loss, fever or weakness.

When these symptoms last for more than two weeks, inflammatory arthritis, such as rheumatoid arthritis may be the cause. Joint inflammation may also be caused by infection, which can lead to septic arthritis. Degenerative joint disease (osteoarthritis) is the most common type of arthritis; joint inflammation is not a prominent feature of this condition.

Bones, Affections of
Ganglion Cyst
Juvenile Rheumatoid Arthritis
Consult Now Signs and symptoms of Juvenile Rheumatoid Arthritis

Chronic, inflammatory, systemic disease which may cause joint or connective tissue damage & visceral lesions throughout the body characterised by fever, rash, hepato-spleenomegaly & arthritis in children.
It is a persistent inflammatory arthritis (> 6 weeks) that begins before age 16 for which no specific cause can be found.

ETIOLOGY of Juvenile Rheumatoid Arthritis:

• Exact cause is unknown.
• Evidence points to autoimmune aetiology.
• Associated with physical or emotional stress.
• Age: Under 16 years of age.
• Sex: Common in girls.
CLINICAL FEATURES of Juvenile Rheumatoid Arthritis
Symptoms
• Onset: acute or insidious.
• Fever.
• Swelling & pain in joints.
• Poor appetite.
• Loss of weight.
• Child refuses to walk without being able to explain why.
• Irritability.
• Listlessness.

Signs:

• Fever: remittent.
• Rash on trunk, limbs as patches of erythema.
• Hepatomegaly.
• Splenomegaly.
• Affected joints hot, tender & swollen.
• Effusion of joint.
• Limitation of joint movement.

GENERAL MANAGEMENT of Juvenile Rheumatoid Arthritis:

• Reassurance.
• Emotional support.
• Encourage child & family to maintain positive outlook.
• Rest during acute stage.
• Splinting of joint.
• Gentle passive joint movement.
• Corrective support to deformity.

Lithaemia / American Gout
Pott's disease / Spinal TB
Prolapsed Intervertebral Disc
Consult Now Signs and symptoms of Prolapsed Intervertebral Disk

When you have a prolapsed disc (commonly called a ‘slipped disc’), a disc does not actually ‘slip’. What happens is that part of the inner softer part of the disc (the nucleus pulposus) bulges out (herniates) through a weakness in the outer part of the disc. A prolapsed disc is sometimes called a herniated disc. The bulging disc may press on nearby structures such as a nerve coming from the spinal cord. Some inflammation also develops around the prolapsed part of the disc.
Any disc in the spine can prolapse. However, most prolapsed discs occur in the lumbar part of the spine (lower back). The size of the prolapse can vary. As a rule, the larger the prolapse, the more severe the symptoms are likely to be.

ETIOLOGY:

• Herniation of intervertebral disc.
• Senile degeneration of disc.
• Obesity.
• Sudden jerk.
• Sprain.
• Trauma to spine.
• Commonly affected discs: L4-L5, L5-S1.
CLINICAL FEATURES of Prolapsed Intervertebral Disc

Symptoms:

• Onset- sudden.
• History of-
1. Over-straining of lumber spine.
2. Lifting weight.
3. Violent coughing.
4. Sudden stooping or twisting.

PAIN:

• Location- in lower back.
• Radiates to gluteal region, back of thigh, calf, foot.
• Character- agonising.
• Worse by- movement, coughing, stooping, turning, walking, bending forwards.
• Better by- rest.
• Tingling, numbness in calf, foot.

INVESTIGATIONS:

X-Ray lumbo-sacral spine
• Narrowed disc spaces.
• Loss of lumber lordosis.
• Compensatory scoliosis.
CT scan lumber spine
• Outline of soft tissues.
• Bulging out disc.
MRI lumber spine
• Intervertebral disc protrusion.
• Compression of nerve root.

GENERAL MANAGEMENT of Prolapsed Intervertebral Disc (Slipped Disc):

• Rest to spine for at least 6-12 weeks.
• Use of hard bed.
• In severe cases- traction is applied to leg or pelvis, provided there is no cord compression.
• Regain mobility gradually.
• Restrict jerky movements.
• Avoid- forward bending, lifting weight.
• Reduce weight if obese.

Rheumatoid Arthritis
Rheumatism
Sjogren's Syndrome
Consult Now What is Sjogren’s syndrome?

Sjogren’s syndrome features a combination of dry eyes, dry mouth, and another diseases of the connective tissues, most commonly rheumatoid arthritis.
Sjogren’s syndrome is an autoimmune disease, characterized by the abnormal production of antibodies in the blood that are directed against various tissues of the body. This particular autoimmune illness is caused by inflammation in the glands of the body. Inflammation of the lacrimal glands leads to decreased water production for tears and eye dryness. Inflammation of salivary glands leads to mouth dryness.
Sjogren’s syndrome that involves the gland inflammation (resulting in dryness of the eyes and mouth, etc.), but not associated with a connective tissue disease, is referred to as primary Sjogren’s syndrome. Secondary Sjogren’s syndrome involves not only gland inflammation, but is associated with a connective tissue disease, such as rheumatoid arthritis, systemic lupus erythematosus, or scleroderma.

Cause of Sjogren’s syndrome:

While the exact cause of Sjogren’s syndrome is not known, there is growing scientific support for genetic (inherited) factors. The illness is sometimes found in other family members. It is also found more commonly in families that have members with other autoimmune illnesses, such as systemic lupus erythematosus, autoimmune thyroid disease, juvenile diabetes, etc. 90% of Sjogren’s syndrome patients are female.

Symptoms of Sjogren’s syndrome:

Symptoms of Sjogren’s syndrome can involve the glands, as above, but there are also possible affects of the illness involving other organs of the body (extraglandular manifestations).

When the tear gland (lacrimal gland) is inflamed from Sjogren’s, the resulting eye dryness can progressively lead to eye irritation, decreased tear production, “gritty” sensation, infection, and serious abrasion of the dome of the eye (cornea).
Inflammation of the salivary glands can lead to mouth dryness, swallowing difficulties, dental decay, gum disease, mouth sores and swelling, stones and/or infection of parotid gland inside of the cheeks.

Other glands that can become inflamed, though less commonly, in Sjogren’s syndrome include those of the lining of the breathing passages (leading to lung infections) and vagina (sometimes noted as pain during intercourse).

Extraglandular (outside of the glands) problems in Sjogren’s syndrome include joint pain or inflammation (arthritis), Raynaud’s phenomenon, lung inflammation, lymph node enlargement, kidney, nerve, and muscle disease. A rare serious complication of Sjogren’s syndrome is inflammation of the blood vessels (vasculitis), which can damage the tissues of the body that are supplied by these vessels.

A common disease that is occasionally associated with Sjogren’s syndrome is autoimmune thyroiditis (Hashimoto’s thyroiditis), which can lead to abnormal hormone levels detected by thyroid blood tests. Heartburn and difficulty swallowing can result from gastroesophageal reflux disease (GERD), another common condition associated with Sjogren’s syndrome. A rare disease that is uncommonly associated with Sjogren’s syndrome is primary biliary cirrhosis, an immune disease of the liver that leads to scarring of the liver tissue. A small percentage of patients with Sjogren’s syndrome develop cancer of the lymph glands (lymphoma). This usually develops after many years with the illness. Unusual gland swelling should be reported to the physician.

Sjogren’s syndrome – How Is It Diagnosed?

• Medical exam
• Lab tests
• Chest X-rays
• Lip biopsy
• Schirmer test/slit-lamp exam (measures dryness of eyes)
• Urine test (for kidney function)

Sjogren’s syndrome Treatment Conventional Therapy:

The treatment of patients with Sjogren’s syndrome is directed toward the particular areas of the body that are involved and complications, such as infection. There is no cure for Sjogren’s syndrome.
Dryness of the eyes can be helped by artificial tears, eye lubricant ointments at night, and minimizing the use of hair dryers.
The dry mouth can be helped by drinking plenty of fluids, humidifying air, and good dental care to avoid dental decay. The glands can be stimulated to produce saliva by sucking on sugarless lemon drops or glycerin swabs. Additional treatment for the symptom of dry mouth are prescription medications that are saliva stimulants, such as pilocarpine (Salagen) and cevimeline (Evoxac). Vitamin E oil has been used with some success.
Salt water (saline) nasal sprays can help dryness in the passages of the nose. Vaginal lubricant should be considered for sexual intercourse.

Spinal Affections
Consult Now Signs and symptoms of Spinal Affection

Ankylosing Spondylitis (AS) is a member of a group of rheumatic diseases that affect the spinal column known as ‘spondyloarthropathies’. Ankylosing spondylitis is a chronic, inflmammatory rheumatic disease that causes arthritis of the spine and sacroiliac joint (the joint at the base of the spine where the spinal column joins the pelvis). The chronic inflammation and irritation of the spinal joints (vertebrae) can eventually cause the vertebrae to fuse together, a condition known as ‘ankylosis’.
Ankylosing spondylitis is a debilitating condition that eventually can cause loss of spinal mobility and function and, therefore, severely impact a person’s quality of life. However, ankylosis may also cause inflammation and pain in other parts of the body :

• where your tendons and ligaments attach to bones.
• joints between your ribs and spine.
• joints in your hips, shoulders, knees and feet.
• your eyes, heart, lungs and kidneys.

Spinal Affections
Consult Now Signs and symptoms of Spinal Affection

Ankylosing Spondylitis (AS) is a member of a group of rheumatic diseases that affect the spinal column known as ‘spondyloarthropathies’. Ankylosing spondylitis is a chronic, inflmammatory rheumatic disease that causes arthritis of the spine and sacroiliac joint (the joint at the base of the spine where the spinal column joins the pelvis). The chronic inflammation and irritation of the spinal joints (vertebrae) can eventually cause the vertebrae to fuse together, a condition known as ‘ankylosis’.
Ankylosing spondylitis is a debilitating condition that eventually can cause loss of spinal mobility and function and, therefore, severely impact a person’s quality of life. However, ankylosis may also cause inflammation and pain in other parts of the body :

• where your tendons and ligaments attach to bones.
• joints between your ribs and spine.
• joints in your hips, shoulders, knees and feet.
• your eyes, heart, lungs and kidneys.

Synovitis
Consult Now Inflammation of a synovial membrane:

Synovitis is the inflammation of a synovial (joint-lining) membrane, usually painful, particularly on motion, and characterized by swelling, due to effusion (fluid collection) in a synovial sac.

Synovitis is a major problem in rheumatoid arthritis, in juvenile arthritis, in lupus, and in psoriatic arthritis. It may also be associated with rheumatic fever, tuberculosis, trauma, or gout.

Rheumatoid arthritis involves synovitis. In rheumatoid arthritis, the synovial membrane lining the joint becomes inflamed. The cells in the membrane divide and grow and inflammatory cells come into the joint from other parts of the body.

Symptoms of Synovitis:

Because of the mass of inflammatory cells in rheumatoid arthritis, the joint appears swollen and feels puffy or boggy to the touch. The increased blood flow that is a feature of the inflammation makes the joint warm. The cells release enzymes into the joint space which causes further pain and irritation. If the process continues for years, the enzymes may gradually digest the cartilage and bone of the joint leading to chronic pain and degenerative changes.

Sciatica
Consult Now Signs and symptoms of Sciatica:

Sciatica refers to pain that begins in the hip and buttocks and continues all the way down the leg. This condition is often accompanied by low back pain, which can be more or less severe than the leg pain. The term “sciatica” indicates that the sciatic nerve, which travels from the lower back through the buttocks and into the leg, is thought to be the cause of the pain in this condition. True sciatica is a condition that occurs when a herniated lumbar disc compresses one of the contributing roots of the sciatic nerve. This type of low back pain is less common than other causes and conditions that produce back pain.

The most common symptom of true sciatica is posterior thigh, lower leg or foot pain that can be much worse than the accompanying lower back pain. Usually a patient will experience moderate to severe pain, which begins in the buttocks and runs down through the leg or foot. It is important to know that true sciatica will produce pain that radiates beyond the knee. Often a patient will have a previous history of lower back pain beginning a few days or weeks before the leg pain occurs, then the leg pain becomes worse than the back pain, and in some cases the back pain will completely disappear.

However, in the case of longstanding history of sciatica, the pain may gradually become localized to the buttocks and back of the leg. In this situation, the patient may have a vague aching pain that does not reach all the way to the lower leg or foot, though it may have done so earlier in the course of the disease