Archive for category Causes
What is Osteoarthritis or OA and what can cause it?
Posted by onkpg in Causes, OA, Osteoarthritis on February 20, 2012
OA is the most common type of arthritis. It is also called hypertrophic osteoarthritis & degenerative joint disease. It is thought to be a wear and tear disease of the joints, occurring because of the ageing process. But there are many other risk factors which can accelerate the development of osteoarthritis, most importantly overweight.
What initiates Osteoarthritis?
Osteoarthritis occurs because of the loss of cartilage between bones. Cartilage is a firm rubbery tissue that cushions bony ends at the joints and allows bones to glide over each other smoothly. If the cartilage starts breaking down and wearing away, the cushioning effect reduces. This puts more stress and strain on the structure between cartilage and bone called transitional or subchondral bone, thereby leading to the changes resulting in hardening of this tissue. This reduces the smooth transition of the pressure from the cartilage to bone. Thus cartilage starts degenerating in the process. After some part of the cartilage has worn away, the bony ends start rubbing against each other, which causes pain. In the wearing away process, the cartilage fragments are separated and fall into the joint cavity. The human body tries to remove these fragments through the inflammatory process. This is what causes the joints to swell. If one side of cartilage wears down more than the other, it causes deformities which leads to angulations of the affected joints. Pain and stiffness is also experienced because of deranged biomechanical properties of the joints due to the stretch of the structures around the joints. As there remains no cartilage, the bones try to expand at the bony ends to reduce the pressure per unit area by forming bony spurs or extra bone which are called osteophytes visible on the X-Rays.
What are the risk factors which initiate development of Osteoarthritis?
- It may be familial, running in families.
- Overweight increases the risk of OA in the hip, knee, ankle, and foot joints because extra weight causes more wear and tear.
- Fractures or other joint injuries may start OA later in life
- Jobs involving kneeling or squatting for more than an hour a day put a joints at the highest risk. Jobs that involve lifting, climbing stairs, or walking also put you at risk.
- Sports involving direct impact on the joint (such as football), twisting (such as basketball or soccer), or throwing increase the risk of developing osteoarthritis.
- Bleeding disorders causing bleed in the joint, such as Hemophilia.
- Disorders that block the blood supply to a joint lead to avascular necrosis and thereby OA
- Chronic gout, pseudogout, Rheumatoid arthritis and other autoimmune rheumatic diseases also lead to rapid development of the OA.
- Endocrine disorders like hypothyroidism can accelerate the process of developing the OA
- Hypermobility of the joints, which runs in families, especially when associated with heavy work and overweight tends to cause early osteoarthritis.
The Single Best thing you can do for your Health
Posted by onkpg in Causes, Diet, Prevention on December 18, 2011
A great visual message about what I have been saying for all these years to my patients. The single best thing you can do to stay health is ‘Stay Healthy’ – Exercise, Eat Good Food, Stay Fit, Don’t Smoke.
Truth about Rheumatoid Arthritis (RA) – from a doctor
Posted by Dr. OP Garg in Causes, Prevention, RA, Rheumatologist, Symptoms, Therapies on July 20, 2011
Frequency of Rheumatoid arthritis in general population is about 1%. Rheumatoid arthritis (RA) is a chronic inflammation of joints. The deformation continues till the inflammation is adequately controlled. It’s rare for rheumatologists to come across a case where the RA disappears without any modern treatment. Modern anti-rheumatic medications play a crucial role in controlling the symptoms of this disease and in halting the damage done by Rheumatoid Arthritis. Treatment started soon after the diagnosis is most effective. There are about 100 types of Arthritis and RA can often be mistaken for other types of arthritis. Therefore, besides the right treatment for Rheumatoid Arthritis, the right diagnosis is of utmost importance. There is new research happening for RA and new treatments are being developed so the universal knowledge about RA is constantly changing and we still have a lot to learn about this arthritic disease. Yet, there are many misconceptions about this treatable and controllable disease. In this blog post, I’m going to help break these myths.
Myth: Rheumatoid arthritis is just like ‘regular arthritis.’
Truth: RA is not “regular arthritis.”, What is commonly known to the general population as “regular arthritis” is osteoarthritis which results by injury or as a result of normal wear-and-tear on aging joints. Osteoarthritis is the most common joint disease in the senior citizens. By contrast, RA occurs as a result of abnormality in immune system initiated by a so far unknown trigger, the body makes antibodies that attack its own joint tissue. It mostly affects the joints, although other body systems can also be affected. Once disease begins, it causes continuous joint inflammation. In some people it can result in intermittent episodes of painful and swollen joints. In some individuals otherwise doing well with the medications, sudden or acute episodes of joint inflammation results, these are called ‘Flares’.
Myth: Only old people suffer from rheumatoid arthritis.
Truth: RA generally starts between the ages 25 to 55, but even teenagers can develop it.
Myth: Rheumatoid Arthritis is not such a serious disease.
Truth: RA is very serious. It can rapidly damage and deform your joints, involve other organ systems and even shorten your life span by few years, if it’s inadequately treated. Many people downplay RA as just ‘Grandma’s rheumatism,’ and they miss the boat completely. They delay seeing a Rheumatologist, often for months or years and a lot of joint damage happens during that time. RA needs prompt diagnosis and regular treatment to protect joints from harm. RA also increases the risk for certain other conditions like cardiovascular diseases, infections and lung disease etc.
Myth: People with rheumatoid arthritis will end up in a wheelchair because nothing can be done other than consuming pain killers & undergoing physiotherapy.
Truth: RA takes a different course in different people, but most people will go on living independently without pain and joint damage if treated early with modern medicines under the supervision of a rheumatologist (Joint physician).
RA has been known to cause much disability in people and this information comes from 20 to 30-year-old studies done before we started treating early RA with methotrexate, before we had the new biologic and other DMARDs (Disease modifying anti Rheumatic drugs. Extra ordinary strides have been made in recent times towards the excellent treatment of this disease. Today, an overwhelming number of people under treatment for rheumatoid arthritis are doing excellent and they regain their independence and mobility. But these results are only true for patients treated by a Rheumatologist. A recent study suggests that 94% of people with rheumatoid arthritis continued to perform all their normal activities independently even after living 10 years with the disease.
Myth: Most people with RA will be unable to work.
Truth: This myth may have been true in an earlier era, prior to the current treatments. Some people may need allowances at work, or will have to limit some activities during disease flares but a large proportion of people suffering from RA will continue working. In fact, in one large study of people who had had rheumatoid arthritis for more than 10 years, their employment rates were no different than their counterparts without RA.
Myth: As RA treatment can be toxic, it’s best to wait until the disease progresses.
Truth: This can prove to be the most dangerous thing to do. In fact, treating rheumatoid arthritis early prevents joint damage and disability. Ideally, aggressive treatment should start as soon as a positive diagnosis. Delaying treatment can worsen the situation. Numerous studies suggest that early treatment could delay full-blown rheumatoid arthritis from developing in some people. Although medications used to treat RA can have side effects but these side effects can be efficiently detected and treated through close monitoring by the rheumatologist and is definitely not worse than untreated rheumatoid arthritis. Simple blood tests and doctor’s visits can detect many of the serious side effects of rheumatoid arthritis medications.
Myth: Most people with rheumatoid arthritis get cancer too.
Truth: RA itself increases the risk for developing lymphoma (blood cancer), but the risk is low overall. For blood cancer, the lifetime risk is about twice as high in people with RA. It’s not clear why; perhaps because of chronic persistent inflammation. But the fact is that only a small minority of people with RA get blood cancer. For example, in one study, after following over two thousand people with rheumatoid arthritis for about eight years, 11 of them developed blood cancer. Most people with RA do not get cancer. Methotrexate, the new biologics, or both may partially increase this risk. However, you have to weigh the risks and the benefits. Untreated rheumatoid arthritis is frequently devastating, while blood cancer is uncommon, often slowly progressing and treatable. On the bright side, the risk of one cancer, colorectal cancer is actually reduced by up to 40% in people with RA. One theory says that the use of anti-inflammatory medicines called NSAIDs in this condition helps to prevent cancer in the colon.
Myth: Painful, stiff joints from rheumatoid arthritis need to rest most of the day.
Truth: In contrast joints affected by RA need stretching and exercise. Immobility can be counterproductive. Joints become painful and stiff making the patient immobile. Immobility sets up a vicious cycle. Muscles around a joint contribute a large part of the joint’s strength and stability and these require regular activity to stay healthy. Everyone with rheumatoid arthritis can perform some kind of exercise. Stretching exercises require minimal exertion and help keep joints flexible. Low-impact aerobic exercise improves joint health. High-impact exercises are to be avoided.
Rheumatoid Arthritis (RA) Explained Part II
Posted by Dr. OP Garg in Causes, Prevention, RA, SLE / Lupus on May 9, 2011
Is RA Genetic?
This issue has yet not been resolved. RA is not a genetic disease but you can say that RA patients generally have genes which may facilitate the production of certain antibodies after exposure to certain triggers (in environment, stress and other unknown triggers). Even if a person has susceptible genes, it is not necessary to develop the disease without triggers. So, generally the disease is multifactorial.
How common is the misdiagnosis of RA?
That is quite common especially by Non-rheumatologists. Laymen and many doctors who don’t specialise in rheumatology think that there is only one type of arthritis. But, in fact arthritis should be considered only as a symptom arising out of 100 causes. RA gets misdiagnosed so often as Osteoarthritis and Gout. And sometimes nonspecific aches and pains also get misdiagnosed as RA. For example in cases of Diabetes, hands get stiff and mildly painful but get diagnosed as a case of RA.
Is it seasonal, will it flare up in change of seasons?
Yes, for unknown reasons, RA tends to flare up periodically, despite consumption of appropriate medications. Adjustment of medications or additions in prescription like steroids are required to control of symptoms.
Will changing our current lifestyle help?
People should reduce weight to decrease the burden on the dysregulated immune system. Patient needs regular excercise within the limit of tolerance to maintain the muscle strength and to maintain the range of motion. Smoking is big NO, NO. Always have a positive attitude. Consumption of fresh fruits and vegetables will always be good. Meditation is recommended.
Is it a condition with which a patient has to live with like Diabetes and it can only be moderated and not cured?
Yes, at present there is no cure for this disease as there is no cure for other majority of diseases except a few infections. As in the case of diabetes, a proper control of blood sugar can be achieved and the damage of various organ systems can be avoided by doing this. In the same way, in case of RA, target of the treatment is controlling the autoimmune inflammation by appropriate medicines so that damage to the joints can be halted and pain can be ameliorated. And as in case of Diabetes, the job of controlling blood sugar is best done by an Endocrinologist, for RA, it is best done by a Rheumatologist.
What will be repurcussion, if RA is not treated or countered?
If Inflammation caused by RA is not controlled, it will continue to damage the affected joints and it can cripple you within a few years, and with proper control of inflammation by a Rheumatologist, joints can be saved from the adverse affect of this inflammation for decades and patients can continue walking through their lifetime without undergoing joint replacement. Early correct diagnosis and treatment by Rheumatologist is of paramount importance in modern times.
Frozen Shoulder, how and why it is developed and how do you treat it
Posted by Dr. OP Garg in Causes, Symptoms, Therapies on October 19, 2010
What is frozen shoulder?
Frozen shoulder, also called adhesive capsulitis is a medical condition in which the movement of the shoulder is severely restricted and is painful. The shoulder is so stiff that even the minor movements becomes difficult like lifting arm above shoulders or touching face during routine activities.
Why you develop a frozen shoulder?
This commonly results after an injury to the shoulder due to lack of use due to pain occurring during movement of shoulder. This condition can also be due to decreased movements secondary to inflammation caused by autoimmune disease like rheumatoid arthritis. Lack of lubricating synovial fluid due to degenerative disease of cartilage which occurs in osteoarthritis.
What are the risk factors for developing frozen shoulder?
Risk factors are diabetes, stroke, accidents, lung disease and heart disease and age more than 40.
Can frozen shoulder be treated?
Cause of development of frozen shoulder is pain which restrict the movement of shoulders thus causing the stiffness of the tissue over time. Hence, reducing joint pain and thereby restoring the shoulder movementa is the aim of treatment, and this may include nonsteroidal anti-inflammatory drugs, heat, and gentle exercises. In case all these prove unsuccessful, intra articular steroid injections in case of inflammatory causes can be the next line of treatment. In some instances, surgery may also be necessary. In my experience supra scapular nerve block to remove pain, which facilitate the joint motion, has proved very effective. My most of the cases regain the full range of movement of shoulder after this procedure.
Depression causes heart disease in SLE patients: Treat early
Posted by Dr. OP Garg in Causes, SLE / Lupus on October 16, 2010
Systemic Lupus Erythematosus SLE also called Lupus, is a chronic inflammatory disease affecting the skin, joints, kidneys, lungs, nervous system, and/or other organs of the body, either simultaneously or at different times. Most commonly found symptoms are skin rashes and arthritis. It mostly affects women, in their prime child-bearing age. Depression is often associated with Lupus and can cause an early development of Cardio vascular disease in the form of Atherosclerosis (the hardening of vessels) according to a research presented at the American College of Rheumatology Annual Scientific Meeting in Philadelphia.
Two independent research teams studied depression as a risk factor for additional health problems in Lupus patients. In the first study, researchers evaluated the biological and psychological risk factors associated with Atherosclerosis—the presence of carotid plaque or coronary artery calcium— in women with lupus.
The researchers, from the University of Pittsburgh, examined 161 women with lupus who had no prior history of cardiac events. Participants were examined for cardiovascular risk factors, lupus activity and depression. Additionally, they scanned their coronary arteries to determine the presence of coronary artery calcium—and performed a carotid artery ultrasound to detect the presence of plaque in the arteries.
Researchers found that 27 percent of the women studied had symptoms of depression and 63 percent of the women studied had Atherosclerosis. They also determined that women with lupus who showed symptoms of depression were at nearly a four-fold risk for having Atherosclerosis. This is very exciting, because depression can be treated. If we help people with lupus to reduce their depressive symptoms in addition to helping them with general disease management, then maybe this will reduce their risk for developing a cardiovascular disease.
In the second study, researchers from the University of California, San Francisco, noted that while the link between cardiovascular disease and depression is well established in the general population, few studies evaluated this relationship specifically among people with Lupus. They followed 725 patients with lupus over five years. Researchers noted that living in poverty, traditional cardiovascular risk and disease, and lupus disease activity were all significant predictors of depression in the participants. This study highlights the relationship among cardiovascular diseases and depression in lupus.
Conclusion: Depression is associated with sub clinical Atherosclerosis in women with SLE, independent of age, education, hypertension, CRP and adiposity. This is important as in that mental health factors are modifiable. Interventions that reduce depressive symptoms may forestall cardiovascular disease in SLE.
This is good news for the medical fraternity as now we know that doctors and family members have the potential to alleviate depression in order to improve the health of Lupus patients by preventing them from developing a heart disease.
For more info, see www.rheumatology.org/annualGene switches turn obesity on
Posted by Dr. OP Garg in Causes on October 3, 2010
A genetic study reveals that chemical changes to our DNA may make us obese.
It is known that sometime in life, methyl chemical groups attach to some of a person’s DNA and can act as dimmer switches. Some of these genetic changes are genetically determined. Others appear to happen very early in life and are pretty much permanent. Still others happen through the life span, and may or may not be permanent. Identical twins have identical DNA when they are conceived but as they age, the chemical attachments to their DNA grow more and more different.
Can these changes make a person more or less vulnerable to disease? To find out, Feinberg and colleagues looked at 4.5 million DNA sites in 74 elderly Icelandic people participating in a gene study. Participants gave blood samples twice, with 11 years between measurements.
Some of the people in the study were obese. Others were not. Feinberg and colleagues found 13 changes that were much more common in the obese people. Four of these changes remained the same in the two tests 11 years apart. The changes were in genes scattered across the human genome.
The researchers suggest that if their findings are confirmed — and if the changes begin in childhood and remain stable — tests might be able to identify children at highest risk of growing up obese.
Feinberg and colleagues report their findings in the Sept. 15 online issue of Science Translational Medicine.
Writer’s Cramp, its symptoms and treatments
Posted by Dr. OP Garg in Causes, Healthcare Personalised, Symptoms, Therapies on September 12, 2010
Writer’s cramp is a cramp or spasm affecting muscles of the hand or fingers. The affected muscles will depend on the task (writing) and the posture of an individual during this repeated task. The symptoms will appear only during this particular movement like writing or playing the piano. Sadly, it is also known to spread and affect many tasks. There are two kinds of writer’s cramp – simple and dystonic.
Simple Writer’s Cramp – People suffering from simple writer’s cramp have difficulty with only one specific task. For example, when the individual picks up a pen to start writing, after writing a few words, the cramped posture of the hand begin to slow down the speed and accuracy of writing.
Dystonic Writer’s Cramp – Symptoms will occur not only during writing but also when performing other tasks like drinking tea/coffee, applying makeup, ironing clothes.
Symptoms
Common symptoms include excessive gripping of the pen, flexing of muscles, and abnormal movement of the wrist or elbow. The individual would often find it difficult to hold on to the pen and keeps dropping the pen. Mild discomfort may occur in the fingers, wrist, or forearm. It affects people between the ages of 30 and 50 years, both men and women. A similar situation can be observed in musicians playing certain instruments, typists and golfers. While it is not fatal or life threatening in any way, it definitely can be a chronic disorder and how it progresses after that is difficult to tell. As is with other diseases, the sooner it is treated, lesser will be the complications and after effects.
Treatment
Treatments are designed in such a way that it helps in the lessening of spasms, pain and disturbed postures or functions. Most therapies depend on individual symptoms. No single strategy can be appropriate in every case. What doctors try to achieve by the treatment is to give the individual greatest benefits while incurring the fewest risks. It allows you to lead a productive life by being able to perform tasks normally. Achieving a satisfactory regimen in every case, requires patience on the part of both the affected individual and the physician.
Doctors approach the treatment from three angles – oral medications, botulinum toxin injections and/or surgery. These therapies can be used alone or in combination depending on the acuteness and complexity of the case and an individual’s requirement. A lot of times, additional care like physical therapy and speech therapy are also recommended. It’s important to add here that, there is currently no known cure for dystonia, although, researchers and doctors are gaining a better understanding of Writer’s Cramp and developing new approaches to treatments.
Some steps followed in treatments are given below. You can also start following them in your daily lives if you feel you are prone to Writer’s Cramp someday due to your profession:
- Alter the grip of your pen and/or try increasing the diameter of the pen.
- Use other writing devices or other means of transcription, such as typing or dictation.
- Behavioral changes may help.
- Botulinum toxin injections seem to have the best results.
However, you must consult a neurologist for proper care.
Rheumatoid Arthritis and how to detect it in the early stages
Posted by Dr. OP Garg in Causes, RA, Rheumatologist on August 5, 2010
Rheumatoid Arthritis, often referred to as RA is an inflammatory diseases but not life threatening. However, you can say that it is life reducing, if not controlled at the right time. With modern medicines, inflammation caused by Rheumatoid Arthritis (RA) can be effectively controlled by modern medicines. However, it cannot be cured.
Causes of Rheumatoid Arthritis
- The cause of rheumatoid arthritis is unknown.
- Infectious agents such as viruses, bacteria, and fungi have long been suspected, but none has been proven as the cause.
- It is believed that the tendency to develop Rheumatoid arthritis might be genetically inherited.
- It is also suspected that certain infections or factors in the environment might trigger the activation of the immune system in susceptible individuals. This misdirected immune system then attacks the body’s own tissues. This leads to inflammation in the joints and sometimes in various organs of the body, such as the lungs or eyes.
- Environmental factors also seem to play some role in causing rheumatoid arthritis. For example, scientists have reported that smoking tobacco increases the risk of developing rheumatoid arthritis.
Symptoms to recognise Rheumatoid Arthritis at an early stage
The symptoms differ from individual to individual but some of the commons symptoms in patients that have reported to me are:
- RA is recognised by early morning stiffness of the joints of hands and feet.
- Joint swelling and pain last for more than 6 weeks.
- It may be associated with fever and fatigue.
- Loss of weight
If these symptoms occur, one should approach a Rheumatologist immediately to confirm the diagnosis and further management of the disease. He might suggest blood tests as certain antibodies related to RA are found in the blood and can be recognised by blood tests.
Prevalence of Fibromyalgia in Diabetes Mellitus and Obesity
Posted by Dr. OP Garg in Causes, Fibromyalgia on August 2, 2010
For years now, in my medical practice, I’ve believed that Fibromyalgia results from recurrent micro-sprains and strains of myofacial junctions in patients with weak biomechanics and hyper mobility associated with obesity or being overweight. And whoever put into practice, my advice to reduce their weight, their symptoms of fibromyalgia significantly resolved. Please read on the abstract of a yet to be published study, which now confirms my deep rooted belief (by experience, of course).
Abstract
To determine the prevalence of fibromyalgia in diabetes mellitus and obesity, 121 consecutive patients have been observed: 27 with obesity (6 males and 21 females; mean age 57 years, range 20-57; mean body mass index [BMI] 34); 88 with type 2 diabetes mellitus (T2DM; 40 males and 48 females; mean age 63 years, range 44-78; mean BMI 28.8; mean glycated haemoglobin [HbA1c] in the last year 8.3%); 6 with type 1 diabetes mellitus (T1DM; 2 males and 4 females; mean age 52 years, range 26-76; mean BMI 24.5; mean HbA1c < 7%). An original questionnaire has been proposed (answer yes/not) as follows:
1. chronic (more than 3 months) and diffuse musculoskeletal pain
2. sleep disturbances
3. generalized fatigue
4. paresthesias at the extremities
5. swollen impression at hands and feet
6. symptoms referred to irritable bowel syndrome
7. headache
8. symptoms change related with environmental climatic variations and/or exercise.
A chronic and diffuse musculoskeletal pain has been reported by 62% of patients as well as in 9% of patients 11/18 positive tender points have been documented. In the patients with a BMI less that 26 the diagnosis of fibromyalgia was negative. Our data seem to reveal the presence of a significant clinical association between obesity, diabetes mellitus and fibromyalgia.
PMID: 12677786 [PubMed - indexed for MEDLINE]