Arthritis

Arthritis

Arthritis means joint inflammation, but the term is used to describe around 200 conditions that affect joints, the tissues that surround the joint, and other connective tissue. It is a rheumatic condition.

Overview

The most common form of arthritis is osteoarthritis. Other common rheumatic conditions related to arthritis include gout, fibromyalgia, and rheumatoid arthritis (RA).

Rheumatic conditions tend to involve pain, aching, stiffness, and swelling in and around one or more joints. The symptoms can develop gradually or suddenly. Certain rheumatic conditions can also involve the immune system and various internal organs of the body. Some forms of arthritis, such as rheumatoid arthritis and lupus (SLE), can affect multiple organs. Arthritis is more common among adults aged 65 years or older, but it can affect people of all ages, including children.

Symptoms

Arthritis:

  • Joint pain.
  • Stiffness when you wake up or after you’ve been sitting for a while.
  • Tenderness - the area is sore when touched.
  • Lack of movement - the joint won’t complete its full range of motion.
  • Grating - the patient might feel things rubbing together inside the joint.
  • Bone spurs - lumps of bone form around the joint.

Rheumatoid Arthritis:

  • Joint pain, swelling and tenderness for 6 weeks or longer.
  • More than one joint affected, especially small joints in the hands, wrists, and feet.
  • The same joints on both sides of the body are affected.

Causes

  • Cartilage degradation: Cartilage is a firm but flexible connective tissue in a human being’s joints. It protects the joints by absorbing the pressure and shock created when one moves and puts stress on them. A reduction in the normal amount of this cartilage tissue cause arthritis.
  • Osteoarthritis: Normal wear and tear causes OA, one of the most common forms of arthritis. An infection or injury to the joints can exacerbate this natural breakdown of cartilage tissue. Your risk of developing OA may be higher if you have a family history of the disease.
  • Rheumatoid Arthritis: Another common form of arthritis, RA, is an autoimmune disorder. It occurs when the body’s immune system attacks the tissues of the body. These attacks affect the synovium, a soft tissue in the joints that produces a fluid that nourishes the cartilage and lubricates the joints. The exact cause of the immune system’s attacks is unknown. But scientists have discovered genetic markers that increase your risk of developing RA fivefold.

Diagnosis

  • Reviewing the medical history and current symptoms of a patient.
  • A doctor can perform arthrocentesis (the procedure of removing fluid from a joint) and analyze it for inflammation levels in the blood and joint fluids, which can help determine what kind of arthritis one has. Blood tests that check for specific types of antibodies like anti-CCP (anti-cyclic citrullinated peptide), RF (rheumatoid factor), and ANA (antinuclear antibody) are also common diagnostic tests.
  • Imaging scans such as X-ray, MRI, and CT scans, produce an image of bones and cartilage. This gives a clear picture and can rule out other causes of symptoms, such as bone spurs.

Treatment

Treatment for arthritis aims to control pain, minimize joint damage, and improve or maintain function and quality of life. A range of medications and lifestyle strategies can help achieve this and protect joints from further damage. Treatment might involve:

  • Medications.
  • Non-pharmacologic therapies.
  • Physical or occupational therapy.
  • Splints or joint assistive aids.
  • Patient education and support.
  • Weight loss.
  • Surgery, including joint replacement.

Medication

Non-inflammatory types of arthritis, such as osteoarthritis, are often treated with pain-reducing medications, physical activity, weight loss if the person is overweight, and self-management education. Medications will depend on the type of arthritis. Commonly used drugs include:

  • Analgesics: These reduce pain, but have no effect on inflammation. Examples include acetaminophen (Tylenol), tramadol (Ultram) and narcotics containing oxycodone (Percocet, Oxycontin) or hydrocodone (Vicodin, Lortab). Tylenol is available to purchase online.
  • Non-steroidal anti-inflammatory drugs (NSAIDs): These reduce both pain and inflammation. NSAIDs include available to purchase over-the-counter or online, including ibuprofen (Advil, Motrin IB) and naproxen sodium (Aleve). Some NSAIDs are available as creams, gels or patches which can be applied to specific joints.
  • Counterirritants: Some creams and ointments contain menthol or capsaicin, the ingredient that makes hot peppers spicy. Rubbing these on the skin over a painful joint can modulate pain signals from the joint and lessen pain. Various creams are available to purchase online.
  • Disease-modifying antirheumatic drugs (DMARDs): Used to treat RA, DMARDs slow or stop the immune system from attacking the joints. Examples include methotrexate (Trexall) and hydroxychloroquine (Plaquenil).
  • Biologics: Used with DMARDs, biologic response modifiers are genetically engineered drugs that target various protein molecules involved in the immune response. Examples include etanercept (Enbrel) and infliximab (Remicade).
  • Corticosteroids: Prednisone and cortisone reduce inflammation and suppress the immune system.
Few of the diseases which can be treated using infusion therapies are :
Vasculitis and Behcet Disease

Vasculitis and Behcet's Disease

What is vasculitis?

It is an inflammation of the blood vessels.  Blood vessels sometimes stretch, become weak, increase in size or become narrow, and sometimes close. Vasculitis can affect people of all ages but it is more prevalent in certain age groups more often than others.  Some types may be mild and some may be severe affecting the internal organs.

What is Behcet's disease?

Behçet disease is a rare vasculitic disorder that is characterized by a triple-symptom complex of recurrent oral aphthous ulcers, genital ulcers, and uveitis. 

Symptoms

Behcet’s syndrome or vasculitis  can exhibit various symptoms. They include:
  1. Eye – anterior and posterior uveitis resulting in blurry vision, light sensitivity, and redness of the eyes.
  2. Mouth – painful ulcers.
  3. Skin – skin lesions that resemble acne in appearance anywhere on the body.
  4. Lungs – aneurysms that can lead to bleeding.
  5. Joints – arthritis or arthralgias.
  6. Brain – headaches, confusion, strokes, personality changes, meningitis.
  7. Genitals – painful genital lesions.
  8. Gastrointestinal Tract – ulcerations anywhere in the GI tract.

Diagnosis

By looking at the medical history and some physical examination,  few diagnostic test and procedures, a doctor could rule out mimic vasculitis from the actual ones. Few of the tests are :
  1. Blood tests - These tests look for signs of inflammation, such as a high level of C-reactive protein. A complete blood cell count can tell whether you have enough red blood cells. Blood tests that look for certain antibodies — such as the anti-neutrophil cytoplasmic antibodies test — can help diagnose vasculitis.
  2. Urine tests - These tests may reveal whether the urine contains red blood cells or has too much protein, which can signal a medical problem.
  3. Imaging tests - Noninvasive imaging techniques can help determine what blood vessels and organs are affected. They can also help the doctor monitor whether the drug is responding. Imaging tests for vasculitis include X-rays, ultrasound, computerized tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET).
  4. X-rays of your blood vessels (angiography) - During this procedure, a flexible catheter, resembling a thin straw, is inserted into a large artery or vein. A special dye (contrast medium) is then injected into the catheter, and X-rays are taken as the dye fills the artery or vein. The outlines of the blood vessels are visible on the resulting X-rays.
  5. Biopsy - This is a surgical procedure in which a small sample of tissue from the affected area of the body is sent for testing of vasculitis.

Additional Tests

  1. ANA (anti-nuclear antibodies).
  2. Complement levels.
  3. ESR.
  4. CRP.
  5. ANCA.

Treatment

The main goal of treating vasculitis is to reduce inflammation in the affected blood vessels. People who have severe vasculitis are treated with prescription medicines. People who have mild vasculitis may find relief with over-the-counter pain medicines, such as acetaminophen, aspirin, ibuprofen or naproxen.

Medication

RITUXAN
SOLUMEDROL

 
Ankylosing Spondylitis

Ankylosing Spondylitis

What is ankylosing spondylitis?

It is a rare type of arthritis which causes pain and stiffness in spine. It starts with the back but spreads to the neck and damages the joints and other parts of the body.  This causes inflammation of the spinal bones and other tissues. It is not a curable condition and the medication can ease the pain and help in sustaining with more strength. 

Causes

Genetic root is the main cause for AS. The gene unleashes the immune system to attack certain bacteria in the body and sets off AS symptoms. Women tend go get affected lesser than men and they have a milder form of AS.

Symptoms

  1. Mild aches in the lower back or buttocks that come and go.
  2. Pain that is  worse in the morning or after sitting for a long time.
  3. Inflexible spine that curves forward.
  4. Pain and stiffness in the shoulders, hips, hands, or even the Achilles tendon in the heel.
  5. Tiredness.
  6. Swelling in the joints.
  7. Pain in the thigh, foot, or heel.

Diagnosis

No single tests  can be performed to confirm AS. Doctors rely on symptoms and physical examination and blood tests. X-rays help but not to perfection because not always does joint damage show up in X-rays.

Treatments

Staying active is one of the keys to managing AS, and also to keep it from worsening. Medications may help some people.

Exercise: Staying active may even banish the pain without medication. 

Physiotherapy: Physiotherapy helps to keep the spine stable.

Medication

Prescription of  nonsteroidal anti-inflammatory drugs (NSAIDs) like indomethacin (Indocin) help most people with AS. 

Infusion medications used are:

Inflammatory Myositis

Inflammatory Myositis

What is myositis?

Myositis is used to refer to a disease involving chronic inflammation of the muscles, often occurring together with other symptoms. This condition is also known as idiopathic inflammatory myopathy (IIM).

Causes

Inflammatory myopathies are autoimmune diseases, meaning the body’s immune system, which normally fights infections and viruses, is misdirected and begins to attack the body’s own normal, healthy tissue. Inflammatory myopathies are rare and it is believed that  certain individuals have a genetic predisposition to develop an autoimmune disease, which is triggered by an environmental exposure to some trigger, such as infection, virus, toxin, or sunlight.

Types

It is a variable disease and it falls under:

  1. Dermatomyositis (DM).
  2. Polymyositis (PM).
  3. Necrotizing myopathy (NM).
  4. Sporadic inclusion body myositis (sIBM).
  5. Juvenile forms of myositis (JM).

Symptoms

Symptoms of weakness, swelling, and muscle damage often appear gradually. Long before patients are diagnosed, they may have trouble getting up from a chair, climbing stairs, or grasping objects with their hands. Patients may fall, find it difficult to reach their arms up, have difficulty swallowing, or other symptoms.

Diagnosis

Myositis is often difficult to diagnose, because many physicians are unfamiliar with the disease and its symptoms. A typical diagnosis process for myositis patients begins with a medical history and physical examination. It may also include blood tests, muscle and skin biopsies, and a variety of other diagnostic tests.

Treatment

Oral steroids is one of the treatments for myopatheis and sometimes intravenously also depending on the symptoms . The objective is to taper the steroids slowly and substitute it with medications that are safer in the long run.

Medication

RITUXAN
INTRAVENOUS IMMUNOGLOBULIN

Rheumatoid Arthritis

Rheumatoid Arthritis

What is rheumatoid athritis ?

Rheumatoid arthritis is a chronic inflammatory disorder that can affect more than just the joints and the condition can sometimes damage a wide variety of body systems, including the skin, eyes, lungs, heart and blood vessels. Rheumatoid arthritis affects the lining of the joints, causing a painful swelling that can eventually result in bone erosion and joint deformity.

Implications

Unlike the wear-and-tear damage of osteoarthritis, rheumatoid arthritis affects the lining of the joints, causing a painful swelling that can eventually result in bone erosion and joint deformity. The inflammation associated with rheumatoid arthritis is what can damage other parts of the body as well. While new types of medications have improved treatment options dramatically, severe rheumatoid arthritis can still cause physical disabilities.

Causes

An autoimmune disorder, rheumatoid arthritis occurs when your immune system mistakenly attacks your own body's tissues. It occurs when the system attacks the synovium - the lining of the membrane that surrounds the joints. The resulting inflammation thickens the synovium, which can eventually destroy the cartilage and bone within the joint. The tendons and ligaments that hold the joint together weaken and stretch. Gradually, the joint loses its shape and alignment.

Symptoms

Symptoms of rheumatoid arthritis may include : 
 
  1. Tender, warm, swollen joints.
  2. Joint stiffness that is usually worse in the mornings and after inactivity.
  3. Fatigue, fever and loss of appetite.
  4. Periods of increased disease activity, called flares, alternate with periods of relative remission — when the swelling and pain fade or disappear.

Over a period of time, rheumatoid arthritis can cause joints to deform and shift out of place. 

Diagnosis

Rheumatoid arthritis can be difficult to diagnose in its early stages because the early signs and symptoms mimic those of many other diseases. There is no one blood test or physical finding to confirm the diagnosis. During the physical exam, doctors check the joints for swelling, redness and warmth.

Treatment

Blood tests will be done to look for rheumatoid factor and anti - CCP in the results. Imaging tests with extras to help track the progression of the condition over time. MRI and ultrasound to judge the severity of the condition in the body.

Medication

REMICADE
ORENCIA
ACTEMRA
RITUXAN
CIMZIA
SIMPONI ARIA

Psoriatic Arthritis

Psoriasis & Psoriatic Arthritis

What is psoriasis & psoriatic arthritis ?

Psoriasis and psoriatic arthritis are two main conditions which are treated through infusion therapies. Psoriasis is a skin condition and psoriatic arthritis is a condition which occurs due to untreated psoriasis over a long period of time.  30% of the patients who are affected by psoriasis have the chances of getting psoriatic arthritis after 9 or 10 years of the onset of psoriasis.

Causes

1) Genes and immune system are main two aspects which can give rise to psoriasis. The genes take care of the major things like eye, hair color and the way your body works and they play a major cause in psoriasis.
2) Hormonal changes play a major role in causing psoriasis. It flares upon during puberty and during menopause but it also disappears during pregnancy and reappears after delivery. 
3) Alcohol has a higher risk of causing psoriasis and it can cause the treatment ineffective.

Symptoms 

1) Swollen fingers.
2) Deformed hands and feet.
3) Nail changes.
4) Foot problems.
5) Low back pain and neck pain.
6) Flaky scalp.
7) Red eyes.

Diagnosis

Changes in skin, nail and joints are few symptoms to look for in persons who are suspected to have psoriasis or psoriatic arthritis. X-rays, MRI , ultrasound and blood tests are used to identify as well. They can be confused with other types of arthritis at times but there are unique symptoms which can confirm the same. 

Treatment

Treatment is based on the severity where sometimes local applications of salicylic acid is used for the psoriasis along with physical therapy and exercise for the arthritis. 
 
Medications like NSAIDs (Non steroidal anti - inflammatory drugs) and other DMARD's such as sulfasalizine and other biologic therapies help in treating psoriasis and psoriatic arthritis.

Medication

Lupus

Lupus

What is lupus?

Lupus is a long - term autoimmune disease where the body's immune systems becomes hyperactive and attacks normal, healthy tissues.  Symptoms include inflammation, swelling , damage to joints, kidneys, heart, blood and lungs. It affects women in the age of 45. 

Types

  1. Systemic lupus erythematosus.
  2. Discoid lupus erythematosus.
  3. Subacute cutaneous lupus erythematosus.
  4. Drug-induced lupus.
  5. Neonatal lupus.

Symptoms

  1. Fatigue.
  2. Loss of appetite and weight loss.
  3. Pain or swelling in joints and muscles.
  4. Swelling in the legs or around the eyes.
  5. Swollen glands, or lymph nodes.
  6. Skin rashes, due to bleeding under the skin.
  7. Mouth ulcers.
  8. Sensitivity to the sun.
  9. Fever.
  10. Headaches.
  11. Chest pain upon deep breathing.
  12. Unusual hair loss.
  13. Pale or Purple fingers or toes from cold or stress (Raynaud's phenomenon).
  14. Arthritis.

Diagnosis

Diagnosis happens through a physical examination. Blood tests and further investigations can confirm the presence of lupus in a person.

Treatment

Though there is no cure available, the patients can achieve remission through appropriate prompt treatment. Intravenous therapies and oral therapies are used to treat lupus which can control the body's overactive immune response. 

Medication

Gout

Gout

What is gout ?

Gout is a type of arthritis which can cause immense pain and stiffness and can be effectively treated using infusion therapies.

Overview

Gout is a very common type of arthritis that can cause pain, swelling and stiffness in a joint. The most commonly affected area is big toe. They relapse after they get cured and they harm the tissues in the region of inflammation and are very painful. Risk factors include hypertension, cardiovascular and obesity.

Causes

The main cause of gout is the excess secretion of uric acid in the blood or hyperuricemia. Normal uric acid gets dissolved in the blood and it is excreted from the body in the urine via kidneys. Gout can be formed by either more of uric acid secretion or by deficit, which causes needle - like crystals built up and that causes the inflammation and pain in the joints and the surrounding tissue.

Types

Gout progresses through various processes which can also  be referred as types also.
 
1) Asymptomatic hyperuricemia.
2) Acute gout.
3) Intercritical gout.
4) Chronic tophaceous gout.
5) Psuedogout.

Symptoms

This is a symptomatic disease which can occur in the middle of the night  and discomfort, inflammation and redness. The pain can be excruciating and frequently affects the large joint of the big toe, but can also affect the forefoot , ankles, knees, elbows, wrists and fingers.

Diagnosis

There are many tests which are used to carry out to identify the amount of uric acid which can confirm the presence of this disease.
 
1) Joint fluid test for the uric acid levels.
2) Look for bacteria in joint Fluid test.
3) Blood tests to measure the level of uric acid.
4) Ultrasound scan for urate crystals around joints. 

Treatment

Gout cases are treated with medication which can prevent future flares and reduce the risk of further complications. Non - steroidal anti - inflammatory drugs (NSAID's) are used to to treat gout and they could be corticosteroids and colchicine.
 
Other treatments include allopurinol and xanthine oxidase which improves the kidney's inability to remove the uric acid from the body.

Medication