Diagnoses, Testing, Treatment of Arthritis
The diagnoses, testing and treatment of the different forms of arthritis vary. This includes degenerative joint disease, osteoarthritis, rheumatic arthritis, fibromyalgia, gout and back pain.
Degenerative Joint Disease, Arthritis in General
To diagnose degenerative joint disease and forms of arthritis in general, a rheumatologist or an orthopedist will examine a patient’s medical records, perform a physical exam and secure laboratory test results, X-rays and medical imaging.
The rheumatologist or orthopedist would see a patient more than once to complete an accurate diagnosis. For example, in the case of osteoarthritis, one test alone cannot fully diagnose this condition. The specialists would combine several methods to isolate the illness and rule out others.
To treat joint conditions or support joint health against degenerative disease and various forms of arthritis, pharmaceutical companies offer, as an alternative to drugs, such nutritional products or medical foods that use pure, concentrated ingredients in such items as green tea, dark chocolate, fruits and vegetables.
A medical food is regulated by the Food and Drug Administration (FDA) under the federal Orphan Drug Act that legally defines them as “a food which is formulated to be consumed or administered enterally (through digestion) under the supervision of a physician and which is intended for the specific dietary management of a disease or condition for which distinctive nutritional requirements, based on recognized scientific principles, are established by medical evaluation.”
Seen as a safer choice to drugs and supervised by primary care physicians and specialists, medical foods do not undergo premarket review or approval by the FDA and are required to be labeled for nutrient health claims under the Nutrition Labeling and Education Act of 1990.
In particular, Fast-Acting Joint Formula is a one-a-day set of compounds to provide joint relief and capacity in a matter of days rather than weeks or months.
The formula offers the patient, in one daily capsule dose, 300 mg of solubilized keratin, a form of keratin protein that provides cysteine and other high-sulfur elements need to build joint tissue.
Keratin helps to oversee pre-inflammatory elements such as prostaglandin E2 that are linked to joint deterioration while promoting antioxidants such as superoxide dismutase and gluthathion to keep joints from aging.
The formula can be used with other nutritional products such as ArthroMax with Theaflavins. ArthroMax, also known as ArthroMax Advanced with UC-Il and ApresFlex, is a form of undernatured chicken cartilage (UC-Il). This product helps protect the immune system as it pertains to remedying joint pain or stiffness or reduced capacity in senior patients.
ArthroMax contains “UC-II chicken cartilage, 40 mg of glucosamine sulfate 2KCI extracted, which contains corn; 1500 mg ApresFlex (Boswellia serrata) extract, and; 100 mg of boron or calcium fructoborate, known commercially as FruiteX OsteoBoron, which contains 1.5 mg of corn.”
ApresFlex is a product of Laila Nutraceuticals. FruiteX B and OsteoBoron are products of BDF FutureCeuticals, Inc.
As another means of addressing immune issues of the joints, ArthroMax is also accompanied by Black Tea Theaflavins without chicken cartilage. Namely, inflammatory chemical activity are supervised by a series of cytokines in the human body. Aging produces an unhealthy balance of cytokines that create promote inflammatory disease.
Research finds that compounds in black tea prevent the inflammatory activity of cytokines. These compounds are called theaflavins and supervise the activity of genes and cytokines connected to inflammatory disease.
ArthroMax with Theaflavins and ApresFlex formulas provide these compounds as well as methylsulfonylmethane, or MSM, which consist of sulfur elements key to maintaining joint function. These formulas also contain commercially known Fruite X B OsteoBoron, a form of boron much like those found in food that promotes healthy bones and joints.
ApresFlex contains boswellia, which assists with resolving inflammatory diseases by inhibiting the enzyme 5-lipoxygenase or 5-LOX. Activity of 5-LOX allows an inflammatory compound known as leukotriene B4 to negatively impact aging joints.
Excess activity of 5-LOX results in the accumulation of leukotriene B4, a pro- inflammatory compound that affects aging joints. Boswellia binds directly to the 5-LOX enzyme to keep it from producing leukotriene.
Another nutritional product, Decursinol-50, a fluid compound extracted from the the herb Korean Angelica, acts quickly to protect joint health through the central nervous system to block the activity of “nuclear factor-kappa B, a DNA transcription factor” linked to inflammatory diseases. Decursinol-50 is taken in 200 mg doses per day.
Hyal-Joint, a form of hyaluronic acid that boosts the thickness of the synovial fluid to protect joint cartilage, is taken in 40 mg doses daily. The product is meant to guard against wear and tear and rebuild joints with a supply of hyaluronic acid, collagen and other glycosaminoglycans.
Additionally, Krill Healthy Joint Formula uses deep-sea krill oil in Antarctica, combined with hyaluronic acid and astaxanthin. Krill oil contains fatty acids successful in promoting joint health by particularly targeting joint tissue.
Hyaluronic acid, which is present in the joints through cartilage and soft tissue, moistens and protects them against potentially harmful physical activity. The acid is a large molecule that is not readily digested in the human body. However, when blended with krill oil, it can be more widespread and, thus, more effective in the blood than by itself as a substance.
Krill oil contains the antioxidant carotenoid astaxanthin, which suppresses free radical activity and improves mitochondrial function, guarding joints against aging. The formula holds 353 mg of these substances and can be taken as a dosage of one softgel per day.
Typically, for degenerative joint disease of the hip, rheumatologists and other specialists use non-surgical treatment methods first. This includes nutritional products or medical foods, rest for the hip, low-to-moderate impact exercise such as swimming or over-the-counter (OTC) drugs to handle joint pain.
However, if nutritional products or medical foods, exercise or OTC medications cannot treat degenerative joint disease, senior patients may have to speak to their rheumatologists or orthopedists. These specialists may turn to medical devices.
For instance, MAKO Surgical Corporation provides MAKOplasty, a surgical procedure that uses robotic arm technology to instruct an orthopedic surgeon to conduct total hip replacement therapy for severe patient cases of degenerative joint disease.
This form of therapy is aimed at boosting movement and capacity in the hip and other impacted parts of the body to enable patients to carry out daily physical tasks.
Also known as total hip arthroplasty, this therapy involves surgery in which the arthritic hip joint is removed and, instead, prostheses or implants are installed. The implants contain “a metal cup with a plastic liner, which replaces the socket (acetabulum) in the pelvis, and a metal femoral stem and head.”
The robotic arm is meant to provide an orthopedic surgeon with guidance to prepare a socket for the pelvis of a patient and to put prostheses or implants in the correct sites in the body.
The accompanying technology is meant to provide real-time data and imagery to allow an orthopedist to clearly identify and manage implant placement, which can be hard to accomplish using traditional surgery without a robotic arm.
Such medical devices can make for greater accuracy in placing hip implants in the body, decrease the odds of hip misplacement, ensure consistent leg lengths, reduce the necessity of a shoe lift, minimize the risk of implants and bones rubbing together to create discomfort for the patient or to lessen the effectiveness of the overall technology.
Prolonging the life of prostheses or implants is important as well and some artificial joints can last 10 to 15 years long. Implants can achieve and must be preserved for a long life span, depending on the patient’s weight, level of physical activity, quality of bone tissue and adherence with a rheumatologist’s or a orthopedic surgeon’s orders.
The orthopedic surgeon must conduct an exam to determine if a senior patient is a fit for the MAKOplasty procedure using the robotic arm. If the patient qualifies, then the orthopedist makes a computed tomography (CT) scan of his or her hip one to two weeks before the date of surgery.
The CT scan creates a 3-D model of the patient’s hip pelvis and femur. The specialist uses software with data about the model and the patient’s anatomy.
The orthopedist must decide if the patient must make a hospital stay for total hip replacement and also if he or she must be referred to a massage therapist, a physical therapist, an occupational therapist, a physiatrist, also known as a rehabilitation specialist, a licensed acupuncture therapist or a chiropractic for rehabilitative therapy.
In turn, senior patients and their families are asked to approach their assigned rheumatologist and orthopedic surgeon if they have questions or concerns about total hip replacement or other procedures:
–What causes my hip pain?
–Will scaling back on physical activity, taking pain or prescription drugs, getting injections or adding physical therapy ease my pain?
–Would total hip replacement relieve me from hip pain?
–Am I a fit for total hip replacement?
–What are the benefits and risks of undergoing total hip replacement?
–How long is the recovery time from total hip replacement?
–What is the life span of the implants that may be implemented in total hip replacement?
–How does my age influence the correct procedure for my illness?
Patients are also asked to manage degenerative joint disease in the following ways:
–Maintain proper weight to decrease joint pain and swelling.
–Recognize physical restrictions and how to cut back on physical activity in time of pain.
–Follow doctors’ orders in taking medications and a proper diet as instructed by dietitians and nutritionists.
–Make use assistive devices such as walkers and canes to reduce pressure on the joints.
–Keep a good posture to, again, reduce pressure on the joints.
–Put on sensible footwear that can bear weight.
–Maintain a sunny disposition to manage stress and control treatment.
–Take initiative in managing disease and adhere to a sound lifestyle.
To diagnose osteoarthritis, including that of the hip, knees, hands, fingers and thumbs, spine or lower back or higher back, a rheumatologist or an orthopedist will examine a patient’s medical record and symptoms. He or she will watch the movement of the knees, grade knee and ankle joint alignment and test reflexes, muscle strength, motion capacity and the stability of ligaments.
These specialists may have X-rays conducted to measure the amount of joint or bone damage done, the mass of cartilage lost and whether bone spurs exist. More imaging tests such as CT scans or magnetic resonance imaging (MRI) can be used to pinpoint the damage and its spread.
The rheumatologist or orthopedic surgeon can order more blood tests to ensure that there are no other causes of the symptoms observed or request a joint aspiration procedure to draw fluid from the joint through a needle and examine its contents under a microscope.
Osteoarthritis is treated based on its mildness or severity in a senior patient. In either case, a primary care physician, a family practice physician, an internal medicine physician, an osteopathic physician, a rheumatologist or an orthopedist will recommend changes in a patient’s style of life to alleviate pressure on his or her joints.
Chronic illness and pain management strategies could include physical exercise, weight loss, reduced pressure on joints, physical therapy, steroid injections, over-the-counter pain medicine such as acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs) or topical pain-relief creams, rubs or sprays.
Goals for treatment of osteoarthritis include controlling pain, improving joint capacity, maintaining a healthy weight and maintaining a sustainable lifestyle.
Otherwise, if none of these or other treatments aren’t effective, a physician or specialist may determine that surgery and possibly complementary and alternative therapies are needed to treat a patient’s incidence of osteoarthritis.
Exercise is used to treat senior patients for osteoarthritis because of its ability to improve mood, lessen physical pain, extend physical range of motion, strengthen hearts and blood circulation, control weight and boost physical activity.
The amount and type of exercise will rely on the strength and stability of a patient’s joints and whether joint replacement therapy has been conducted. Exercise regimens could include strengthening exercises, aerobic activity, walking, swimming and water aerobics, range-of-motion activities and agility motion.
Both medicinal and non-medicinal relief to treat the pain of osteoarthritis may include heat and cold therapy with warm towels, hot packs or a warm bath or shower; transcutaneous electrical nerve stimulation (TENS) to use an electronic device to send electric pulses to nerves under the skin of the area of pain; creams, rubs and sprays such as Zostrix, Icy Hot, Therapeutic Mineral Ice, Aspercreme and BenGay; painkillers such as Tramadol, codeine, hydrocodone, corticosteroids, and hyaluronic acid substitutes.
NSAIDs are used when acetaminophen ceases to work with the best examples being ibuprofen and naproxen. Oftentimes, opioids, a form of narcotic drugs, are prescribed as well.
Complementary and alternative therapies come into use when patients don’t receive pain relief from traditional medications and treatments for osteoarthritis. They include acupuncture, folk remedies and nutritional supplements. Sounder sleeping habits are also recommended.
Acupuncture, the practice of placing fine needles at particular points of the skin, is considered effective in treating osteoarthritis because of its ability to incite the release of painkilling chemicals from the nervous system.
Folk remedies for osteoarthritis include copper bracelets, herbal teas, mud baths and WD-40 on joints to “oil” them. However, no research demonstrates that they are able to treat this illness.
Nutritional supplements that are found to address the symptoms of senior patients with osteoarthritis include glucosamine and chondroitin and a prescription medical food known as Limbrel, which can be found at http://limbrel.com. More research is being conducted to study the validity of the claims of glucosamine and chondroitin.
Additionally, improving sleep can reduce pain and enable patients to handle the effects of osteoarthritis. Senior patients with sleep problems due to arthritic pain are asked to consult their primary care physicians or physical therapists about obtaining the right mattress, the most accommodating sleeping positions or the correct timing of medications to incur pain relief at night.
Patients are asked to improve their night’s rest by getting sufficient physical exercise during the daytime; steering clear of caffeine and alcohol at night; making sure the bedroom is “dark, quiet and cool”; and taking warm baths to relax and relieve aching muscles.
When medicinal and non-medicinal methods of treating ostearthritis don’t work, rheumatologists and orthopedic surgeons may turn to surgery such as MAKOplasty partial knee resurfacing.
Partial knee resurfacing is a form of knee replacement surgery that uses robotic arm technology to guide the orthopedist to use computer imagery and “intelligent” instruments to place a prosthesis or implant in the right spot of the knee.
The procedure can be conducted through a four-to-six incision over the knee with slits in both the femur or thighbone and the tibia or shin. Restoring healthy bone, tissue and ligaments with more precise implant placement leads to a more natural-feeling knee for the patient and wearer.
Primary care physicians, family practice physicians, internal medicine physicians, and osteopathic physicians find it hard to diagnose rheumatic diseases because of the overlap between their symptoms and signs and that of other illnesses. These doctors may examine a patient and refer him to a rheumatologist or orthopedic surgeon.
A doctor needs to conduct a thorough medical exam of a patient to make an accurate diagnosis, researchers say. He or she may pose the following questions to a patient:
–Is the pain in one or more joints?
–When does the pain occur?
–How long does the pain last?
–When did the patient first notice the pain?
–What was a patient doing when he or she noticed the pain?
–Does physical activity make the pain better or worse?
–Has the patient had any illnesses or accidents that may account for the pain?
–Is the patient experiencing any other symptoms aside from pain?
–Is there a family history of arthritis or other rheumatic disease?
–What drugs is the patient taking?
–Has the patient had any recent infections?
Sometimes, patients may be asked to maintain a daily journal that provides details of the pain. Primary care physicians, family practice physicians, internal medicine physicians, osteopathic physicians, rheumatologists and orthopedists may encourage patients to write down how the affected joint appears, how it feels, how long the pain lasts and what they were doing when the pain began.
Doctors may examine a patient’s joints for redness, warmth, damage, range of motion and tenderness. Some forms of arthritis such as lupus, may target organs and, thus, a complete exam of the heart, lungs, abdomen, nervous system, eyes, ears, mouth and throat may be needed.
These physicians may also require some laboratory tests to support a diagnosis. Samples of blood, urine or synovial fluid in the joint may be necessary. Tests may include the following: antinuclear antibody, or ANA; CCP; C-reactive protein tests; complement; complete blood count; creatinine; erythrocyte sedimentation rate, or SED RATE or ESR; hemocrit (PCV or packed cell volume); rheumatoid factor; synovial fluid examination; urinalysis, and; X-rays, CT, MRI and arthrography.
Treatments for rheumatic disease include sleep, physical exercise, sound nutrition, pain relief, medical devices and instruction from physical therapists, occupational therapists, physiatrists, licensed acupuncture therapists and chiropractics about massage and alternative therapy.
Primary care physicians, family practice physicians, internal medicine physicians, osteopathic physicians, rheumatologists and orthopedic surgeons plan treatment with the senior patient to enhance his or her lifestyle. The plans may blend different types of treatment and change, depending on the rheumatic illness and the patient.
Physical exercise for rheumatoid patients falls into three categories and the benefits feed into each other: range-of-motion exercises such as stretching or dance to move joints, boost flexibility and alleviate stiffness; strengthening exercises such as weight lifting, to support muscle strength, which translates into joint support and protection, and; aerobic or endurance exercises such as waking, bicycle riding and swimming, to promote heart fitness, control weight and effect overall health and well-being.
The most common medications to treat rheumatic diseases include oral analgesics or pain relievers taken by mouth; topical analgesics or pain-relieving creams, ointments and sprays; counterirritants; NSAIDs; DMARDs; biologic response modifiers; corticosteroids, and; hyaluronic acid substitutes.
Medical devices used to treat rheumatic diseases include TENS and a blood-filtering device titled the Prosorba Column to weed out dangerous antibodies for especially severely ill patients. Massage and alternative therapies include heat and cold therapies, hydrotherapy, mobilization therapy, relaxation therapy, splints and braces and assistive devices.
The categories of surgeries to treat rheumatic disease are anthroscopic surgery, needed to view the joint through a small scope inserted through a small slit over the joint; bone fusion used to remove joint surfaces from the ends of two bones; osteotomy, a procedure involving removing a section of bone to improve the positioning of a joint, and; arthroplasty or total joint replacement.
NIAMS and NCCM research finds that fibromyalgia patients will visit with many specialists before they are provided with a diagnosis of the actual disease. This is because the attendant pain and fatigue, the key symptoms of fibromyalgia, overlap with other chronic illnesses.
As a result, doctors must isolate other causes of these symptoms before delivering a diagnosis. Additionally, there are no other diagnostic laboratory tests for the illness as lab tests do not show a physiological cause for pain.
Sometimes, because there is no official, standard test for fibromyalgia, a physician is forced to judge that a patient’s pain is not real or often inform the patient that he or she cannot help him or her.
The greatest approximation to a standard test are the nine paired tender points created by the American College of Rheumatology, or ACR, for fibromyalgia. As a result of this institutional and trade professional standardization, a physician is empowered to make a diagnosis based on the criteria by the ACR.
Criteria for a diagnosis may include a patient’s record of widespread pain spanning more than three months and other symptoms such as fatigue, being aroused from sleep and feeling unrefreshed and cognitive issues such as with memories or thoughts.
Under this standard, pain is defined as widespread if it influences all four quadrants of the body, meaning that the patient encounters it on the left and right sides of the human body and above and below the waist. ACR has set aside 18 sites in the human body for tender points.
Fibromyalgia is hard to treat. Not all physicians understand the disease and its treatment so patients must find a doctor who does and then a team of specialists must be formed to work with both.
Three drugs have been approved the FDA to treat fibromyalgia, duloxetine, which was once developed for and is used to treat depression; milnacipran, and; pregabalin, which is meant to treat neuropathic pain caused by damage to the nervous system. Other treatments for fibromyalgia include painkillers, NSAIDs, complementary and alternative therapies.
Still, overtime, with treatment, conditions for patients with fibromyalgia improve, researchers say. Fibromyalgia is not a progressive illness. It is not deadly and will not damage the joints, muscles or organs.
To improve their quality of life under fibromyalgia, patients are asked to get enough sleep, make changes at their place of work, practice sound nutritional habits and obtain physical exercise.
To diagnose gout, physicians would search for uric acid crystals or hyperuricemia around joints though some patients with hyperuricemia may not develop the illness. Bouts of gout may imitate joint infections and physicians who detect a joint infection rather than gout may also examine joint fluid for bacteria.
Physicians may confirm a diagnosis of gout by placing a needle in an inflamed joint and draw a sample of synovial fluid, which softens a joint. While uric acid crystals may not appear in an examination, this does not mean that a patient does not have gout.
Gout is treated with a number of therapies and the goals for these are to relieve the patient of pain associated with acute attacks, prevent future attacks, and avoid the formation of tophi and kidney stones. Common treatments include NSAIDs, oral colchicine, corticosteroids, weight loss, alcohol consumption and avoidance of high-purine foods.
The condition can be managed. Patients with gout can reduce the severity of attacks and lower their risk by taking drugs as prescribed. Gout is best treated with medications at the first sign of pain or swelling.
Patients are also encouraged to take other measures to treat gout include the following:
Inform the physicians about the drugs and vitamins taken and they will instruct whether any of them will boost their chances of hyperuricemia;
Conduct followup visits with physicians to monitor their progress;
Drink an abundance of fluids, including water and alcohol;
Practice physical exercise and keep a sound body weight, and;
Steer clear from foods high in purines.
To diagnose back pain, physicians and specialists will examine a patient’s medical history and conduct a physical exam. If needed, physicians may also request tests, which includes X-rays.
At the time of a patient’s medical examination, doctors will ask the following questions:
–Has the patient fallen or injured his or her back recently?
–Does his or her back feel better or worse when he or she lies down?
–Are there any activities or positions that ease or aggravate pain?
–Is the pain worse or better at a certain time of day?
–Does the patient or any family members have arthritis or other diseases that might affect the spine?
–Has the patient had back surgery or back pain before?
–Does the patient have pain, numbness, or tingling down one or both legs?
During an exam, physicians will watch patients stand and walk, check their reflexes to judge if they are slowed or heightened, test for fibromyalgia by checking their backs for tender points, watch for muscle strength and check for nerve root irritation.
These doctors may order the following tests: X-rays, MRIs, CT scans, blood tests, CBC, SED rates, CRP and HLA-B27.
Patients are asked to avoid back pain by exercising regularly, especially Tai Chi, yoga and weight-bearing exercise; keeping back muscles strong; maintaining a healthy diet, including one rich in calcium and vitamin D; practicing solid posture through supporting the back, and; avoiding heavy lifting whenever possible if this is not done by placing stress on the legs and hips.
They are also advised to visit the doctor only if back pain is accompanied by numbness, tingling, difficulty in urination, weakness, fever or unintended weight loss and a lack of pain relief from the use of medication or rest — as all of these symptoms are signs of more serious problems.
Back pain is typically treated based on whether it is acute or chronic. Treatments include pain relievers such as NSAIDs, acetaminophen, aspirin, ibuprofen, naproxen sodium, Tylenol, narcotics such as oxycodone or hydrocodone, and; creams, ointments and sprays such Zostrix, Icy Hot and Bengay.
Other solutions include physical exercises such as flexion, extension, stretching, aerobics and traction and; different categories of surgeries and medical devices such as hot and cold packs, corsets and braces, injections, nerve root blocks, facet joint injections, trigger point injections and prolotherapy, complementary and alternative therapies, spinal manipulation, TENS, acupuncture, acupressure, rolfing, and; surgical treatments such as laminectomy/diskectomy, microdiskectomy, laser surgery, spinal fusion and vertebroplasty, kyphoplasty, intradiskal electrothermal therapy or IDET, and; disk replacement.
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SOURCES: Advocates for Fibromyalgia Funding, Treatment, Education and Research, http://www.affter.org American Academy of Orthopedic Surgeons,
Diagnoses, Testing, Treatment of Arthritis The diagnoses, testing and treatment of the different forms of
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