The lifestyle you lead can make you prone to a very specific set of injuries. We have illustrated some of the most common to look out for. Which best represents you? How about your friends and family? Share the below. The best way to treat these conditions is to catch them before they happen!
A recent article in the Journal of Musculoskeletal Medicine reviewed the do’s and don’ts in patients with rheumatoid arthritis to help these patients function at their best.
- DO rest for at least one hour in the afternoon when you begin to feel fatigued.
- DO wear an orthothic device prescribed for you.
- DO use and ice bag to reduce pain; apply a heating pad or take a hot shower to relax muscles before exercise.
- DO use available devices to help you with dressing, bathing, cooking, working, and other activities.
- DO make adjustments, at home and work, in your pace in completing tasks, to conserve energy.
- DO apply for disability benefits if you are eligible or if you can no longer work.
- DO perform muscle strengthening exercises once inflammation diminishes.
- DO NOT stay in bed longer than necessary.
- DO NOT continue to wear an orthotic device that is uncomfortable or does not fit.
- DO NOT overdue exercise. Daily exercise in small amounts is best.
- DO NOT continue exercise if you are sore for more than 2 hours following exercise.
- DO NOT exercise a joint that is acutely inflamed.
- DO NOT forget to exercise regularly when disease is in remission.
- DO NOT stay at home all day; if you don’t go out to work, be a volunteer or join an activities group.
- DO NOT keep your fears and concerns about your health, or feelings of sadness or depression, to yourself. Talk to family, friends, or your doctor.
Rodney Bluestone Medical doctors are rheumatology specialists located in Los Angeles, California. We provide treatment for all types of arthritis including osteoarthritis, gout, rheumatoid arthritis and lupus. For more information, including treatment and symptoms of arthritis, please visit www.rodneybluestonemedical.com.
Most people think that the number one cause of death among American women would be due to breast cancer or accidents. But the reality of the situation is that heart attacks kill more women than any other cause – the same as men. In the past, heart disease was mistakenly thought of as an exclusively male disease, but patients and physicians have learned that preventing and treating heart disease is critical in women too. The aging population and increasing prevalence of obesity and diabetes suggest a possible increase of women’s heart disease on the horizon.
The American Heart Association published its updated recommendations for the prevention of cardiovascular disease in women early this year. These updates alert physicians to cardiovascular risks that have been previously unappreciated – such as, complications of pregnancy, including gestational diabetes and preeclampsia. Autoimmune disease such as lupus and rheumatoid arthritis area also associated with increased cardiovascular risk.
The recommendations also feature and highlight an important reminder about interventions that do not prevent heart disease in women:
- Estrogen replacement therapy does not prevent stroke or heart attack
- Antioxidant vitamin supplements (vitamin E, C, and beta carotene) do not prevent stroke or heart attack.
- Folic acid, vitamin B6, and vitamin B12 do no prevent stroke or heart attack.
Unfortunately, some of these treatments have become so popular through misinformation.
The most valuable parts of the recommendations are:
- Avoid smoking
- Exercise regularly
- Eat a diet rich in fruits, vegetables, and whole grains, eat fish at least twice a week, and limit intake of saturated fat, alcohol, and sugar.
- Maintain normal blood pressure though the above lifestyle modifications or through necessary medications.
- Maintain normal cholesterol levels though the above lifestyle modifications or through necessary medications.
- Maintain normal blood sugar levels though the above lifestyle modifications or through necessary medications.
These recommendations are not new and have been known for years, but they deserve repetition because they are the most effective means of cardiovascular disease prevention. The same recommendations also apply to men.
Rodney Bluestone Medical doctors are rheumatology specialists located in Los Angeles, California. We provide treatment for all types of arthritis including osteoarthritis, gout, rheumatoid arthritis and lupus. For more information, including treatment and symptoms of arthritis, please visit www.rodneybluestonemedical.com.
In this day and age, where technology runs the show and most of us are utilizing computers, it is important to adjust your workspace. If hand pain from arthritis forces you to change the way you type, you may be doing more harm than good.
Dr. Nancy Baker, an associate professor at the University of Pittsburgh, was a lead investigator in a study of typists with rheumatoid arthritis. Her study was presented at the 2010 American College of Rheumatology Annual Scientific Meeting. People compensated by floating their wrists above the keyboard, typing with fewer fingers or straightening fingers they couldn’t bend – none of which are good for people with arthritis in the hands.
According the Dr. Baker, workers should make sure the workstation fits them and not try to fit themselves to the workstation. Although the study focused on RA, other conditions, such as osteoarthritis and carpal tunnel syndrome, also impact posture and typing.
Here are a few guidelines to help optimize a workstation:
CHAIRS
- Go to a store and sit in a variety of chairs to see what’s most comfortable.
- Make sure it’s height is adjustable. Your thighs should be parallel to the floor and your feet flat on the floor. Use a footrest if they aren’t.
KEYBOARDS & MOUSE
- Get an adjustable keyboard tray that allows you to raise and lower it’s height and angle for your hands and wrists.
- Put your keyboard in the right place, so your elbows are bent and your forearms are resting on your desk and approximately parallel to the floor.
- Try ergonomic options, like a split keyboard or a modified mouse with a larger scroll and click wheel or trackball.
MONITORS
- The top edge of the screen should be the same height as your eyes unless you wear bifocals; if you do, position the monitor as low as you can.
- Avoid a laptop as your primary computer; the low screen can cause neck strain. OR use it with a separate keyboard, mouse and monitor.
Rodney Bluestone Medical doctors are rheumatology specialists located in Los Angeles, California. We provide treatment for all types of arthritis including osteoarthritis, gout, rheumatoid arthritis and lupus. For more information, including treatment and symptoms of arthritis, please visit www.rodneybluestonemedical.com.
No one really thinks much about popping a nonsteroidal anti-inflammatory drug (NSAID), such as ibuprofen (Advil, Motrin), naproxen (Aleve), or Celebrex, for minor complaints, but we should give it more thought. A 9-year study, based on detailed registry data of more than 1 million NSAID users, that was completed last year found that certain pain relievers can increase cardiovascular risk, even in healthy people. The researchers looked at several different types of NSAIDs and this is what they found:
- Ibuprofen — 29% greater risk for fatal or nonfatal stroke;
- Rofecoxib (Vioxx) — 66% increased risk for cardiovascular death. (Remember the high rate of heart attack and stoke is why it was taken off the US market back in 2004.);
- Diclofenac (Arthrotec) — 91% increased risk for cardiovascular death. (Diclofenac has high COX-2 inhibition selectivity.)
- Celecoxib — findings inconclusive. The number of events was too small but available data did seem to show a trend for increased cardiovascular risk;
- Naproxen (Aleve) — NOT associated with any increased cardiac risk.
That why these researchers say naproxen is the safest choice for your heart. As with any new medical regimen, always consult your physician first.
Rodney Bluestone Medical doctors are rheumatology specialists located in Los Angeles, California. We provide treatment for all types of arthritis including osteoarthritis, gout, rheumatoid arthritis and lupus. For more information, including treatment and symptoms of arthritis, please visit www.rodneybluestonemedical.com.
Pseudogout may be one of the most misunderstood forms of arthritis, often mistaken for gout and other conditions. Proper diagnosis is important, though, because untreated pseudogout may lead to a severe form of joint degeneration and on-going inflammation, resulting in chronic disability. Anyone can develop pseudogout; risk greatly increases with age. Proper diagnosis depends on identifying the causative calcium pyrophosphate crystals found in the fluid of an affected joint. Anti-inflammatory medications may be prescribed to prevent or control joint symptoms.
What is pseudogout?
Pseudogout is a type of arthritis that, as the name implies, can cause symptoms similar to gout but in reaction to a different type of crystal deposit. Pseudogout, sometimes referred to as calcium pyrophosphate deposition disease, can cause severe episodes of localized pain and swelling resulting in incapacitation for days or weeks. It also can cause more chronic arthritis that mimics osteoarthritis or rheumatoid arthritis. Knees most often are involved, but wrists, shoulders, ankles, elbows or hands can be affected.
Pseudogout develops when deposits of calcium pyrophosphate crystals accumulate in a joint. Crystals deposit first in the cartilage and can damage the cartilage. The crystals also can cause a reaction with inflammation that leads to joint pain and swelling. In most cases it is not known why the crystals form, although crystal deposits clearly increase with age. Because the condition sometimes runs in families, genetic factors are suspected of contributing to the disorder, as can a severely underactive thyroid (hypothyroidism), excess iron storage (hemochromatosis), low magnesium levels in blood, an overactive parathyroid gland, and other causes of excessive calcium in the blood (hypercalcemia).
The calcium crystal deposits seen in pseudogout affect about 3 percent of people in their 60s and as many as 50 percent of people in their 90s. Any kind of insult to the joint can trigger the release of the calcium crystals, inducing a painful inflammatory response. Attacks of pseudogout also can develop following joint surgery or other surgery. However, not everyone will experience severe attacks.
Diagnosis is made on the basis of symptoms and medical tests. The physician will use a needle to take fluid from a swollen or painful joint to determine whether calcium pyrophosphate crystals are present. An X-ray of the joint may be taken to determine whether calcium-containing deposits are present in the cartilage, creating a condition known as chondrocalcinosis. Other potential causes of symptoms must be ruled out. Pseudogout often is present in people who have osteoarthritis.
The doctor may prescribe nonsteroidal anti-inflammatory drugs (NSAIDs) such as indomethacin (Indocin) and naproxen (Naprosyn) to treat pain and disability during severe episodes of pseudogout. Then, to prevent further attacks, low doses of colchicine or NSAIDs may prove effective. However, no treatment is available to dissolve the crystal deposits, and those with poor kidney function, a history of stomach ulcers and/or on blood thinners often cannot take NSAIDs. These patients may find a corticosteroid injection into the affected joint a useful option.
It is not known how to prevent pseudogout. If the condition has developed because of some other medical conditions, such as hemochromatosis (too much iron stored in the body), or parathyroid problems, treatment of that condition may prevent progression of other features of that potentially dangerous illness and may, in some cases, slow the development of pseudogout.
Diagnosis is confirmed by microscopic identification of calcium pyrophosphate crystals. Anti-inflammatory agents can help lessen symptoms, but there is currently no way to eliminate the crystals themselves
Rodney Bluestone Medical doctors are rheumatology specialists located in Los Angeles, California. We provide treatment for all types of arthritis including osteoarthritis, gout, rheumatoid arthritis and lupus. For more information, including treatment and symptoms of arthritis, please visit www.rodneybluestonemedical.com.
Gout is sometimes referred to as the “disease of kings” or “rich man’s disease” because it long has been associated with the kind of overindulgence in food and wine only the rich and powerful could afford. In actuality, anyone can be affected, and the risk factors vary. Fortunately, it is possible to treat gout and reduce its agonizing attacks by avoiding food triggers and taking advantage of medication options.
What is gout?
Gout is a painful and potentially disabling form of arthritis that has been recognized since ancient times. Initial symptoms usually consist of intense episodes of painful swelling in single joints, most often in the feet (especially the big toe). Gout occurs when excess uric acid (a normal waste product) accumulates in the body, and needle-like crystals deposit in the joints. This may happen because either uric acid production increases or, more often, the kidneys are unable to remove uric acid from the body adequately. Certain foods, such as shellfish and alcohol, may increase uric acid levels and lead to gout attacks.
Some medications also can increase uric acid levels. Examples of such medications include moderate-dose aspirin, diuretics such as hydrochlorothiazide, and immunosuppressants used in organ transplantation. With time, increased uric acid levels in the blood may lead to deposits of monosodium urate crystals in and around the joints. These crystals can attract white blood cells, leading to severe, painful gout attacks. Uric acid also can deposit in the urinary tract, causing kidney stones.
Gout afflicts up to 3 million Americans. This condition and its complications occur more often in men, women after menopause, and people with kidney disease. Gout is strongly associated with obesity, high blood pressure, high cholesterol, and diabetes. Because of genetic factors, gout tends to run in some families.
Several other kinds of arthritis can mimic gout, so proper diagnosis is essential. Gout is suspected when a patient experiences joint swelling and intense pain initially in one or two joints followed, at least at first, by pain-free periods between attacks. Initial gout attacks often occur at night. A definite diagnosis depends on finding the characteristic crystals by extracting fluid from an affected joint and examining that fluid under a microscope to determine whether monosodium urate crystals are present. Crystals also can be found in deposits under the skin (called tophi) that occur in advanced gout – these appear as bumps or lumps. Uric acid levels in the blood are important to measure but can be misleading, as these may be temporarily normal or even low during attacks. Uric acid levels often are elevated in people who do not have gout.
How is gout treated?
One treatment for acute gout is colchicine, which can be effective if given early in the attack. However, colchicine can cause nausea, vomiting, diarrhea and other side effects. Low doses may be better tolerated; doses must be lowered in patients with kidney disease. Non-steroidal anti-inflammatory drugs, such as indomethacin (Indocin) and naproxen (Naprosyn), can decrease inflammation as well as pain in joints and other tissues. There is no evidence that any one NSAID is better than others. High doses of
short-acting NSAIDs provide fastest relief of symptoms. These medications may cause stomach irritation, ulcers, or diarrhea but, if used for the short term, are generally well tolerated. Some people are unable to take NSAIDs because of medical conditions such as ulcer disease, impaired kidney function or the use of blood thinners. Corticosteroids are important options in patients who cannot take NSAIDs or colchicine. Resting the affected joint and applying cold compresses to the area also may help alleviate pain.
Efforts to normalize blood uric acid levels should be considered for patients who have repeated gout attacks, unusually high levels of serum uric acid, or tophi or kidney stones. These medications (Allopurinol, Probenecid, Uloric) do not help the painful flares of acute gout and should be started after acute attacks have subsided. Flares of gout often can occur during use of urate lowering agents so efforts at prevention of flares by use of low-dose colchicine are advised. A newer medication, Krystexxa, can also be used in patients who have severe tophaceous gout and do not respond to oral medication. What works well for one person may not work as well for another, so decisions about when to start treatment and what drugs to use have to be tailored for each patient, and depend on kidney function and other factors. Once commitment is made to use any agents to lower uric acid levels, therapy should be increased gradually with monitoring of serum urate until levels are less than 6 mg/dl, at which point crystals can be dissolved and new crystal deposits prevented.
Drinking alcohol should be reduced or stopped. Diets that restrict foods rich in the purines found in meat and certain types of seafood or high-fructose beverages may help. Purines in vegetables appear to be safe, and low-fat dairy products may actually help lower uric acid levels. In almost all cases, it is possible to successfully treat gout so that the patient experiences a gradual end to attacks, and decreases in the number and size of tophi.
Rodney Bluestone Medical doctors are rheumatology specialists located in Los Angeles, California. We provide treatment for all types of arthritis including osteoarthritis, gout, rheumatoid arthritis and lupus. For more information, including treatment and symptoms of arthritis, please visit www.rodneybluestonemedical.com.
Why is colchicine so expensive? It turns out that colchicine was never evaluated by the US Food and Drug Administration (FDA) for safety prior to its marketing because it was available before the Food, Drug, and Cosmetic Act took effect in 1938. This act required the FDA to assess newly introduced drugs but not drugs that had previously been available. In 2006 the FDA began an Unapproved Drugs Initiative in which they encouraged companies to investigate unapproved drugs and to gather the necessary safety data for FDA approval. The incentive for companies to do this was 3 years of market exclusivity granted under an act that defines the pathway for approval of generic drugs. In 2007 URL Pharma, Inc. a company in Philadelphia, Pennsylvania, initiated 17 studies as well as drug-drug interaction studies and a randomized, placebo-controlled trial of colchicine in the treatment of acute gout. Thus, approval was granted in July 2009 for the marketing of Colcrys for the treatment of acute gout. As a result, URL Pharma was granted 3 years of market exclusivity for the use of colchicine in acute gout. In October 2009 they were also granted market exclusivity for 3 years for prophylaxis of gouty arthritis.
This is a reasonable reward for a company that invests a significant effort in studying a medication, even if the medication has been available in an unapproved form. However, as a rheumatologist I’m concerned about the ability of my patients to have access to medications. When initiating treatment with a xanthine oxidase inhibitor, such as Allopurinol or Uloric, to lower serum uric acid levels chronically and prevent gouty arthritis, it has been shown that one should use colchicine prophylaxis for the first 6 months of those medications to prevent acute flares of gout. Thus, when patients are initiated on allopurinol or uloric they need to take 6 months of colchicine to prevent acute flares of gout. Prior to the approval of Colcrys, unapproved colchicine sold for about 10 cents a pill.
Once Colcrys was approved the price increased 50-fold to about $5 a pill. This is often difficult for patients to afford. To mitigate this problem URL Pharma has established a rather generous patient assistance program in which patients with incomes up to 6 times the federal poverty level are able to receive Colcrys with a reduced copay. The American College of Rheumatology has encouraged URL Pharma to consider patient well-being and patient welfare in the pricing and marketing of these agents.
Rodney Bluestone Medical doctors are rheumatology specialists located in Los Angeles, California. We provide treatment for all types of arthritis including osteoarthritis, gout, rheumatoid arthritis and lupus. For more information, including treatment and symptoms of arthritis, please visit www.rodneybluestonemedical.com.
In the United States, about 50 million adults have arthritis and about 72.5 million adults are obese. Among the 50 million Americans with arthritis, rising rates of obesity are a cause for concern. This is mainly because excess weight is associated with increased problems for arthritis patients, according to a new study.
Obesity in people with arthritis is associated with disease progression, reduced activity, disability, poorer quality of life, total joint replacement and poor outcomes after joint replacement.
The US Centers for Disease Control and Prevention researches analyzed data from 2003 to 2009 and found that obesity prevalence among adults with arthritis was approximately 54% higher than among adults without arthritis. The number of states in which more that 40% of adults with arthritis were obese increased from zero in 2005 to seven in 2007 and 12 in 2009.
These findings highlight the need to expand programs to prevent obesity among arthritis patients and to promote treatment and management of the disease.
Rodney Bluestone Medical doctors are rheumatology specialists located in Los Angeles, California. We provide treatment for all types of arthritis including osteoarthritis, gout, rheumatoid arthritis and lupus. For more information, including treatment and symptoms of arthritis, please visit www.rodneybluestonemedical.com.
Most women have an inherent desire to purchase shoes. The price they pay for those shoes is not visible until much later. At that point, was it really worth it just for a pair of cute shoes?
The predominance of several musculoskeletal foot conditions in women is largely the result of biomechanical alterations caused by ill-fitting shoes. These alterations, associates with high-heeled shoes and shoes with a narrow toe box, has been linked to hallux valgus, (crossover toes), hammer toe deformity, Halgund syndrome, metatarsal stress fracture, Freiberg infarction, and Morton neuroma. Contemporary shoe styles for women continue to cause deformity and predispose to injury. Traditionally, men’s shoes tend to be wider and have lower heels than women’s shoes. High-heeled shoes transmit increased pressure and stress toward the forefoot and increase the risk of fracture and falls. Even shoes with heels as short as 1.5 inches have been shown to significantly increase knee torque and may have implications for knee osteoarthritis in women.
Rodney Bluestone Medical doctors are rheumatology specialists located in Los Angeles, California. We provide treatment for all types of arthritis including osteoarthritis, gout, rheumatoid arthritis and lupus. For more information, including treatment and symptoms of arthritis, please visit www.rodneybluestonemedical.com.
Rodney Bluestone Medical
Our professional challenge as clinical Rheumatologists is to care for patients with Arthritis and various autoimmune diseases. www.rodneybluestonemedical.com
436 NORTH BEDFORD DRIVE SUITE 303 BEVERLY HILLS, CALIFORNIA 90210 Tel: (310) 657-2222
www.rodneybluestonemedical.com
bluestonemedical@gmail.com
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