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Information for Doctors

Sports-Medicine Kalyan-Dombivali
Do I have Arthritis? How is it Diagnosed?
Warning Signs of Arthritis:
Causes of Arthritic Pain:
Why Pain Varies from persons to persons?
What are the symptoms of Arthritis?
What Can I Do?
What will happen during your first visit to the doctor?
What Medical History Doctor Will Ask?
How does medical history help?
Difference Between Inflammatory & Non Inflammatory arthritis
How physical examination helps?
What are the common investigations done?
Who can treat arthritis pain?
What Are The Treatments Available?
How Should I use Arthritis Medicine?
Making The Most Of Treatment:  
Do I have Arthritis? How is it Diagnosed?
Pain is the way your body tells you that something is wrong. Pain is defined as an unpleasant experience associated with actual or potential tissue damage to a person's body. There are specialized nervous system cells (neurons) that transmit pain signals which are found throughout the skin & other body tissue. These cells respond to tissue damage due to trauma or inflammation. Most kinds of arthritis cause pain in the joints. The pain may be acute (temporary lasting for a few seconds or longer but wanes as healing occurs) or chronic (for examples as seen in OA & RA which last for months to years).

Warning Signs of Arthritis:

  • Joints pains & stiffness
  • Fever
  • Loss of Weight
  • Difficult breathing
  • Skin rashes or itching.

Causes of Arthritic Pain: The causes of pain in arthritis may vary depending upon type of arthritis. The causes include:

  • Inflammation of synovial membrane, tendons or ligament.
  • Muscles strain & fatigue.
  • Stretching of capsules.
  • Increased tension inside the bone (raised intra-osseous pressure).
  • Rubbing of bone ends with each other due to wearing of cartilage.

Why Pain Varies from persons to persons?

There are various factors which influence the severity of pain. These include:

  1. Swelling within the joint.
  2. Severity of inflammation.
  3. Severity of joint damage.
  4. Individual patient threesold & tolerance for the pain.
  5. Social support network like "Institute of Arthritis Care & Prevention" can make an important contribution to pain management.

What are the symptoms of Arthritis?

These depends upon the type & severity of arthritis commonly occurying symptoms include:

  1. Swelling in joint/ joints.
  2. Stiffness in the joints which may last for more than one hour.
  3. Warmth & redness in a joint.
  4. Difficulty in moving or using the joint.
  5. Pain (which may be constant or recurring) & tenderness (pain on manual pressure) in a joint.

What Can I Do?

You must consult a doctor as early as possible. Only a doctor can tell if you are suffering from arthritis or related condition & what you can do about it. The earlier you consult, the better; as prognosis (long term outcome) may vary depending upon early or late medical intervention.

You will need to tell the doctor how you feel & where it hurts.

If you are using any herbs or over the counter medical preparation you should tell your doctor about them

What will happen during your first visit to the doctor?

The doctor will usually do the following:

  1. Take your medical history.
  2. Review the medication which you are already using.
  3. Conduct a clinical examination to determine the cause & severity of arthritis.
  4. Doctor may take x-rays (pictures) of bones & joint. X-rays don't hurt & are not dangerous except in pregnancy. If you are pregnant, inform your doctor before x-rays.     
  5. Doctor may request blood and/ or urine samples to decide which kind arthritis you have & also the severity of arthritis.

What Medical History Doctor Will Ask?

These are certain questions doctor is likely to ask:

  1. When did you first notice the pain?
  2. When does the pain occur: Morning, night or throughout day?
  3. How long does the pain last?
  4. Is the pain in one or more joints?
  5. What is the type of pain dull aching, throbbing or otherwise?
  6. Whether there is stiffness in the morning lasting for more than 30 minutes.
  7. Does activity make the pain better or worse?
  8. Does rest make the pain better or worse?
  9. Have you had any previous injury or disease that may account for the pain?
  10. Is there any family history of any rheumatic disease.
  11. Any medication which you are taking?

How does medical history help?

Medical history helps in differentiating between inflammatory & non-inflammatory arthritis. It not only helps in attaining diagnosis but also an indication of severity of disease & determines the treatment protocol.

Difference Between Inflammatory & Non Inflammatory arthritis

Click here to see table

How physical examination helps?

During the examination, the doctor looks for redness, warmth, damage, ease of movements & tenderness. This helps in determining the diagnosis & severity of disease.

The examination also includes examination of heart, lungs, abdomen, nervous system, eyes, ears & throat as may be necessary as some forms of arthritis have multiple system involvement.

What are the common investigations done?

These include blood investigations, urine & x-rays

Blood Investigations:

  1. Complete Blood Count: This test determines the number of different types of cells in the sample of blood. Some rheumatic conditions & drug therapy are associated with a low white blood count (leukopenia), low red cell count (anaemia), or platlet count (thrombocytopenia). Periodic examinations may be required if some drugs known to cause these have been prescribed to you.
  2. Erythrocyte Sedimentation Rate (ESR): This blood test is used to detect inflammation in the body. Higher ESR rate indicate presence of inflammation. It also helps determining the response to medication. Reduction in ESR following medication is suggestive of favourable response.
  3. Rheumatoid factor: Rheumatoid factor is an anti-body (Protein Molecule) found in most people (but not all) rheumatoid arthritis. This test detects the presence of this protein molecule. This factor may be found in many disease besides rheumatoid arthritis & sometimes in normal healthy individuals.
  4. C-Reactive Protein Test: This nonspecific test detects presence of inflammation in body. It helps in monitoring response to medication as levels reduce when anti-inflammatory medications are used.
  5. Urine Examinations: Here urine sample is tested for presence of proteins, red blood cells, pus & bacteria. These may indicate kidney disease in rheumatological syndrome & also may suggest any untoward side effect of drugs being used for treatment.
  6. Complement: This test measures a group of proteins which help destroy foreign substances like germs entering into the body. The group of protein known as complement is characteristically low in active lupus disease.
  7. Antinuclear Antibody (ANA): This tests detect levels of antibodies that are often present in autoimmune disorders. They are referred as antinuclear antibodies as these react with material in the cells nucleus (control center). There are different individual types of ANAs that are specific to certain autoimmune disorders. These may sometimes found in normal healthy individuals.
  8. Synovial Fluid Examinations: Here the fluid is collected from the joint itself using a local anaesthesia injection. The fluid is examined for white blood cells (found in RA & infection), pus cells (found in infection), bacteria or virus (found in infection), or crystals (found in gout & pseudogout).

X-rays & Other Imaging Procedures:

Xrays provide an image of the bones & doctor can get a fair idea of how the joint looks like inside. But x-rays donot shows cartilage, muscles & ligament.

Other imaging methods which show the whole joint include CT Scan, MRI & arthrography.

Alternatively doctor may use arthroscope to visualize inside of the joint. Arthroscope is a small, flexible tube which when inserted in the joint through a small incision transmits the image of the inside of a joint to video screen.

Who can treat arthritis pain?

A number of different specialists are usually involved. Often a team approach is use. The team essentially comprises of a physician (rheumatologists) surgeons (orthropaedists), & physical & occupational therapists. The health professional team, and you; the patient all play a vital role in achieving  

How Will The Doctor Help?

After the doctor knows the disease you have, he will talk & explain the best treatment methods available. He may prescribe medicine to give pain relief & reduce inflammation. Ha may refer you to a physical therapist for heat therapy, exercise etc.

What Are The Treatments Available?

The treatment modalities available are:

  1. Rest & relaxation
  2. Exercise
  3. Proper Diet
  4. Medication
  5. Instruction about the proper use of joint with conservation of energy
  6. Use of assistive devices such as splints or braces
  7. Surgery in severe cases

Treatment plans usually combine several type of treatment and may require modification depending upon response to treatment

How Should I use Arthritis Medicine?

Before leaving doctor's clinic, it makes sense for you to ask about the best way to take the medicines the doctor has prescribed. For example, some medicines are taken before meals & some after meals. Some medication may be required to be taken with milk.

You should also ask how often the medicines are to be taken, for how many days & how local cream advised is to be used over the joint. If you feel certain irritation, rash or skin burns with use of ointment you should inform the doctor.

Making The Most Of Treatment:

It is important to make the most of your appointment with the healthcare team & build an equal relationship with them. You need to be sure that you understand & are satisfied about any treatment you are suggested.

  1. Write down what you want to tell the doctor before hand.
  2. Make your notes when you are with doctor
  3. If you don't understand something ask for more detailed explanation
  4. If you feel the treatment suggested is not right for you, say so & ask the doctor for more information & options
  5. If any treatment does not seem to be working please inform your medical team
  6. Remember that you can always ask for a second opinion. You can ask you GP to refer you to a Rheumatologist or orthopaedic surgeon
  7. If you see a junior doctor & are not happy about the information or treatment you are given, you can always ask to see the consultant
  8. It is always better to be accompanied by a friend or relative along.

Research has shown that patients who are well informed & participate actively in their own care experience less pain & require fewer visits to the treating doctor.