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LOC clinicians also see patients with musculoskeletal symptoms related to particular areas such as knees, shoulders, hands, elbows, hips, feet and musculoskeletal conditions such as:

 

Adults Still’s disease is a rare inflammatory arthritis associated with fevers, joint pain and swelling, and a salmon-pink rash appearing on your body,  especially in the evening.

The diagnosis is largely clinical but there are tests to support the diagnosis.

Treatment involves anti-inflammatories, steroids, methotrexate, and biologics drugs.

 

 

Ankylosing spondylitis (AS) primarily involves the spine and back, with patients experiencing pain and stiffness of the back (sometimes severe).  AS can also affects peripheral joints and other organs in the body, there are streamlined approaches to clinical assessments and several forms of treatment, including physiotherapy, anti-inflammatories, (few disease modifying drugs) and biologics drugs.

The aims of treatment are:

  • Symptom relief
  • Restore musculoskeletal function
  • Prevention of  joint damage
  • Prevent spinal fusion  and loss of function
  • Reduce extraarticular manifestations
  • Prevent complications of spinal disease

 

 

Back pain is common and can be self-limiting.  If however back pain is associated with loss of function and activities impaired, weight loss, sweating, weakness or numbness, swelling, bladder or bowel incontinence, it can require urgent medical attention.

If you are in any doubt about diagnosis or treatment, please seek the advice of your GP or contact us.

 

 

Gout is caused by the deposition of uric acid into joints.  Uric acid inflames and eventually may damage joints.  The body is unable to either rid itself or over produces uric acid.

Symptoms
Early on there is severe pain, redness and swelling in the big toe.  It may feel like your foot is being held in a hot oven.  The onset of symptoms is typically abruptly and during the night.

If untreated over a period of years, many joints may become involved.  Chronic gouty arthritis causes swelling and pain as well as deformity at the wrists, hands, elbows, knees and ankles.  There may be deposits of uric acid (which is a chalky white substance) under the skin most commonly on the elbows, hands or feet.  Uric acid may accumulate in the kidney causing kidney stones, or deposit inside the kidney damaging kidney function.

Diagnosis
The diagnosis of gout is made by removing fluid from a joint or from a tophus and demonstrating the presence of uric acid crystals using a polarizing microscopic examination.

 

 

Osteoarthritis (OA) is a common form of arthritis.  Causes are age, injury, repetitive trauma, and genetic.

The basic abnormality in OA is wearing of the articular cartilage.  The normal sponginess is amazing shock-absorbing properties.  There is impaired repair, and mal-alignment of the joints compounds the problem.

Symptoms
You may experience intermittent pain, swelling of the bone and soft tissue, crunchy-sounds and an inability to use join

Diagnosis
The diagnosis is made from the clinical symptoms and examination.  This is confirmed by x-rays and sometimes blood tests and other imaging investigations.

Treatment
Contrary to popular opinion, OA can be prevented by joint protection techniques.  Its progression can be slowed dramatically in the same way, if the proper medications and instruction are used concurrently.  The medications used to increase comfort and decrease pain are useful in adjunct physical therapy and joint protection techniques.

 

 

Pain and Arthritis is an important protective mechanism that the body uses to warn of possible injury/harm.  We all vary in our perception of pain, and it has physical and emotional aspects.  The injury leading to pain may be physical such as a cut, a broken bone or a burn, or a bodily biochemical process resulting in inflammation.

The nerve endings sense temperature and chemical changes or mechanical change/stresses.  The signals are relayed via the spinal cord to the brain.

Pain sensation may also be triggered by damage or altered sensitivity of nerves.  This causes the nerves to signal pain in response to something that would not normally hurt.

In some instances it is difficult to explain the exact cause of chronic pain and impossible to make it go away completely, and this can add to the distress or anxiety.  This type of chronic pain can be either confined to one part of the body or felt all over the body.  It could be hard to explain where the pain is coming from and may vary over time.  Often pain is multi-faceted with physical injury, altered nerve sensitivity and individual psychological and physiological factors.

We often find patients politely putting up with symptoms for long periods of time, losing muscle function and unable to do all their hobbies and activities with the families.  However, with safe and effective treatments, they could become symptom-free.

If your pain symptoms are interfering with your activities then you need to see your doctor and discuss different treatment options.

 

 

Polymyalgia rheumatica (PMR) is an inflammatory condition that causes many painful muscles (poly = many, myalgia = muscle pain). Any muscles can be affected, but it mainly affects the muscles of the shoulder and thigh.  PMR can start at any age from 50 but mainly affects people over the age of 60.  Women are affected 2–3 times as often as men and it affects about 1 in 2,000 people.  If you have polymyalgia rheumatica you’ll usually have severe and painful stiffness, which is often worse in the morning, especially in your shoulders and thighs and usually affecting both sides.  PMR often strikes suddenly, appearing over a week or two and sometimes just after a flu-like illness.  The symptoms are quite different from the ache you may feel after exercise.  The pain and stiffness is often widespread, is worse when resting and improves with activity or as the day goes on.  However, it may also wake you at night.Other symptoms include:

  • feeling unwell
  • a slight fever
  • weight loss
  • overwhelming tiredness
  • feeling low, anxious or depressed.

Rheumatoid arthritis (RA) is the most common and serious form of arthritis.  There is damage to bone and cartilage, and joint deformities, loss of joint movement, and limitations of activities requiring use of joints.

The exact cause is currently unknown, however it is thought that genetic predisposition plays a role.  Elements of the immune system gather in the synovium causing inflammation and subsequent joint damage as a result of excess tumor necrosis factor (TNF) and other inflammatory mediators such as IL-6.

Symptoms
RA usually begins in middle age, but can start at any age including during childhood [2-3 times more common in women]. Symptoms in early disease include general fatigue, soreness or aching, and stiffness, particularly in the morning.

Joint pain and swelling usually occurs in the hands or feet, but can affect wrists, elbows, shoulders, the neck, knees, hips and ankles.  Some patients develop nodules at the back of elbows or along the forearm.

Diagnosis
The diagnosis is based on medical history, physical examination, x-rays and laboratory tests.  Distinction needs to made from more than 200 different types of arthritis and related conditions.

Common laboratory tests include rheumatoid factor, C-reactive protein and the erythrocyte sedimentation rate; x-rays are used to assess damage to cartilage and bone.

Treatments
Early rheumatology intervention and the start of appropriate treatment is important in the prevention of long-term damage to joints.  The treatment goals are to reduce joint swelling, relieving stiffness, preventing joint damage, and maintaining normal joint function.

Aspirin-like drugs called nonsteroidal anti-inflammatory drugs (NSAIDS) and corticosteroids (prednisone) help reduce joint pain, stiffness and swelling.  Drugs referred to as disease-modifying anti-rheumatic drugs (DMARDs) include methotrexate, hydroxychloroquine, sulfasalazine, leflunomide, gold salts and a new class of drugs called biologics.

Treatment most often involves some combination of exercise, rest, joint protection, use of heat or cold to reduce pain, and physical and occupational therapy.  Surgery is available to relieve pain and improve function of damaged joints.