ARTHRITIS A WHITE COAT ARTHRITIS A WHITE COAT VIEWVIEW

DR. VISPI JOKHIDR. VISPI JOKHIORTHOPEDIC SURGEONORTHOPEDIC SURGEON

WHAT IS ARTHRITIS?WHAT IS ARTHRITIS?

•Arthritis means inflammation of Arthritis means inflammation of a joint.a joint.

•Synonymous terms are rheumatism Synonymous terms are rheumatism

spondylitis osteoarthritis.spondylitis osteoarthritis.

NORMAL JOINTNORMAL JOINT

TYPES OF ARTHRITISTYPES OF ARTHRITIS

• Over 200 types are known but the Over 200 types are known but the main ones are:main ones are:

• Osteoarthritis.Osteoarthritis.• Secondary OsteoarthritisSecondary Osteoarthritis• Rheumatoid Arthritis.Rheumatoid Arthritis.• Ankylosing Spondylitis.Ankylosing Spondylitis.• Gout.Gout.• Miscellaneous SLE PML UC Amoebiasis Miscellaneous SLE PML UC Amoebiasis etc.etc.

• Juvenile Rheumatoid Arthritis.Juvenile Rheumatoid Arthritis.

PRIMARY OSTEOARTHROSISPRIMARY OSTEOARTHROSIS

•Arthritis of ageing.Arthritis of ageing.

•Load bearing joints involved.Load bearing joints involved.

•Mostly affects knee in east but Mostly affects knee in east but hip in the west and also hands hip in the west and also hands and feet.and feet.

•Pain not always proportionate Pain not always proportionate to degeneration.to degeneration.

OSTEOARTHRITISOSTEOARTHRITISWHAT HAPPENS?WHAT HAPPENS?

OSTEOARTHRITISOSTEOARTHRITIS

OSTEOARTHRITISOSTEOARTHRITIS HOW TO TREAT? HOW TO TREAT?

• Drugs only for pain relief.Drugs only for pain relief.• Exercises static range of movement Exercises static range of movement and resistance.and resistance.

• Aerobics word of caution.Aerobics word of caution.• Weight loss.Weight loss.• Glucosamine Chondroitin sulphate and Glucosamine Chondroitin sulphate and MSM dubious role.MSM dubious role.

• Surgery arthroscopic debridement and Surgery arthroscopic debridement and replacement.replacement.

OSTEOARTHRITISOSTEOARTHRITIS

SECONDARY SECONDARY OSTEOARTHROSISOSTEOARTHROSIS•Post traumatic,post infective Post traumatic,post infective or following osteonecrosis.or following osteonecrosis.

•End stage arthritis.End stage arthritis.•Exercises and weight loss Exercises and weight loss compensates for damage and compensates for damage and deformity.deformity.

•Finally surgery is the only Finally surgery is the only answer.answer.

RHEUMATOID ARTHRITISRHEUMATOID ARTHRITIS

•Probably auto-immune disorder.Probably auto-immune disorder.•Polyarticular small joint Polyarticular small joint affectation followed by the affectation followed by the larger ones.larger ones.

•Pauci-articular with few large Pauci-articular with few large joints involved.joints involved.

•Remissions and exacerbations Remissions and exacerbations with systemic disease.with systemic disease.

RHEUMATOID ARTHRITISRHEUMATOID ARTHRITIS

•Under the weather a myth with Under the weather a myth with no scientific basis.no scientific basis.

•““Khatta” in fact good for Khatta” in fact good for cartilage.cartilage.

RHEUMATOID ARTHRITISRHEUMATOID ARTHRITISWHAT HAPPENS?WHAT HAPPENS?

RHEUMATOID ARTHRITISRHEUMATOID ARTHRITIS

RHEUMATOID ARTHRITISRHEUMATOID ARTHRITISTREATMENTTREATMENT

• Drugs for symptomatic relief and Drugs for symptomatic relief and disease modification.disease modification.

• Exercises to prevent stiffness and Exercises to prevent stiffness and preserve range of motion.preserve range of motion.

• Deformity prevention by judicious Deformity prevention by judicious splintage.splintage.

• Lifestyle modification.Lifestyle modification.• Diet has a role but not well defined Diet has a role but not well defined by allopathy.by allopathy.

RHEUMATOID ARTHRITISRHEUMATOID ARTHRITISTREATMENTTREATMENT

•Inverted Pyramid approach.Inverted Pyramid approach.•Disease modifying drugs toxic Disease modifying drugs toxic but effective and need to be but effective and need to be taken for long duration.taken for long duration.

•Surgery synovectomy, deformity Surgery synovectomy, deformity correction and finally correction and finally replacement of joint.replacement of joint.

ANKYLOSING SPONDYLITISANKYLOSING SPONDYLITIS

•Definitely auto-immune disorder.Definitely auto-immune disorder.•Starts from back bone followed Starts from back bone followed by spine shoulder hip and by spine shoulder hip and others.others.

•Stiffening the defining feature.Stiffening the defining feature.•Bamboo spine and reduced chest Bamboo spine and reduced chest expansion extremely disabling.expansion extremely disabling.

ANKYLOSING SPONDYLITISANKYLOSING SPONDYLITISWHAT HAPPENS?WHAT HAPPENS?

• Inflammation at Inflammation at joints.joints.

• StiffnessStiffness

• Scar tissue in Scar tissue in front of front of vertebrae.vertebrae.

• Finally fusion.Finally fusion.

ANKYLOSING SPONDYLITISANKYLOSING SPONDYLITIS

ANKYLOSING SPONDYLITISANKYLOSING SPONDYLITISTREATMENTTREATMENT

•Pain relief by drugs.Pain relief by drugs.

•Exercise most important.Exercise most important.

•Exercise regime halts Exercise regime halts progression of disease.progression of disease.

•Range of motion resistance very Range of motion resistance very important.important.

GOUTGOUT

•Deposition of uric acid crystals Deposition of uric acid crystals in joints.in joints.

•Uric acid is end-product of Uric acid is end-product of protein metabolism.protein metabolism.

•Diet directly related to gout.Diet directly related to gout.•Great toe joint of foot most Great toe joint of foot most commonly involved followed by commonly involved followed by ankle knee hand wrist and elbow ankle knee hand wrist and elbow jointjoint

GOUTGOUT

•Acute attacks triggered by very Acute attacks triggered by very high protein meals and alcohol.high protein meals and alcohol.

•Severe pain and redness seen.Severe pain and redness seen.

•Chronic gouty tophi deposited Chronic gouty tophi deposited in joints and soft tissues.in joints and soft tissues.

GOUTGOUTWHAT HAPPENS?WHAT HAPPENS?

GOUTGOUT

GOUTGOUTTREATMENTTREATMENT

• Colchicine is taken in acute phase.Colchicine is taken in acute phase.

• Pain relievers except aspirin can be Pain relievers except aspirin can be used.used.

• Diet restrictions for red meat Diet restrictions for red meat alcohol pulses seeded fruits and alcohol pulses seeded fruits and vegetables.vegetables.

• Drugs to excrete uric acid used.Drugs to excrete uric acid used.

MISSCELLANEOUS MISSCELLANEOUS

• Mainly idiopathic secondary to other Mainly idiopathic secondary to other diseases.diseases.

• Usually associated with skin and eye Usually associated with skin and eye lesions like lupus psoriasis and lesions like lupus psoriasis and iritis.iritis.

• Also associated often with gastro-Also associated often with gastro-intestinal disturbances.intestinal disturbances.

• Could be auto-immune.Could be auto-immune.• Spine affected in most cases.Spine affected in most cases.

MISSCELLANEOUSMISSCELLANEOUSTREATMENTTREATMENT

•Treatment of the skin and Treatment of the skin and gastro-intestinal problem.gastro-intestinal problem.

•Pain relief drugs.Pain relief drugs.

•Steroids and disease modifying Steroids and disease modifying drugs as in Rheumatoid drugs as in Rheumatoid ArthritisArthritis

JUVENILE RHEUMATOID JUVENILE RHEUMATOID ARTHRITISARTHRITIS

•Almost similar to RA auto-Almost similar to RA auto-immune.immune.

•Polyarticular or oligo-Polyarticular or oligo-articular.articular.

•Less common in India than in Less common in India than in the West.the West.

PHYSIOTHERAPY AND PHYSIOTHERAPY AND OCCUPATIONAL THERAPYOCCUPATIONAL THERAPY

•Major role in the management of Major role in the management of arthritic patient.arthritic patient.

•Static, Range of Motion and Static, Range of Motion and Resistance or strengthening all Resistance or strengthening all have a role to play.have a role to play.

•Re-education of patient Re-education of patient movements to improve function.movements to improve function.

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ALLOPATHY OR THE RESTALLOPATHY OR THE REST

•From white coat view to a From white coat view to a balanced view.balanced view.

•Allopathy not curative but Allopathy not curative but effective and with side effective and with side effects.effects.

•Many alternatives available, Many alternatives available, effective but not on their own.effective but not on their own.

•Answer Allopathy and the rest.Answer Allopathy and the rest.

ACUPUNCTURE ACUPUNCTURE ACUPRESSUREACUPRESSURE

• Chinese origin Chinese origin pain reliever.pain reliever.

• Balances ying Balances ying and yang forces.and yang forces.

• Acts by “pain Acts by “pain gate” closure.gate” closure.

• No real effect No real effect on arthritis.on arthritis.

AROMATHERAPYAROMATHERAPY

• Originates from Originates from Egypt adopted in Egypt adopted in Ayurveda and Ayurveda and other systems.other systems.

• Oils used for Oils used for massage.massage.

• Have anti-Have anti-inflammatory inflammatory effects.effects.

CHIROPRACTIC OSTEOPATHY CHIROPRACTIC OSTEOPATHY OR BONE SETTEROR BONE SETTER

• Ancient system Ancient system Hippocratic Hippocratic time.time.

• Relies on Relies on manipulation of manipulation of joints.joints.

• Not to be used Not to be used in the acute in the acute phase.phase.

MASSAGEMASSAGE

• Indian origin.Indian origin.• Relaxes and Relaxes and soothes.soothes.

• Increases blood Increases blood and lymphatic and lymphatic flow.flow.

• Alleviates pain.Alleviates pain.• Can damage if Can damage if done vigorously.done vigorously.

REIKIREIKI

• Japanese Japanese technique Rei technique Rei spiritual Ki spiritual Ki forceforce

• Hand touch to Hand touch to harmonize energy harmonize energy channels.channels.

• Popular but non-Popular but non-specific.specific.

YOGAYOGA

• India’s gift to India’s gift to the West.the West.

• Asanas or Asanas or postures as postures as means to means to healing.healing.

• Holistic and Holistic and very useful in very useful in Ankylosing Ankylosing spondylitis.spondylitis.

YOGAYOGA

AYURVEDAAYURVEDA

• From India based From India based on Charaka on Charaka samahita.samahita.

• Kerela popular Kerela popular destination for destination for oil massages.oil massages.

• Negative Negative publicity due to publicity due to use of toxic use of toxic heavy metals.heavy metals.

HOMEOPATHYHOMEOPATHY

•Based on Samuel Hahnemann’s Based on Samuel Hahnemann’s principles.principles.

•Dilution increases potency.Dilution increases potency.

•Treatment fully individualized.Treatment fully individualized.

•Holistic in approach,Holistic in approach,

•Slow in showing effect.Slow in showing effect.

•Negligible side effects.Negligible side effects.

NATUROPATHYNATUROPATHY

• Popularized by Popularized by Mahatma Gandhi Mahatma Gandhi in this century.in this century.

• Use of element Use of element mud packs sitz mud packs sitz baths enemas.baths enemas.

• Nutrition and Nutrition and detoxification detoxification importantimportant

NUTRITION THERAPYNUTRITION THERAPY

ANJU VENKAT IS THE BOSSANJU VENKAT IS THE BOSS

MISCELLANEOUS THERAPIESMISCELLANEOUS THERAPIES

•Psycho-analysis and Psycho-analysis and counselling.counselling.

•Hypnotherapy.Hypnotherapy.

•Hydrotherapy.Hydrotherapy.

•Music Therapy.Music Therapy.

•Spiritual Healing.Spiritual Healing.

•Meditation.Meditation.

FINAL WINNER THERAPYFINAL WINNER THERAPYPRAY TO THE ALMIGHTY PRAY TO THE ALMIGHTY LORD!!!LORD!!!